Is that sniffle a sign of seasonal allergies or COVID-19? It’s a question you’ve likely asked yourself at least once—and perhaps lots of times—over the last few years.
Especially during a pandemic, it’s normal to analyze your health. But for some people, those thoughts can cross a line into more problematic territory. At least 4% of the U.S. population lives with what’s known as health anxiety, or an excessive preoccupation with health and illness—and symptoms of the condition may have emerged or worsened for certain people during these virus-dominated recent years, experts say.
“Health anxiety, to a certain extent, is normal during the pandemic,” says Michelle Patriquin, director of research at the Menninger Clinic, a mental health treatment center in Texas.
In 2013, the Diagnostic and Statistical Manual of Mental Disorders retired the term “hypochondriasis,” which many people found belittling and inadequate. Since then, health anxiety has been formally known as “illness anxiety disorder” and is characterized by excessive worry about having or developing a serious disease, often even if tests don’t show anything wrong. People with this condition frequently become fixated on mild or routine physical sensations—fearing that a headache could be an early sign of a brain tumor, for example.
Health anxiety overlaps with obsessive-compulsive disorder (OCD) and panic disorder, explains Paul Salkovskis, a clinical psychologist in the U.K. who has studied health anxiety for decades. People with both health anxiety and OCD may engage in behaviors like frequent hand-washing or temperature-taking. And, similar to panic attacks, health anxiety can manifest physically through symptoms like shortness of breath, dizziness, and elevated heart rate. People with health anxiety often misinterpret these sensations as a sign that something is physically wrong, in the future if not in the moment. They may believe a racing heart is the first sign of developing cardiovascular disease.
Everyone worries about their health from time to time. But when that worry interferes with daily life or spirals into behaviors like obsessively researching symptoms online (what some researchers call “cyberchondria”), it could be health anxiety.
The pandemic has understandably added fuel to the fire, Patriquin says. Due to valid fears of catching and spreading COVID-19, isolation, political unrest, and upticks in substance use, it’s no surprise that many people have experienced psychological distress over the past few years, she says. Rates of anxiety and depression have increased worldwide since the pandemic began, and Menninger Clinic research shows that symptoms worsened for many people with preexisting mental health issues.
For some, the COVID-19 pandemic may have prompted or exacerbated symptoms of health anxiety due to legitimate fears of illness and 24/7 news coverage about health and disease, among other factors, according to a 2021 study published in the International Journal of Cognitive Therapy. The fact that the virus is highly transmissible and can be spread even by people without symptoms can also fuel anxiety, the paper adds.
To learn more about health anxiety in the general population, another team of researchers turned to Reddit. In January 2020, even before many countries began responding to the threat of COVID-19, they saw that activity in Reddit’s health anxiety forum began to spike—and as time went on, the language used in other mental health-related forums began to mirror that used in the health anxiety thread, with many posts using words like “virus,” “respirator,” and “vaccine,” they found.
Salkovskis, however, noticed something interesting in his practice: some people with contamination fears temporarily saw their symptoms improve early in the pandemic, because lots of people were taking disease precautions. “However, that’s kind of a holiday rather than a cure,” he says.
Indeed, by the spring of 2021, rates of psychological distress—including health anxiety—were elevated in high-income countries including the U.S., U.K., and Italy, according to research that has not yet been published in a peer-reviewed journal and was led by Marcantonio Spada, a professor of addictive behaviors and mental health at London South Bank University. Health anxiety was more common in countries, including the U.S., that took aggressive pandemic-management tactics like lockdowns, as compared to countries, including Sweden, that took more relaxed approaches, Spada says.
“You ask people to avoid situations, to mask, to monitor a threat,” Spada says. “Then you’re left with a collection of thinking patterns and behaviors that make you vulnerable next time there’s uncertainty.” Spada’s research also suggests that people who score highly on measures of neuroticism have been more likely to develop health anxiety during the pandemic, which is in turn correlated with the development of generalized anxiety and depression.
Three years of fear and rumination about COVID-19, however understandable, has caused an uptick in obsessive behaviors, like methodically wiping down groceries, as well as generalized anxiety, Salkovskis says. But not everyone with these symptoms meets the diagnostic criteria for illness anxiety disorder, he says. People with health anxiety believe they are ill and hold onto that belief for a long period of time, he says. Someone could think for years that they’re in the early stages of developing cancer or heart disease, and it’s hard to definitively prove them wrong. But it becomes clear fairly quickly whether or not someone has COVID-19, Salkovskis says.
It can be difficult to tell if your health concerns are normal in the COVID-19 era, when it’s natural to be on high alert about disease. Behaviors that otherwise might be red flags for health anxiety, like frequent hand-washing or mask-wearing, have become normal and recommended over the past few years. But Patriquin says there are still signs to look for. If you feel compelled to take virus precautions in very low-risk situations—such as wearing a mask when you’re at home, around only those you live with—or if your relationships and work are suffering as a result of your routine, speaking to a mental-health professional may be worthwhile.
Cognitive behavioral therapy (CBT) is the only treatment for health anxiety with strong evidence behind it, Salkovskis says. According to the Mayo Clinic, CBT can help people with health anxiety acknowledge and adjust their fears related to illness and physical sensations and develop coping strategies. Two-thirds of people with health anxiety saw a reduction in symptoms after being treated with CBT, and about half went into complete remission, according to a research review published in 2019.
Lifestyle remedies can also be useful for managing anxiety disorders, Patriquin says. Getting enough sleep can make a significant difference in symptoms, as can seeking social support, she says. Even socializing online can help buffer the negative consequences of health anxiety, one study published in 2021 found—so if you’re struggling with this condition, reaching out to both a mental-health professional and your loved ones is a good place to start.
More Must-Read Stories From TIME