Background <p>The study aims to investigate how far and in what way health anxiety as a symptom in somatic symptom disorder (SSD) is associated with the use of different strategies to regulate emotions.</p> Methods <p>The sample consisted of 72 subjects with SSD (with or without a concurrent medical condition) and 36 nonclinical controls. A structured diagnostic interview (DSM-5) and questionnaires regarding emotion regulation (ER), health anxiety, severity of somatic symptoms, and related disabilities were used. MANOVAs, correlation, hierarchical regression and mediation analyses were calculated.</p> Results <p>Participants with SSD reported less adaptive ER use (<i>d’s</i> = 0.72–1.03) and more rumination than controls (<i>d</i> = − 0.57). Both maladaptive (<i>R</i>² = 0.18) and lack of adaptive ER strategies (<i>R</i>² = 11 and <i>R</i>² = 0.15), but not symptom burden, predicted significantly the degree of health anxiety in the SSD group. Some ER strategies, particularly reappraisal and rumination, partially mediated health anxiety differences between SSD and nonclinical controls.</p> Discussion <p>Since ER are associated with varying degrees of health anxiety in people with SSD, they may benefit from learning adaptive ER strategies for dealing with health-related issues.</p>