The misinterpretation of bodily symptoms as an indicator of a serious illness is a key feature of the criteria and the cognitive–behavioural models of hypochondriasis. Previous research suggests that individuals suffering from health anxiety endorse attributions of physical disease, whereas persons with elevated general anxiety have the tendency to attribute psychological causes to their symptoms. However, whether a somatic attribution style is specific to patients with hypochondriasis, as opposed to those with anxiety disorders, has not yet been investigated and is therefore part of the present study. Fifty patients with hypochondriasis, 50 patients with a primary anxiety disorder and 50 healthy participants were presented with nine common bodily sensations and had to spontaneously attribute possible causes to the symptoms. Patients with hypochondriasis differed from patients with anxiety disorders and healthy controls in giving significantly fewer normalizing explanations, but attributing more often in terms of moderate or serious diseases. Patients with anxiety disorders also made significantly fewer normalizing attributions and more somatic attributions to a severe illness than healthy controls. There were no differences between the groups in the frequency of psychological attributions and somatic attributions concerning mild diseases. The present study demonstrates that hypochondriasis is associated with a disorder‐specific attribution style connecting somatic symptoms primarily with moderate and serious diseases. By contrast, normalizing attributions are largely omitted from consideration by patients with hypochondriasis. The findings conform with the cognitive conception of hypochondriasis and support the strategy of modifying symptom attributions, as practiced in cognitive–behavioural therapy. Copyright © 2013 John Wiley & Sons, Ltd.Key Practitioner Message Patients with hypochondriasis show a disorder‐specific attribution style, which is biased towards moderate and serious diseases. This finding stresses the importance of therapeutic interventions challenging dysfunctional symptom attributions. In addition to attributions in terms of moderate and serious diseases, patients with hypochondriasis also produce constructive attributions (normalizing, psychological or in terms of mild illnesses). Therefore, particular emphasis should be placed on a comprehensive exploration of all existing symptom attributions. By identifying beneficial attributions already in existence, the patient's resources are brought into focus and form the basis for reattribution training.