Health Anxiety

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Generally we think of health anxiety as a continuum of anxiety related to worries about health that are resistant to medical reassurances. To know if you have health anxiety ask yourself if you have worry about your health that is persistent, out of proportion, causing you unhelpful behaviors, and interferes with your day to day functioning.

You can have health anxiety if you have:

a real illness

unexplained illness

nothing wrong with you. 

Here are some questions you can ask yourself to see if you might suffer from health anxiety.

  • Do you worry about an illness or the idea of getting one in the future?
  • Do you have excessive concern about pain in your body or are your preoccupied about pain to the point of being unable to live your life? 
  • Do you focus on areas of your body where you think you may have a tumor even though doctors have continuously reassured you nothing is wrong?
  • Do you repeatedly check on the internet to reassure yourself about the symptoms you have or to calm your worries?
  • Do you have trouble paying attention to other things besides your health worries?
  • Do you amplify or excessively focus on your physical sensations?
  • Do you have a fear that you are about to die, or are you convinced that you are going to die soon or at any moment?
  • Do you check your body repeatedly for symptoms of illness and make frequent medical visits to doctors?
  • Do you have a fear that you suffer from a disease such as aids, cancer or diabetes even though there is no evidence that you could have this disease?

If you answered yes to several of these questions than you may have health anxiety. It's important to know you are not alone and you are not crazy!

  • Thirty percent of people worry about their health, and more than ten percent of people worry that they may have a serious disease ( Furer 2007).
  • Twenty one percent of people say they worry about getting a disease( Furer 2007).
  • Sixteen percent of people say they don't believe a doctor when they tell them not to worry about having a medical illness( Furer 2007).
  • Also, it's very common to have health anxiety if you have another anxiety disorder. Nearly half the people who have panic disorder also have health anxiety ( Furer 2007).

If you have health anxiety, its important to face your problem with kindness and compassion and to understand many people are dealing with the same thing.

Why Do You Have Health Anxiety?

We don't entirely understand health anxiety, but it does seem that childhood experiences contribute to it. If you had experiences with physical or sexual abuse in childhood, you are more likely to have health anxiety. It may be that you were unable to express your feelings about the abuse, and because of the physical nature of it, you suppressed those feelings in your body. If you were a child  who had an experience such as living with an alcoholic parent,  poverty, or other stressors you are also more likely to have health anxiety.

Additionally, if you had experiences with death or sickness in your childhood or had a similar difficult experience in adulthood you may also develop health anxiety.  It's possible that you received certain messages in your family that helped form beliefs about your health that contributed to this anxiety.

Some people may also develop health anxiety after experiences with tests such as a mammogram or with an actual illness such as cancer. 

Understanding and Treating Health Anxiety

Currently the most effective treatment for health anxiety is considered to be cognitive behavioral therapy ( CBT). I also incorporate mindfulness based techniques into my therapy as research is finding them to be equally effective.

CBT suggests you ask yourself what are all of the components that go into creating and maintaining anxiety and then get an understanding of how to modify those components. 

Look at the picture  below to get a sense of how the CBT model helps conceptualize health anxiety.

Internal and External Triggers

If you have health anxiety it's likely you pay too much attention to your physical sensations, and then have inaccurate thoughts about what they mean. We call these internal triggers and they can set off a chain reaction which creates a false alarm in your body convincing you that you are in danger. 

You are likely also triggered into this alarm in other ways that people without health anxiety are not. For example by being around people who are sick, by hearing something about illness on the news, or by getting a sore throat. We call these external triggers.

Unhelpful Beliefs and Rules

We all have false beliefs and assumptions that we learn in childhood or as we are growing up. People with health anxiety likely have false beliefs about health.  Some of them may be " If my doctor doesn't know what's wrong with me, it's very serious" or " If I miss a symptoms I will die" or "If I have dizziness it could be cancer". Figuring out what your false beliefs are can be important to helping yourself with your health anxiety. 

CBT suggests we alter those false beliefs. Mindfulness approaches require only that we recognize our beliefs and thoughts are not true. 

