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by Ken Goodman, LCSW

As she stares at the ceiling, trying to fall asleep, Dina ruminates on one statement from her doctor, “Brain tumors can grow at any time. Come back in six months if you’re concerned.”   She tosses and turns, “Why did he tell me that? If there was nothing wrong, why would he say come back in six months?”  More questions race through her mind, “Why do I keep getting headaches and dizziness? What if the doctors missed something? Why did he tell me to come back if there was nothing wrong?”  Dina feels so anxious she gets out of bed and searches the web for answers.  As she rereads the same articles about symptoms of brain cancer she begins to feel lightheaded.  “Why do I keep feeling this way? Do I really have brain cancer? Is this really happening?”  

The good news is, Dina does not have brain cancer or a brain tumor.  Dina has a health anxiety.  There are two types of health anxieties: Somatic Symptom Disorder and Illness Anxiety Disorder, formally known as hypochondriasis.  Many people with health anxiety are often unable to function or enjoy life due to their fears and preoccupations.   They obsess over bodily functions (breathing, heartbeat), physical oddities (skin blemishes), and physical discomfort (headaches, stomach aches, lightheadedness). They might worry about a specific organ (brain, heart) or a disease they heard about on the news or at work (MS, diabetes).  They are preoccupied with the belief that they have, or are in danger of contracting, a serious illness. Many will purse doctors and tests repeatedly for reassurance, but are reluctant to seek mental health treatment since they believe their condition is medically based.   

Why does health anxiety persist despite reassurance from doctors?

Although some refuse to be examined by their primary care out of fear of discovering the worst, seeking reassurance from doctors, insisting on repeated medical tests, and visits to the ER and urgent care, are more common in health anxiety. Being reassured by the doctor that there is no serious medical illness brings relief -- temporarily.   The vicious cycle quickly resumes as new thoughts and physical sensation surface, followed by interpretations of danger, anxiety, and more visits to doctors to resolve the uncertainty. Soon the cycle ignites again with the next alarming thought.  

The False Alarm

Car alarms are set off when a criminal breaks in but imagine how problematic it would be if the siren blared each time a pedestrian walked by.  The car alarm would be misinterpreting innocent people as dangerous criminals. 
With health anxiety there is the misinterpretation of discomfort and normal bodily sensations as dangerous. The body is very noisy. Healthy human bodies produce all sorts of physical symptoms that might be uncomfortable, unexpected, and unwanted, but not dangerous. 

Normal sensations in the body that can produce fear and worry include changes in visual acuity, heart rate, blood pressure, saliva levels, depth of breathing, balance, and muscle tone,  just to name a few.  These are normal and harmless bodily changes, but when a person believes they are symptoms of a terrible disease, it causes anxiety.  The sensations are real, but the beliefs are false.

Why do people misinterpret sensations in their body and overestimate danger?  

Sometimes misinterpretation is due to assumptions about an illness. For example, “My cousin died of cancer. It’s only a matter of time until I get it.”  Or, “viruses sped easily. People in Africa are dying of Ebola. It could easily spread to the U.S.” People with health anxiety might hold rigid definitions of good health, perhaps believing that any discomfort whatsoever means bad health. 

Anxiety is a protective mechanism and scanning the body for an illness seems like the right thing to do to protect ourselves. However, when we are preoccupied with something, we tend to notice it.  Last month when I was looking to purchase a new car, I suddenly began to notice every car on the road; the make, model, and the color.  Previously, I didn’t pay attention.  Looking for symptoms makes you notice subtle sensations you might otherwise ignore. When you become preoccupied with bodily sensations, those sensations become amplified and last longer. 

This is when it gets tricky.  

Each scan of the body produces uncertainty and doubt, giving the imagination opportunity to create stories.  As you imagine the worst, your body’s alarm system sounds off in the form of symptoms of anxiety (racing heart, tightness in the chest, difficulty breathing, jitters, tingling, lightheadedness, nausea, stomach discomfort, sweating, headaches, etc.) giving your imagination additional fuel to create great works of fiction.   The symptoms are real. The thoughts are false. 

