A racing heart. Pressure in the chest. Headaches that keep returning. Pain that seems to move from one part of the body to another. Shortness of breath that suddenly becomes impossible to ignore.

When physical sensations become frightening, the natural response is to look for an explanation. A person may visit a primary care doctor, then a cardiologist, neurologist, urologist, or another specialist. Tests may come back reassuring, yet the fear does not disappear.

Sometimes the problem is not that the symptoms are imaginary. The symptoms can feel completely real. The deeper problem is the amount of anxiety, attention, fear, and disruption that becomes attached to them.

This is where somatic symptom disorder and, in some cases, illness anxiety disorder may enter the picture.

The Symptoms Are Real — Even When the Explanation Is Complicated

Somatic symptom disorder is a recognized mental health condition in which a person becomes intensely focused on physical symptoms such as pain, weakness, fatigue, dizziness, or breathing difficulties. The symptoms cause genuine distress, while thoughts and fears about health begin consuming a significant amount of time and emotional energy.

One important point is often misunderstood: a person does not need to have medically unexplained symptoms to receive this diagnosis. A physical medical condition may be present. What matters is whether the person's thoughts, anxiety, and behaviors surrounding the symptoms become excessive and interfere with everyday life.

This distinction matters because telling someone that “nothing is wrong” can sound dismissive. The discomfort is not being invented or deliberately produced. The person is experiencing something real, even when repeated medical testing does not reveal the serious disease they fear.

When Reassurance Doesn't Last

A familiar pattern can develop.

1. A physical sensation appears. It feels unusual or threatening.
2. Anxiety rises quickly, and the mind begins searching for the worst possible explanation.
3. Medical testing may show that the heart, nervous system, or another part of the body is functioning normally. For a while, that reassurance helps.
4. Then another sensation appears.

The worry returns, sometimes centered on an entirely different disease. Another appointment is scheduled. Another test is requested. Another specialist is consulted.

The frustrating part is that normal test results do not always end health anxiety. Research has found that when the likelihood of serious disease is already low, additional diagnostic testing often provides surprisingly little lasting reassurance.

Eventually, a person can become trapped between two powerful thoughts: “Something is seriously wrong with me” and “No one has found it yet.”

Somatic Symptom Disorder and Illness Anxiety Are Not Quite the Same

These conditions overlap, but there is an important difference.

• With somatic symptom disorder, distressing physical symptoms are usually prominent, and the person becomes excessively worried or preoccupied with them.
• With illness anxiety disorder, the central problem is the persistent fear of having or developing a serious illness, while physical symptoms are absent or relatively mild. This condition was historically associated with the term hypochondriasis, but current U.S. psychiatric terminology uses illness anxiety disorder.

Someone may repeatedly check their body, search for explanations online, ask others for reassurance, avoid activities that seem medically risky, or repeatedly seek professional evaluations.

Unfortunately, every attempt to obtain absolute certainty can sometimes strengthen the cycle rather than end it.

Why Stress Can Make Everything Feel More Intense

Physical sensations often become more noticeable during periods of emotional strain.

Stress and anxiety can increase awareness of heartbeat, breathing, muscle tension, gastrointestinal sensations, pain, heat, dizziness, and other normal or uncomfortable bodily experiences. Once attention becomes intensely focused on the body, even a small sensation can begin to feel like evidence of danger.

That creates a difficult loop: sensation leads to fear, fear increases attention to the body, and increased attention makes the sensation feel even more significant.

The person is not pretending. The nervous system, attention, emotions, and interpretation of bodily signals are interacting in a way that makes reassurance increasingly difficult to hold onto.

When Medical Care Turns Into an Endless Search

Physical symptoms should never automatically be assumed to have a psychological cause. New, severe, or changing symptoms deserve appropriate medical evaluation.

The problem begins when reasonable evaluation gradually turns into an endless search for certainty.

Repeated consultations and unnecessary tests can consume time, money, and emotional energy without resolving the underlying fear. This is why having one trusted primary care clinician who understands the complete medical history can be especially helpful. The goal is not to ignore symptoms, but to evaluate them appropriately while avoiding a cycle of fragmented and repetitive testing. The American Psychiatric Association similarly emphasizes regular care with a trusted health professional as part of management.

Treatment Is About More Than Saying “Don't Worry”

Health anxiety rarely disappears simply because someone is told to relax.

Psychotherapy can help a person recognize catastrophic interpretations of normal bodily sensations, reduce repeated checking and reassurance-seeking, manage stress, and gradually change the relationship with physical symptoms.

Cognitive behavioral therapy (CBT) has particularly good evidence for treating health anxiety and related somatic concerns. Research has found meaningful improvement in health anxiety with CBT-based treatment.

Medication may also be considered when significant anxiety or depression occurs alongside the condition, depending on an individual medical evaluation. Treatment is often most useful when physical and psychological care are not treated as competing explanations but as parts of the same healthcare picture.

Perhaps the most important shift is understanding that accepting a psychological component does not mean accepting that the suffering is imaginary.

• The symptoms may be real.
• The fear may be real.
• The exhaustion of constantly watching the body may be real.

And that also means the problem deserves real treatment.

References

• American Psychiatric Association. (2024). “What Is Somatic Symptom Disorder?”
  • A patient-focused clinical overview explaining current U.S. definitions of somatic symptom disorder and illness anxiety disorder, including symptoms, diagnosis, and treatment. It also emphasizes that somatic symptom disorder does not require the absence of a medical explanation.
• Löwe, B., Levenson, J., Depping, M., et al. (2022). “Somatic symptom disorder: a scoping review on the empirical evidence of a new diagnosis.” Psychological Medicine, 52(4), 632–648. doi:10.1017/S0033291721004177.
  • Reviews the evidence surrounding the modern diagnosis of somatic symptom disorder and its relationship with physical symptoms, functional impairment, anxiety, depression, and healthcare use.
• Kikas, K., Werner-Seidler, A., Upton, E., & Newby, J. (2024). “Illness Anxiety Disorder: A Review of the Current Research and Future Directions.” Current Psychiatry Reports, 26(7), 331–339. doi:10.1007/s11920-024-01507-2.
  • Reviews current research on illness anxiety disorder, including health-related fears, assessment, maintaining factors, and evidence supporting CBT.
• Cooper, K., Gregory, J. D., Walker, I., Lambe, S., & Salkovskis, P. M. (2017). “Cognitive Behaviour Therapy for Health Anxiety: A Systematic Review and Meta-Analysis.” Behavioural and Cognitive Psychotherapy, 45(2), 110–123. doi:10.1017/S1352465816000527.
  • A systematic review and meta-analysis examining CBT for health anxiety and supporting its effectiveness compared with control conditions.
• Rolfe, A., & Burton, C. (2013). “Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease: Systematic Review and Meta-analysis.” JAMA Internal Medicine, 173(6), 407–416. doi:10.1001/jamainternmed.2013.2762.
  • Examines whether additional medical testing provides lasting reassurance when the initial probability of serious disease is low. The review found that testing often has limited effects on anxiety and symptom persistence.