The concepts of hypochondriasis and health anxiety are described in historical and modern contexts
and justification given for the preferred usage of health anxiety, with the condition better classified
with the anxiety disorders. The prevalence of hypochondriasis is reviewed and it is noted that most
of the data are in primary care with only one paper from genitourinary medicine. The treatments for
health anxiety and hypochondriasis are reviewed and noted, until recently, to be relatively limited in
efficacy. A prevalence study of health anxiety in genitourinary medicine in two centres found that 8‐
11% of attenders had significant health anxiety recorded by the Health Anxiety Inventory; that
symptoms persisted over a 9 month period, and were associated with higher numbers of medical
consultations. This was followed by a randomised controlled trial in a genitourinary medicine clinic
in which an adapted form of cognitive behaviour therapy was given by me as a medical practitioner,
and compared with a single explanatory interview in a control group. Assessments of clinical
symptoms, social functioning and costs were made at baseline, 3, 6 and 12 months after
randomisation. In 49 patients allocated, greater improvement was seen for the primary outcome of
Health Anxiety Inventory (HAI) scores in patients treated with CBT (n=23) than in the control group
(n=26) (P=0.001). Similar but less marked differences were found for the secondary outcomes of
generalised anxiety, depression and social function, and there were fewer health service
consultations. These differences were maintained in the six months after treatment was completed. The treatment costs were only partly offset by the savings in clinic appointments and for every unit
reduction in HAI score there was an incremental cost of £33. It is concluded that the treatment,
given in this manner, has the potential to be generalised.