Headache or Brain Tumor: Breaking Down the Health Anxiety Spectrum
Written By Dr. Melissa Jermann
The CHOOSE framework offers a practical approach to overcoming decision paralysis by breaking down the process into manageable steps.
Health anxiety has become a popular buzzword in today’s climate, especially on social media. However, when we take a look at the various health and somatic diagnoses in the DSM-5-TR (i.e., manual for diagnosing mental health conditions), there can be overlap in symptoms. Humans are complex beings and are not meant to fit into boxed categories! Many mental health care practitioners, including myself, will typically talk about this as one of the faults of the categorizing nature of the DSM. Given this overlap, I thought creating a post educating folks on the similarities and differences among the health and somatic diagnoses would be helpful. Understanding the key differences can help you get the most effective support and treatment! Before you continue to read this post, I want to remind you that this post is strictly for educational purposes and should not be used to self-diagnose any mental health condition. I encourage contacting a trained mental health professional if you resonate with anything in the post.
First, I want to point out that there is no diagnosis in the DSM-5-TR of “Health Anxiety.” This is just an easier way to label a cluster of different symptoms. There are five separate diagnoses from the DSM that involve health and somatic concerns, which I will discuss in this post.
1. Generalized Anxiety Disorder (GAD) (Health-Focused)
2. Obsessive-Compulsive Disorder (OCD) (Health-Focused)
3. Illness Anxiety Disorder (IAD)
4. Somatic Symptoms Disorder (SSD)
5. Panic Disorder (PD)
These diagnoses have shared features that create a spectrum where individuals may move between these diagnoses based on their symptoms and presentation. The first overlap involves an excessive focus on health, fears around illness or death, and physical symptoms. The second is that these diagnoses are associated with high levels of anxiety, which lead individuals to engage in reassurance-seeking behaviors, symptom monitoring, or total avoidance of doctors or health-related information. The third is catastrophic thinking patterns, meaning folks will imagine and focus on worst-case outcomes surrounding their health or well-being. This is typically tied to a misinterpretation of physical cues in the body. When individuals feel something (e.g., pain, sensation, change in arousal), they will misinterpret and catastrophize it as serious and life-threatening. Lastly, there is pervasive difficulty tolerating uncertainty around health and well-being. Although these diagnoses share some overlaps, I will break each into four categories: core features, focus of worry, cognitive/behavioral patterns, and treatment approaches.
1. Health-Focused Generalized Anxiety Disorder (GAD)
Core Features:
GAD is marked by persistent and excessive worry that varies across numerous life domains and can involve physical symptoms of muscle tension, fatigue, and feeling on edge.
Focus of Worry:
The critical thing to remember about GAD is that individuals will have generalized worry around work/school, relationships, and health, which reflects a broader pattern of anxiety about the future. There may be worries about health, but it is not the core focus of their anxiety.
Cognitive & Behavioral Patterns:
Responses to anxiety include mentally ruminating about various worries, seeking reassurance, and engaging in avoidance behaviors. However, these patterns tend to be less pervasive than the compulsions seen in OCD, which I will discuss in the next section. People with GAD can recognize that they are worrying excessively but feel that they can’t “control” their worries.
Example:
Someone with GAD may worry about getting sick (e.g., cancer, heart disease) in the future, among other worries in their life. When someone with GAD goes to the doctor for a health-related concern and gets a negative test result, they can accept this as reality and move forward. Typically, their anxiety will attach to something else until a new health trigger occurs. Overall, health-focused GAD mainly focuses on the uncertainty and possibilities of getting sick in the future instead of fixating on a specific illness or physical sensation in the present moment.
Treatment Approaches:
Cognitive Behavioral Therapy (CBT) can be beneficial to help point out and reframe cognitive distortions that are leading to increased levels of anxiety as well as target avoidance behaviors. Acceptance and Commitment Therapy (ACT) can help separate you from rumination and help you embrace and accept the uncertainty of your future health.
2. Health-Focused Obsessive Compulsive Disorder
Core Features: OCD is defined by intrusive thoughts, images, sensations, or urges (obsessions) that lead to repetitive mental or physical behaviors (compulsions) aimed at reducing uncomfortable emotions (e.g., anxiety, doubt, guilt) while seeking to gain certainty. When OCD focuses on health, individuals may fixate on specific fears of illness or death, often tied to intrusive thoughts/images about their health status. The key difference between GAD and OCD is the perpetual doubt within OCD. Individuals with OCD who have good insight will recognize these thoughts around their health as intrusive and separate from their own beliefs. However, the feelings of doubt and uncertainty within OCD make it challenging to disengage from compulsions.
Focus of Worry: Health-focused OCD typically revolves around specific illnesses or health conditions (e.g., “What if I have cancer?” or “What if I die in my sleep tonight?”). Unlike GAD, which involves broader worries, OCD obsessions feel intensely distressing and are often accompanied by compulsive behaviors.
Cognitive & Behavioral Patterns: People with health-focused OCD may engage in rituals like excessive checking (e.g., inspecting their body for lumps, checking heart rate), compulsive Googling of symptoms, or seeking repeated reassurance from loved ones or doctors even after normal results. Conversely, some may avoid doctors entirely out of fear of confirming their worst fears. The hallmark is that these compulsions are driven by an attempt to neutralize intrusive thoughts or distress, which reinforces the cycle of OCD.