The Most Effective Treatment is Cognitive-Behavioral Therapy

Since it is possible to suffer with anxiety and a serious medical condition, medical problems must be ruled out with a thorough physical exam. Once this is accomplished, Cognitive Behavioral Therapy (CBT) is the most effective treatment for any form of anxiety including health related anxiety.

CBT is a therapy model that focuses on our cognition, the way we think, and our behaviors, the way we act. The main concept behind CBT is that our thoughts about a situation (the fear of ALS) effect how we feel (afraid and anxious) and how we behave (scanning the body, going to the doctor). We tend to assign meaning to specific situations (tingling means we have MS).  It’s not the actual situation causing our anxiety, but the meaning – accurate or not. And, when you have anxiety, you give your thoughts a lot of meaning, and thus, a lot of power.  

CBT aims to help you overcome fears by correcting irrational thoughts and changing problematic behaviors.  By acquiring a certain mindset, you can learn to approach anxious situations differently and learn to tolerate discomfort and uncertainty. Health anxiety can be overcome with the help of a skilled anxiety specialist and CBT.  You can find a therapist on the ADAA website.  

Also by Ken Goodman:

Additional Resources:
Health Anxiety Is Way More Than Being A Hypochondriac — And It’s Way More Common Than You Think


About the Author

ADAA_Ken-Goodman-websize-1.jpgKen Goodman, LCSW, treats anxiety and OCD in Los Angeles.  He is the author of The Anxiety Solution Series: Your Guide to Overcoming Panic, Worry, Compulsions and Fear, A Step-by-Step Self-help Audio Program., and Break Free from Anxiety, a coloring, self-help book for anxiety sufferers. Ken Goodman is an ADAA board member and Clinical Fellow. Visit his website.

 

radiantholisitcs

November 5, 2018

Very interesting article, nice information shared which is really reliable and useful .Thanks for sharing this and keep up the good work.

I came upon this article during another session of - you guessed it - reassurance seeking, which ol' Dr. Google is stingy with. On paper, I'm in excellent health, but I refuse to believe it. My sister is 500lbs and extremely hypertensive. My mother AND brother are both hypertensive (and both obese). My mother has had 2 primary cancers unrelated to each other (one in the breast - my main fear, yet her genetic tests were negative). And here I am, 5'7", 120lbs, non-smoker, BP is low (100/60 usually) and I exercise every single day. Yet after watching people around me suffer and fall ill from terrible things (watched my 45 year old brother-in-law rot and die from a terrible cancer) I can't shake the feeling that I'm next... that i'm a ticking time bomb. It has ruined my life. Therapy and meds have yet to help. Thank you for this article to reassure me, at least for the moment, that my problem really does lie within my thoughts.

I started having problems after abusing steroids a year ago. I constantly think I am having heart attack’s even though every doctors test has come out great. I have a low athletic heart rate and low bp and I exercise regularly. It’s almost like I take on symptoms that I start Dr googling too. I hate being this way and I totally get it. The worst part are all the weird symptoms followed by massive panic attack’s. You are not alone.

I know exactly what you mean! I was on adderall for 4 years and quit 2 years ago and ever since, I have had really bad panic attacks and health anxiety. I am always thinking my heart is going to give out. Or I have a tumor when I have a headache. I have gone to all kinds of specialists and have gotten so many tests done and even took three months off from work to get better. I am not looking into CBT. Good luck!

So happy that I’m not alone iv been going through the heat thing myself mine skips beats ect and ever dr I’ve seen said I’m fine and it won’t hurt me but keep an eye on it... feel so alone in this at times as I have yet to fodn anyone els with the same thing

Don't worry, your not alone, I have that too and I'll get so worried and when for a heart scan, but with god blessing, the result was good. So trying to keep your mind positive will ease your worries.

You are not alone . I have had a fear of having a heart attack to the point I fear my own heartbeat. I have been suffering with this for a few years now. It is hard to live with this I feel like my life is passing me by and I'm missing out because I'm always afraid

Anxiety has pretty much riddled my life. I have this fear of a heart attack as well to the point I can’t even do everyday stuff without noticing the changes in my heart rate and damn near panicking every time. It’s getting exhausting. I need to find a way to overcome this. You are not alone.

