OCD and Health Anxiety: What You Need to Know

Professor Lynne Drummond has been treating OCD and related anxiety disorders since the 1980s. She trained under two pioneers in the field: Professor Isaac Marks, who developed exposure-based psychological treatments, and Professor Stuart Montgomery, who advanced medication approaches. We spoke to her about the overlap between OCD and health anxiety, the compulsive cycle that keeps people stuck, and what actually works when it comes to treatment.

Watch the full conversation on YouTube.

OCD is not a personality quirk

One of the first things Prof. Drummond wanted to address is how the term "OCD" has been co-opted into casual conversation, and the damage that does.

"Now, everybody thinks they know what it is. Anyone that's slightly neat or tidy says, 'Oh, I'm a bit OCD.' And it's become a joke. And that is actually terrible because OCD is not a joke."

OCD consists of two components. First, obsessions: thoughts, images, or impulses that are deeply distressing and intrusive. Second, compulsions: behaviours or mental acts designed to reduce or prevent the anxiety those obsessions cause. The compulsion might be washing, checking, or -- critically for health anxiety -- seeking reassurance.

"If you had a phobia of a spider, you could run away from the spider. You can't run away from something that's in your head."

This is what makes OCD so difficult. The threat is internal, and it follows you everywhere.

Where health anxiety meets OCD

Health anxiety and OCD share fundamental mechanics. You have a distressing thought ("my heart is beating fast, I'm going to have a heart attack"), your anxiety spikes, and you do something to neutralise it: call the GP, Google symptoms, check your body. The relief is temporary. The cycle restarts.

Prof. Drummond described how the medical profession can inadvertently make this worse:

"Off you trot and you go to your local GP and they take a history and examine you and they say, 'No, you're absolutely fine.' So your anxiety reduces a bit. Then you get outside the surgery and you think, 'I wonder if doctors have been known to get things wrong.' And so you go back."

Each visit, each test, each reassurance feeds the loop. Medical professionals, she notes, rarely say things with 100% certainty, which leaves just enough ambiguity for the anxious mind to exploit.

"You can end up with somebody getting ridiculous numbers of unnecessary investigations, which all feeds into this health anxiety. And then the people that are really suffering get labelled as being nuisance patients."

This mislabelling is dangerous. Prof. Drummond has seen patients banned from A&E -- not because they were being manipulative, but because they were genuinely suffering and the system did not recognise it.

The reassurance trap

Reassurance-seeking is one of the most powerful compulsions in both OCD and health anxiety. Prof. Drummond explained the mechanism clearly:

"When somebody says, 'No, you haven't,' the anxiety goes down a bit. And because high anxiety is horrible, that reduction in anxiety is a bit like a reward. So what you're doing is rewarding the asking for reassurance. And if you reward any behaviour, you increase the chances of it happening again and again."

This applies equally to reassurance from doctors, family members, Google searches, and AI chatbots. The short-term relief strengthens the long-term pattern.

Cyberchondria and the algorithm problem

The conversation turned to social media and what Prof. Drummond calls "cyberchondria," the compulsive use of the internet to research symptoms. Once you search for something, the algorithm takes over.

"There's a lot of really awful, terrible misinformation out there, nowadays actually coming from very high places that used to be respected institutions."

She stressed the importance of sticking to reliable sources like NHS Choices or PubMed for direct access to original research papers. If a claim cannot be traced back to a published study, treat it with caution.

What actually works: ERP and medication

Prof. Drummond outlined two evidence-based treatment approaches.

Medication: Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, paroxetine, and fluoxetine have evidence for treating both OCD and health anxiety, typically at higher doses than used for depression. Side effects are usually minor and short-lived, though for someone who is already monitoring their body closely, even temporary side effects can trigger more anxiety.

Exposure and Response Prevention (ERP): This is the psychological treatment with the strongest evidence base. The goal is to experience the anxiety-producing thought without performing the compulsion that reduces it.

"You want to expose to the anxiety-producing thought but not have the anxiety-reducing bit."

This might mean recording your feared thought in your own voice and listening to it on repeat until the anxiety naturally subsides, without checking, Googling, or seeking reassurance. Prof. Drummond also noted that mindfulness can complement ERP by helping calm an overactivated nervous system, making exposure work more accessible.

She recommends building these skills yourself, because health anxiety themes shift over time:

"As soon as you tackle one, another one pops up. That's why it's so important to actually learn how to deal with it yourself, because otherwise it's a bit like whack-a-mole."

"You can't snap out of it"

When asked about the single biggest misconception around OCD and health anxiety, Prof. Drummond did not hesitate.

"The idea that you can snap out of it. Nobody would ever wish themselves to have OCD or hypochondriasis. You wouldn't wish it on your worst enemy."

It's not a willpower problem. It's a cycle that needs structured intervention to break — and treatment works, even when previous attempts haven't. Timing matters, and life stress can reduce the effectiveness of otherwise sound approaches.

"It is not your fault. You really are not alone."

"The most important thing is never give up. There is light at the end of the tunnel. Trust me."

How to know if health anxiety is affecting you

Prof. Drummond offered a simple test: is what you're doing interfering with your ability to live your life, reach your goals, reach your dreams? If you're not sure, look at your peers. Are they doing things you want to do but can't because of your symptoms?

If the answer is yes, you might have health anxiety or OCD. But the checking, the Googling, the reassurance-seeking — these aren't character flaws. They're a cycle, and with the right treatment, the evidence shows it can be broken.

• Learn about the evidence-based approaches discussed in this conversation
• Read more about Prof. Lynne Drummond

This article is for informational purposes only and is not medical advice. If you're concerned about your health or mental health, speak to a qualified professional. If you or someone you know is in crisis, contact a helpline near you.