Example: Someone with health-focused OCD might fixate on the idea that a headache is a sign of a brain tumor. Even after medical tests confirm they are healthy, their OCD may doubt the results, which leads the individual to continue seeking reassurance or engaging in checking behaviors.
Treatment Approaches: The gold standard for OCD treatment is Exposure and Response Prevention (ERP), a type of CBT that helps individuals confront fears and reduce compulsions. Acceptance & Commitment Therapy (ACT) can help individuals be more willing to have intrusive thoughts and uncomfortable emotions while learning to separate from them. Inference-based CBT can also be beneficial to target the obsessional doubt within OCD.
3. Illness Anxiety Disorder (IAD)
Core Features: Previously known as hypochondriasis, IAD is characterized by a preoccupation with having or developing a serious illness despite having little to no physical symptoms or medical evidence of illness.
Focus of Worry: Unlike OCD, the worry in IAD isn’t tied to specific intrusive thoughts but rather to a broader belief or fear of being ill. The fear persists even after medical reassurance, and the individual truly believes something is “wrong” with their health, leading to more ego-syntonic (i.e., tied to their beliefs) symptoms.
Cognitive & Behavioral Patterns: People with IAD may frequently visit doctors, request tests, or excessively research symptoms online. Alternatively, some may avoid medical care entirely, fearing the confirmation of their worst-case scenario. Their concern is often driven by a persistent and deep belief that something is “wrong” with their body.
Example: A person with IAD might worry constantly about having a heart attack, interpreting normal bodily sensations like a racing heart as evidence of impending doom. Despite receiving a clean bill of health, their fear that something is “wrong” does not dissipate.
Treatment Approaches: CBT is highly effective, particularly interventions that target catastrophic thinking and health-related avoidance behaviors. ACT can also help individuals accept uncertainty about their health.
4. Somatic Symptom Disorder (SSD)
Core Features: SSD involves excessive thoughts, feelings, or behaviors related to physical symptoms that cause significant distress or impairment. Unlike IAD, the focus here is on actual physical symptoms, even if the symptoms have no medical explanation.
Focus of Worry: The key feature of SSD is that the person experiences real physical sensations (e.g., pain, fatigue) and becomes overly preoccupied with these symptoms, worrying that they indicate a serious illness.
Cognitive & Behavioral Patterns: People with SSD may catastrophize about their symptoms, believing that minor sensations are signs of severe conditions. They might frequently seek medical attention but feel unsatisfied with the care they receive. Somatic OCD does share some overlaps with SSD. However, in somatic OCD, the focus is not on the physical symptom itself but on obsessive fears and doubts related to the symptom. For example, someone with somatic OCD might have intrusive thoughts like, “What if this sensation is a sign of something fatal?” or “What if I’ve missed a serious condition?” These obsessions drive compulsions, such as excessive symptom checking, seeking reassurance, or mentally reviewing past events to ensure nothing was overlooked. Unlike SSD, individuals with OCD often recognize their fears as irrational but feel unable to stop the obsessive-compulsive cycle.
Example: Someone with SSD might experience chronic stomach pain and repeatedly fear it’s caused by a life-threatening condition, even after multiple tests show no abnormalities.
Treatment Approaches: Treatments like CBT focus on reducing symptom-related anxiety and maladaptive behaviors. Mindfulness within ACT can also help individuals respond to physical sensations in a more accepting and less reactive way.
5. Panic Disorder (PD)
Core Features: PD is defined by recurrent, unexpected panic attacks and persistent worry about future attacks. Health concerns arise when individuals interpret panic symptoms (e.g., rapid heartbeat, dizziness) as signs of a serious medical condition, such as a heart attack or stroke.
Focus of Worry: The fear in PD is often linked to the physical sensations of panic, which individuals misinterpret as life-threatening. Unlike OCD or IAD, the focus is typically tied to the immediate experience of the body’s physiological state.
Cognitive & Behavioral Patterns: People with PD may avoid situations or activities they associate with triggering panic attacks, like exercise or crowded spaces. They might also frequently visit ERs or urgent care, convinced they are experiencing a medical emergency.
Example: A person with PD might experience chest pain during a panic attack and rush to the ER, fearing a heart attack. Even after being told they are healthy, the fear of another attack persists.
Treatment Approaches: Interoceptive exposures (exposing oneself to feared bodily sensations) within the CBT model can be helpful. ACT can also promote more willingness and acceptance of feelings of panic without responding to it as a threat that something is “wrong.”
Final Thoughts
Understanding the spectrum of health-focused mental health conditions helps receive effective care. While these diagnoses share overlapping features—like health fears, catastrophic thinking, and difficulty tolerating uncertainty—they are distinct in how they manifest and what drives the behaviors. Remember, it’s not your job to diagnose yourself!
If this post resonates with you, I want you to know that you’re not alone, and treatment is available. Take the next step by contacting a mental health professional who can guide you toward the proper care!
© 2025 Dr. Melissa Jermann Psychology Services LLC - All Rights Reserved - Disclaimer: This site should not be construed as therapeutic recommendations or personalized advice. Interaction with this blog does not constitute a therapeutic relationship. This blog aims to provide general information for educational purposes only. It is not intended or implied to supplement or replace the advice of your mental health professional. This information should not be used to self-diagnose mental health conditions. Consult with your mental health provider before implementing anything read here.