Checking and Reassurance Seeking

One way CBT suggests we modify anxiety is by stopping particular behaviors. Checking and reassurance seeking are things people with anxiety do to temporarily reduce their discomfort and fear. CBT suggests we can modify our checking and reassurance seeking and improve our anxiety. If you have health anxiety modifying your checking and reassurance behavior might be an easy place to start helping yourself at home, even without a therapist. 

Examples of reassurance seeking are:

  • Asking loved ones if they think you need to go to the doctor, have an illness, are okay, will be okay, or have anything to worry about.
  • Looking online for information about potential symptoms to see if they means something more significant.
  • Using a voice in your head to reassure yourself that you are fine and nothing is wrong. 

Examples of checking include:

  • Checking in with your body parts to investigate how they feel or look
  • Monitoring your pulse to see if it is high several times a day
  • Checking your moles frequently to see if they have changed shape

Checking and reassurance seeking are part of compulsive behaviors that maintain the cycle of health anxiety. They reinforce the idea that you are in danger and that your thoughts about your health being in jeopardy are true. Instead of this behavior, we want you to learn not to respond to your anxious thoughts about your health, or give them attention, so that they go away. 

What Can You Do?

 Modify Checking and Reassurance Seeking

  1. Postpone it. One way to change your reassurance and checking behavior is to postpone it. You might say to yourself, I am feeling anxious and I notice that I want to check with my loved one or go on the internet to see if this is a sign that I am sick. However, I am going to wait one half hour before I do that. This is a helpful strategy because often, the anxiety will have naturally dissipated by the time you have waited.
  2. Decrease the amount of times you seek reassurance a day. If you are reassurance seeking many times a day, this can be a helpful strategy. It may be that you are seeking reassurance from a primary partner. Often people with health anxiety will engage their loved ones in this process. If this is the case, the loved one can be involved and agree to limit the number of times they will reassure you. Or alternatively, you can agree for yourself to limit the amount of times on the computer that you will be checking or seeking reassurance. 
  3. Don't engage. Ultimately, this is the goal you want to aim for. Your anxiety will improve in the long run if you are not engaging in reassurance seeking. Reassurance seeking/ and checking are a big part of what maintains and drives health anxiety. Practicing these strategies should yield relief for you so you can see this for yourself. 

Practice Acceptance and Mindfulness

  • Learn to tolerate and expand to accept physical symptoms in your body that are uncomfortable.
  • Practice not responding to uncomfortable physical symptoms through reassurance and /or checking but instead allowing feelings and sensations to dissipate. They will always dissipate even if they feel like they wont.
  • Practice recognizing the thoughts that arise in your mind related to the physical symptoms that start the chain of events ( "I am going to die" or "My heart is beating fast and it must mean I am going to have a heart attack" or "This mole means I have cancer"). Label these thoughts health anxiety or junk thoughts. Don't respond to them. 
  • Proceed with whatever you need to be doing while allowing your worried thoughts or distressing sensations to be there. Let time pass and don't react with an urgency or struggle with the thoughts or sensations. Work to cultivate an attitude that the thoughts are just thoughts and they can come and go as you continue to focus on whatever tasks and daily routines you need to be focusing on. 

Learning to tolerate thoughts, feelings, and sensations rather than try and get rid of them are a fundamental part of helping yourself with health anxiety. 

Find good medical care

Finding  one good doctor that you trust is paramount for people with health anxiety. Find a primary care doctor, gynecologist, and eye doctor etc, and do not shop around after that. Let them know you have health anxiety and you need them to give you one opinion that is clear and concise. Then, do not meet with multiple medical providers or seek further testing then they recommend. 

Depending on the severity of your health anxiety these tips may be enough to help you. If not you may need to find the help of a therapist who can engage you in a more comprehensive treatment plan. 

References

Furer,P.  (2007, March). Cognitive Behavioral Treatment for Health Anxiety and Fear of Death. Paper presented at ADAA 27th Anual Conference , ST Louis Missouri

Starčević Vladan, & Noyes, R. (2014). Hypochondriasis and health anxiety: a guide for clinicians. New York: Oxford University Press.

https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Health-Anxiety

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