Hi,
I am really struggling at the minute. I have had health anxiety for years but I’m having a really bad time this week in particular. My chest is tight and I have pounding heart and a few fluttery ones! I have been checked thoroughly over the years but the normal/negative results only reassure me for a short while. Can anyone relate??

I’ve had every test ran that you can think of, angiogram, triple rule out, mri of my brain (for stroke of course) ct on my abdominal area, I keep getting the same results. They said that I’m fine. I hope everything gets better for you. I’m 37 and my heart rate scares the crap out of me and that in turn makes it worse. It’s a vicious cycle and trust me when I say I completely understand.... I hope you find peace

Yes had palpations for 3 day's for about 5 hour's each day. I am on ace inhibitors for high bp and found that they can cause high potassium levels, i also had bananas which increases potassium. High potassium levels cause all the symptoms you mentioned especially palpations, fluttery heart so if you are not sure get potassium levels checked by simple blood test

I can completely relate. I’ve been utterly dominated by this type of anxiety for over a year now. Hearing everyone who have been struggling with this as well as slightly helped me. Maybe I’m not the only one?

Hi.usually am on youtube checking thing related to HA.1st time i google it.i got long story i wil try to shortcut.am a worrier on every pettty thg since april 2014 n most is the HA.after my 1st panic attack in july 2017 i hv develop palpitation which add to my HA and depression.i can be happy and getting good times but my heart keeps palpitate for no reason.i was diagnosed later hyperthyrodism n after medication i was hypo n after that i had none until now.it was hell everyday inspite of hving a healthy heart n overall good health.i was like depressed every single day.i got everythg to b happy but my HA ruins everything.i did many ECG'S, blood test, Echo for heart and monitoring..all ok.but on April 2019 i got a heart beat of 210pm for no reason (medical) but i was very stress that day.i was so so so very afraid as i was seeing the beats as if it will burst out my chest.i kept my calm though i thought i was may b hving or will hv a heart attack.i start panic.usually my bp is 9/6 10/6 11/6 but that day it climp to 17.my family gave me lemon water.vinegar and it came down but my heart stays on 210 then 200..i was then admited they tried 3times to reset my heart but it ddnt went down.it was so scary.they gave me so many treatment but it wld nt get down.finally down to 130.125.120.all night i was on monitoring n in the morning it was on 70.75.80bpm.i did again all heart test which came out very good.am healthy.it was an electroslyte.nthtg serious but very scary..since was on medication n got very little palps when stress.now after 2nd visit dr told me its just anxiety n that he continue my medcine only bcoz of my anxiety.but since 1 month i dnt get palps as i hv accept its my anxiety nthg more..but i wil knw for sure once i stop the medication..so thats it..hope i can help and sorry if my story triggered symptoms to HA sufferers..cheers

I constantly fear I’m going to die for no reason, like my heart beats fast, I get dizzy or lightheaded, so I feel like something is wrong with my brain. I’ve also thought “maybe I’m dizzy because I have a tumor or aneurysm pressing on vessels in my brain, also triggering minor headaches here and there”. The thoughts are endless, and with health anxiety, I now know that it’s just my brain freaking myself out and heightening my dizziness because of anxiety. I never had this last year. But I’m thinking a couple events that have happened within the past 7-8 months have triggered the constant worry and fear of dying or passing out or not being ok in the grocery store. Being in public is very difficult. Even knowing I have to go to work gives me anxiety, because I know I have to deal with people. It’s a constant battle within ourselves and it’s very hard but we CAN overcome some of it. I’m still trying to train my brain differently and get in touch with a specialist. I really, truly hope the best for everyone on this site, because I understand you. 100%. Let’s all try our best to get better and feel healthier.

