Health anxiety is a ubiquitous experience that arises when bodily sensations or changes are believed to be indicative of a serious disease. Severe expressions of health anxiety are most often classified as hypochondriasis in the current DSM-IV-TR; however, various alternative classification schemas have been proposed for the DSM-V. Regardless of classification, severe health anxiety has significant negative impacts on well-being, social and occupational functioning, and health care resource utilization. In this review, we focus on classification issues pertinent to severe health anxiety, summarize recent research regarding potential mechanisms underlying the condition, and summarize the state of the art with respect to assessment and treatment. Future research directions are noted and suggested throughout.

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Background Empty nose syndrome (ENS) is characterized by the paradoxical perception of nasal obstruction despite patent sinonasal anatomy after surgery. We investigated the relationship between ENS, and anxiety, depression, obsessive‐compulsive disorder, and somatic symptom disorder (SSD) compared to individuals with chronic rhinitis (CR) and chronic rhinosinusitis (CRS). Methods This cross‐sectional survey study compared ENS and CR and CRS patients. A total of 116 patients participated: 58 ENS patients from digital support groups, and 58 CRS and CR patients from tertiary rhinology clinics. Study participants completed four validated surveys: (1) Empty Nose Syndrome 6‐Item Questionnaire, (2) Rhinosinusitis Disability Index (RSDI), (3) Obsessive Compulsive Inventory – Revised (OCI‐R), and (4) PRIME MD Patient Health Questionnaire (PHQ). Results ENS patients exhibited a mean RSDI of 78.6, 95% confidence interval [CI] 72.8–84.5, compared to 25.2, 95% CI 18.6–31.8 for CRS/CR patients (p < 0.0001). This difference was seen across all subdomains. Using the PHQ, 53% of ENS patients met diagnostic thresholds for SSD compared to 14% of CRS patients (p < 0.0001). In relation to obsessive compulsive disorder (OCD), 18.37% of ENS patients compared to 8.62% of CRS/CR patients scored above the diagnostic threshold (>21) on the OCI‐R questionnaire (p = 0.159). Conclusion ENS patients had diminished sinonasal quality of life and a higher prevalence of comorbid anxiety and depression, compared to CR and CRS. ENS patients were more likely to exceed thresholds for OCD and SSD compared to controls. Future studies are needed to assess the role of SSD in ENS to help optimize treatment for these complex patients.

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