How can I effectively differentiate between health anxiety and other anxiety disorders in a primary care setting?

In a primary care setting, effectively differentiating health anxiety from other anxiety disorders requires a focused clinical assessment that emphasises the nature and focus of the patient's worries. Health anxiety is characterised by persistent preoccupation with having or acquiring a serious illness, often despite medical reassurance, whereas other anxiety disorders such as generalized anxiety disorder (GAD), panic disorder, or social anxiety disorder centre on broader or different themes of worry or fear NICE CG159.

Key differentiating features include:

• Content of anxiety: Health anxiety involves excessive concern about physical health and bodily sensations, often leading to frequent health-related behaviours (e.g., repeated checking, doctor visits), while GAD involves pervasive worry about multiple life domains, panic disorder is marked by recurrent panic attacks, and social anxiety disorder involves fear of social situations [1, Valente 1996; Culpepper 2006].
• Response to reassurance: Patients with health anxiety typically do not find lasting relief from medical reassurance and may seek repeated evaluations, whereas other anxiety disorders may respond better to reassurance or cognitive interventions [1, Noyes R Jr et al. 1995].
• Somatic focus and symptom interpretation: Health anxiety patients often misinterpret normal bodily sensations as signs of serious illness, a feature less prominent in other anxiety disorders where somatic symptoms may be present but are not the primary focus [1, Noyes R Jr et al. 1995].
• Duration and pattern: Health anxiety tends to be chronic and centred on health concerns, whereas panic disorder is episodic with discrete panic attacks, and social anxiety disorder is situation-specific [1, Valente 1996; Culpepper 2006].

In practice, a thorough history exploring the specific worries, their triggers, and behavioural responses, combined with validated screening tools where appropriate, can aid differentiation. Awareness of somatisation and the tendency to focus on physical symptoms is crucial, as highlighted in the literature on somatisation and health anxiety Noyes R Jr et al. 1995. This integrated approach supports accurate diagnosis and guides appropriate management pathways in primary care NICE CG159.