Your comment is me to a tea! I have always lived a very positive life, with a very get on with it attitude, but since this march I have become so anxious about my health, every little ache pain or twinge has my brain going mad! Before I would of ignored it or even no noticed it but now, I'm convinced it's something really serious! It's ruining Evey part of my life! I feel so acres and worried all the time and it's exhausting! I really hope that we can all get some help and feel better soon because this is an unbearable way to live! X

I have spent years seeking help from doctors, specialists and worrying about all different types of cancers. I must have spent thousands on private scans. My brain is so In tune to find something to latch on to that even in the middle of the night when I role over I wake myself up convinced that there is a lump under my arm from how I’ve been laying. It completely ruined my life and I’m always on guard. I had to ban myself from putting cream onmy body just in case I’d find a lump. I’ve given myself permanent skin damage from feeling under my arms for lumps. You always feel very alone as it’s quite embarrassing as nobody that I know can relate to how I am or understand. We obviously don’t want to be this way and is the most disabling feeling. We wouldn’t watch animals suffer like this, there really needs to be more awareness for this type of anxiety. I hope everyone finds some peace.

I am with you here Fay,i have suffered this hell for many years,over thinking everything about illness.
You are so right about feeling alone,i do not think even my psychologist knows how i feel.The only piece i have seen on the web that says how we feel is by some women,look it up it is so real[The glow hypochondria] it comes up as mamamia,but read underneath and it says The glow.
These ladies certainly know about h/a,they all suffer from it.
All my doctor says is go to psychology,but it does not work for h/a,and yes it has completely ruined my life,and that of my wife as well.
Best wishes Fay.Geezer.

Hi Fay,
I just want to ask you if you would like to write to me about h/a.
You are so like me with what you have written that i felt i had to ask you.
like you i do not know anyone like me and it does feel lonely.
If you do not wish to then that is o/k.
Geezer46

Hi every1 this is so me this as ruined my life i dont go anywhere no more its so frightening even got to the point where iv visited my doctors anf hospital so many times they call me a frequent flyer if only they understood where im coming from ill chat with any1 on here so if u like email me rebeccacook358@yahoo.co.uk

I get stuck in this loop too. I'm doing it right now, because I'm thinking about having to leave the house. I'm also out of the beta blocker that I was using to maybe help control this. It could easily be the placebo effect, thinking it was working anyway. I don't have anyone to talk about this stuff with either. If anyone wants to talk, my email is katalepsy and it's @gmail.com

Kate it’s like you are living my life! I fear the grocery store, I always want to be with someone so if (when) I pass out I’ll have someone I know with me and they will be able to get help or contact my family! I have fought this off and on for about 18 months, though I had it under control but it’s coming back pretty strong last couple months. News stories about “sudden” deaths due to Heart issue or aneurism are a real trigger for me and I tend to go off the edge. This is where I am tonight, afraid to go watch fire works because I don’t want to be out in public in case I die! I just want to be normal! God help me!

I’m the exact same!!! I think it’s tome to get on anti depressants but oh wait I’m scared to take them😭

Yes! I also have a phobia of taking medicines or even trying anything new for fear of having a reaction. I cannot eat chicken or eggs and it makes eating out impossible. I never thought I could be a hypochondriac before yesterday. Mainly because I don't think I have any diseases and am very healthy, but let me get a bug bite or an itch/rash/anything out of normal and I am in orbit with a hypersensitive acknowledgement of every tiny twinge or sensation in my body. I often tie my panic attack into something I have eaten and then I refuse to eat that item again. I don't eat out, I cannot try new things, and my food list is a short one to say the least. Generally, I don't go to the Dr but have been more this year because of some female issues. I've learned how to use natural methods of healing if I get sick- which is very rare. I do know that when my thyroid is out of whack, the anxiety hits. I would like to encourage everyone on this thread to ask for a complete thyroid panel (not just a TSH) to make sure that isn't what's causing a lot of your issues. When I have mine in balance, I'm a different person. Thank you all for sharing. I hate that we are all in this shape but it helps to know you're not alone. Praying for us all tonight and asking for miracles.

Hi Cassie. Hope you find yourself well. I wonder if I'm depressed even though I don't feel like it, but often wonder if antidepressants would help, but I'm scared to take them. Have you made any changes since?

I'm 56 and the older I get, the more I worry. I am starting to fear driving because I am worried I will suffer sudden death at the wheel. I don't want to be alone in public because I worry a medical emergency will occur and my husband will not be with me. Anxiety really SUCKS!

