Health Anxiety as Costly Signalling: Clinical and Systemic Implications of an Undiagnosed Condition

The present review examines how undiagnosed health anxiety, recently reclassified as Illness Anxiety Disorder in DSM-5, manifests through clinical and behavioural patterns and explores signalling theory as a conceptual framework to explain the persistence of these behaviors. The review synthesizes literature published between 2010 and 2024 from PubMed, PsycINFO, Google Scholar, and ResearchGate using a narrative approach. The findings indicate that undiagnosed health anxiety is reflected in diagnostic confusion, repeated reassurance-seeking, cyberchondria, medical mistrust, unsafe self-medication, and family-based anxiety by proxy. These behaviors consume considerable emotional, financial, and temporal resources yet rarely provide lasting relief. Signalling theory suggests that these actions operate as costly signals of distress that persist when recognition fails. In the Indian context, short consultation times, stigma, and cultural idioms of distress reinforce these patterns. The review emphasizes the need for early recognition, culturally sensitive interventions, and physician training to reduce unnecessary medical use and address invisible psychological suffering.