What's the Difference Between OCD and Health Anxiety?

In short, no; health anxiety and OCD are two different concepts.

OCD involves having repetitive, upsetting, intrusive thoughts (obsessions) and feeling the need to address those obsessions with rituals (compulsions), which can also be distressing.

Sometimes obsessions and compulsions focus on a “theme.”

Examples of OCD themes include:

• harm OCD, which is where you worry that you’ll hurt yourself or others
• symmetry or order OCD, where you feel anxious when things are not in order
• religious OCD, where you worry about accidentally or intentionally sinning

It’s also possible for your OCD to revolve around fears of illness.

Contamination OCD is a kind of OCD where you have obsessions and compulsions around dirt and germs, often with an underlying fear that you will become sick.

Typical contamination-related compulsions include:

• excessive handwashing
• excessive cleaning
• seeking reassurance from doctors

It’s also possible to have health-related obsessions and compulsions that aren’t focused on contamination. For example, you might feel the need to repeat a mantra to “protect” yourself against illness or sudden death.

Health anxiety is characterized by irrational worries about having serious medical conditions. Someone with health anxiety might imagine symptoms or misinterpret minor symptoms as a sign that they have a serious health issue.

Health anxiety is not categorized as a specific illness in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

However, if you experience significant anxiety about your health, you might be classified as having:

• illness anxiety disorder, which is when you have no physical symptoms or only mild symptoms
• somatic symptom disorder, which is when you have physical symptoms that you perceive as distressing

We may all feel anxious about our health from time to time. It’s common to be concerned about your health and to worry about the possibility of falling ill. During the COVID-19 pandemic, in particular, many people understandably felt particularly worried about their health.

However, health anxiety goes beyond regular levels of concern. Health anxiety becomes an issue when it interferes with your ability to function. For example, it might interfere with your relationships, school or work performance, and other areas of your everyday life.

Sometimes, people with legitimate illnesses have their symptoms dismissed as illness anxiety disorder. When you’re experiencing this, it isn’t easy to tell whether your concerns are justified or whether you’re having irrational anxieties about your health.

There is no litmus test for this, but either way, you deserve compassionate treatment that takes your concerns seriously, even if they aren’t symptomatic of a physical illness. Having health anxiety is not the same as “faking” or exaggerating illness. It’s a condition that should be taken seriously.

What’s the difference between health anxiety and OCD? It’s easy to mistake one for the other.

Both involve what may seem like irrational anxieties, distressing thoughts about health, and taking excessive steps to avoid falling sick or being diagnosed with an illness.

Because the DSM-5 doesn’t categorize health anxiety as a mental illness, it doesn’t specify any symptoms. However, “health anxiety” refers to being irrationally worried about your health — specifically, that you have a medical condition.

Health anxiety can refer to illness anxiety disorder or somatic symptom disorder.

Illness anxiety disorder

The symptoms of illness anxiety disorder include:

• being preoccupied with having or acquiring a serious illness for 6 months or longer (although the specific illness you fear might change during that time) despite having no somatic symptoms
• repeatedly checking one’s body for signs of illness
• repeatedly checking in with physicians or seeking medical care or the opposite: maladaptively avoiding medical appointments
• being very anxious about health
• being easily alarmed about personal health issues

To be diagnosed with illness anxiety disorder, the healthcare professional should rule out the possibility that your symptoms are caused by depression and other mental disorders.

Somatic symptom disorder

While illness anxiety disorder can revolve around imagined symptoms, somatic symptom disorder is when real discomfort and symptoms cause you significant distress.

The symptoms of somatic symptom disorder include:

• experiencing great distress or disruption due to one or more physical symptoms
• excessive thoughts related to those symptoms, especially highly anxious thoughts
• excessive time and energy spent on health concerns

This disorder can only be diagnosed if at least one symptom is constantly present, although the nature of the symptom can change over time.

OCD

On the other hand, OCD is specifically characterized by obsessions and compulsions.

The symptoms of OCD include:

• obsessions, which are intrusive, distressing, persistent thoughts, images, or urges
• compulsions, which are specific acts you perform repeatedly to stop the thoughts or soothe your distress

According to the DSM-5 criteria for diagnosing OCD, your obsessions and compulsions must take up at least an hour of your day or significantly affect your ability to function.

In OCD, your obsessions and compulsions might revolve around more than just health. For example, if you also experience obsessions and compulsions about safety from crime or natural disasters, it might suggest that OCD is at play, not just health anxiety.

Regardless of whether you have OCD, illness anxiety disorder, or somatic symptom disorder, it can help to seek professional help. All three issues can be treated, and therapy is the first port of call.

Therapists often use cognitive behavioral therapy (CBT) to treat OCD, illness anxiety disorder, and somatic symptom disorder. A specific kind of CBT called exposure and response prevention (ERP) therapy is particularly effective for treating OCD.

Self-care strategies can be helpful for anyone with a mental health disorder or anyone who’s currently experiencing a great deal of stress and anxiety. This can include:

• caring for your basic needs by getting enough quality sleep, eating a nutritious and balanced diet, and exercising
• spending time with loved ones
• attending a support group, either online or in person
• engaging in relaxing hobbies, like meditation and journaling
• cutting out unnecessary stressors

In some cases, medication can be prescribed for OCD or health anxiety, although this isn’t always necessary.

Health anxiety is not a form of OCD, but it can look similar. Illness anxiety disorder and somatic symptom disorder, however, have very different diagnosis criteria compared to OCD.

Both health anxiety and OCD are treatable. These conditions can be managed through therapy and self-care strategies.

If you suspect you have OCD or health anxiety — or if you’re just feeling particularly anxious about falling ill — you’re not alone. Help is available.

Not sure where to get help? Take a look at Psych Central’s resources on finding a therapist and choosing one that works for you.