Your post describes me as if you knows me personally WOW this anxiety is taking over my life only had it about a yr now but reading everyone’s post has me so afraid that this is something I will be dealing with the rest of my life I definitely need help I can’t sleep most night because my thoughts are everywhere and mainly on my heartbeats this is very difficult to deal with.

I too am fixated on what my hearts doing .. beating too fast too slow, skipping beats. Have to try to find a way to lay in bed where I cant feel it or hear it. Making my life a complete misery

My heart makes me so uncomfortable. It feels like it will explode. My palms sweat my hands shake & I can't sleep.
Just started propranolol today.

At this very moment I am sitting at work in the middle of a panic attack because I thought I was having a stroke. I am NOT having a stroke. It is the most bizarre thing ever and completely self fulfilling because the panic makes the 'symptoms' worse. Then heart starts beating out of your chest, hold on, now its a stroke and a heart attack! Or perhaps it was a heart attack the whole time. Anyway I always know I'm being ridiculous but there's always that thought of 'but what if I'm not?'...and then round we go again. Reading this thread has made me feel better though!

I have really bad anxiety and I keep having real neck pain but doctors can’t figure out what’s causing the pain. I’ve done plenty of mri ct scans X-ray blood work and nothing sinister shows up feel helpless cause my mind keeps racing with fear

To be clear: Im not a doctor. I have health anxiety and I am not qualified to hand out any advice : just my experience as a lay-person with health anxiety.

In response to your post - I have had lots of physical stuff including neck pain thats just nothing to do with my anxiety (and also nothing catastrophic) that i worked through with an osteopath and a personal trainer to great effect. Maybe ur neck pain is just a bit of an alignment issue or imbalance with muscle strength. Easily resolved and not dangerous. I recommend u talk to an osteopath - you might find a couple of adjustments fixes the issue immediately . And if ur a desk worker - try a standing desk or adjusting monitor height - sometimes its just the little things.

I have been suffering from anxiety since past 4 years. I feel dizzy or weird sensations in my head most of the times of the day which make me really anxious. Sometimes I feel a vertigo kind of sensation in my head just for a second which make me feel very uncomfortable. I have gotten into few stupid beliefs and real experience the symptoms like if I don’t nap in the afternoon I feel dizzy in the evening and cannot do any activity can’t even cook. I can’t go anywhere on my own, even when I have to go to the grocery store I try to make the trip as quick as possible or convince myself that I can get uber if things get out of control. Travelling to work is a real issue for me I get really anxious about public transport and dread getting a panic attack in trains or while in transit , fear fainting in front of hundreds of people. At work as well when ever I get weird sensations and get obsessed with the thought of leaving work midday and taking a cab home. There have been so many times in my last job that I gave so many different excuses and left mid day from work , it also happened so many times that I left for work from home and changed my mind took a leave and came back home from half way to work. Because of this I got fired from my last job. Now with my new job I am really nervous of how I am going to manage this issue. I am so depressed. I envy people when I see them commute to work, go on holidays and be stress free and enjoy. I wish I can be like that but the symptoms are so real and worst we cannot control them. I feel trapped unable to do even the simple of the chores people do everyday and every day is like a battle for me which I am tired of fighting now.

Finally i came across someone with whom i share similar symptoms...or thoughts i would say...it gets better when my family is around...but returns once im left alone with my toddler ...scared that if something happens 2 me who will take care of him...whats the solution to such prob?

I have horrible health anxiety since finding my mom in the floor 3 years ago. No none health issues. My dad chose not to have an autopsy it was ruled cardiac. Now as a single parent I have horrific health anxiety afraid I have a ticking time bomb inside me and that my son will find me or that I'll die and leave him all alone. Every day I think I'm dying of a heart attack or stroke. I hit my head last week and convinced myself it was going to kill me. The dr sent me home because I didn't have and neurological symptoms. Today I've cried for at least an hour because I noticed a bruise on my gums which lead me to look in my throat and now I'm afraid I have cancer. I hate this so much. I'm so miserable. I'm scheduling appointment now for oral cancer screening. Last weekend I whipped myself up into such a panicked and frenzied stated my blood pressure and heart rate really were dangerously high. Not due to any underlying disease but solely because of a vicious cycle panic attack over the thought of having a heart attack. I just wish I could find some peace and lead a happy normal life.

