Gynecologically-focused illness anxiety in an autistic adult: An adapted cognitive behavioural therapy case study

Cervical cancer is the fourteenth most common cancer in the United Kingdom, with a national screening programme offered to women aged 25–64. Autistic women are significantly less likely than non-autistic women to engage in cervical screening, yet there is limited research examining psychological barriers to uptake. Illness Anxiety Disorder (IAD), characterised by excessive health-related worry alongside checking or avoidance of medical investigation, offers one possible explanatory mechanism. Despite a strong evidence base for cognitive behavioural therapy (CBT) in the treatment of IAD, there is minimal literature addressing its development, maintenance, or treatment in autistic adults, and none focused specifically on autistic women. This clinical case study describes the assessment, formulation, and treatment of an autistic woman presenting with gynecologically focused IAD centred on fears of cervical cancer. An adapted CBT intervention was delivered within a community post-diagnostic autism service over twelve sessions, incorporating structured visual formulation, imagery rescripting, integration of special interests, and targeted family involvement to address interpersonal reassurance processes. Change was monitored using the Short Health Anxiety Inventory alongside goal-based and behavioural indicators. Reliable improvement in health anxiety was observed, with marked reductions in checking behaviours, increased engagement in valued activities, and cessation of crisis service use, although health anxiety scores remained above clinical threshold at treatment end. The case highlights key adaptations required when delivering CBT for IAD in autistic women and discusses clinical implications, limitations, and directions for future research.