I can understand you completely. I too have dizziness very often and whenever something is wrong with my body, it immediately trigger the silly thoughts that I have some disease or sickness. I see doctor very very often to get assurance. I hate this feelings too. I even have anxiety attack when I think that something is wrong with me. The more I think the worst I become. Sometimes I even think that I have hiv, and this thought is killing me that I live in fear and check every symptoms and read every article online to confirm my symptoms and I get blood test every few months to make sure I am ok. I hate this feeling so so much.

This panic episode is centered around the heart, a favorite of mine in my rotation of health problems I fear. Amongst issues such as having a heart attack, I’m deathly afraid (no pun intended) of being diagnosed with a brain tumor and/ or ALS. Oddly enough, cancers and things of that nature don’t bother me as much since I view cancer as something you can beat and something that, if caught, will not take your life suddenly like some of my other concerns. Between those three major issues, I am living in constant fear of sudden death. It’s exhausting and terrifying and frustrating at the same time. There are days I want to cry, and sometimes do, because I am a prisoner in my own body, and then there are days where I’m so fed up I find myself saying “just kill me already so I can at least be at peace!”, but either way, I am always in a heightened state of panic. Reading through these comments, I can insert my name into just about all of them as so many of my symptoms mirror everyone else’s. This is comforting to a degree, but as you know, there is always a little voice inside your head saying “but you actually DO have a medical issue”, so comfort is fast and fleeting. I wish everyone here peace, calmness, and strength as we all fight big bad health anxiety.

Hi Adi, hope you are feeling better or at least having a better week. I have also developed these stupid symptoms of thinking that if I don't take a nap I can't function and feel dizzy or light-headed and start to panic. Wondering how things are going with for you so far. It's nice to talk to people that feel the same way and knowing we're not alone. I have good and bad days, but I can slowly feel it creeping up:/

Its calming to see im not alone in this constant fear of a heart attack. 32 y/o it started last year after a night of drinking and partying. Came home and took a shower to go to bed and when i stepped out my heart went crazy, full on first ever panic attack. I 100% thought i was dying, couldnt get my heart rate to go back down until i passed out after about 25-30 minutes. Ever since then ive convinced myself something is wrong. Went to ER a few times, and cardiologists. All looked good, expect BP is normally at 150/85, but gets up to 180/95 when having anxiety attacks. So doc put me on carvedilol. Daily i stuggle with concentrating on how my chest and back feels. And now i guess from being so tense i have real back and chest pain and tightness, which of course triggers the anxiety creating a vicious cycle. Wondering if anyone else has the constant chest and upper back tightness/soreness and if so how they handle it. Also the random sharp pains in arms, legs, chest etc.

Yes I experience the same thing. Been to multiple doctors and was told I’m fine. Look into seeing a rheumatologist you might have Fibromyalgia. Also go to a Gastroenterologist you may also have GERD. I had an endoscopy done and was told that I had GERD. GERD can mimic a lot of heart Attack symptoms. Shortness of breath, chest pain etc.

I feel the same I have had anxiety since I was 16 I didn’t leave the house for 2 years and it went away and came back and went away now I am 25 just had a baby 6 weeks ago and it has came back horrible but last couple times I notice it’s health anxiety I have I fear something is wrong with my heart have had all tests all came back fine but now I have convinced myself labour has done something h to my heart (most likely just In My head) I started getting etopic beats now and again which has just started a vicious circle of symptoms like tight chest and back and pain breathless etc glad to see im not alone

Jeremy, I am experiencing a lot of the same things you are! I was diagnosed with an irregular heartbeat a few weeks ago and ever since I’ve had extreme panic attacks and anxiety overthinking that my heart is going to give out, despite the fact the docs all say it is ok. I too was placed on carvedilol for this and my hypertension. Have been on it for a week but have lightheadedness and chest and arm shoulder heaviness. You are not alone!

I also get the chest pain/tightness that’ll stick around for days after a panic attack and make me obsess over them even though nothing is really wrong. I get the random sharp pains too, I think it’s just the muscles being mad at us for being so tense.

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