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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.  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.

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.

You are not alone I've had this and other health anxiety fears since I was 19 in 55 now and life is a living hell
All the best to you

Hello Jess. I came across this article and saw your post. I too have skipped beats, some days I have none, others a have a few a day, then other days I may have skipped beats for 3 days constantly all day. If you are the same as me then it feels as if your heart misses a beat, sometimes it thumps hard, other times it may feel like a flutter or a flip flop in the chest. I had a heart monitor on for 78 hours and they said that I had an ectopic heartbeat which most people have they just tend not to notice but someone with an anxiety disorder like myself will focus on that missed beat and wait for the next therefore focusing on and waiting for the next so that I notice them more than someone without an anxiety disorder and with my OCD I will focus on it so much that I convince myself there is something wrong with my heart. My heart recently has been beating in the 50's sometimes and now I'm focused on that and constantly checking and now I'm worried that I have a heart problem again. It's a never ending circle for me. Always focusing on things that others would just dismiss. You are not alone.

Ive suffered with this for the last three years it started wen out of the blue i started havin panic attacks. Ive also had tests and theyve come back clear. I defo think its anxiety wen im busy and my minds not fixated on it it will vanish. So to all the people who are worried about this you are not alone.

Hi
For those with skipped beats. A low level of magnesium within the system often shows itself as skipped heartbeats. People are often very pleased to hear that something so simple can rectify this frightening symptom. It is a muscle relaxant which also helps regulate. The heart is a muscle and dependant upon magnesium. Hope that may help. Obviously medical supervision is required too.

You are definitely NOT alone. If you have a Facebook account there are some virtual support groups there, once you find the right one, it can be a big help. You'll be amazed at how many others are just like you, like us.

My mother died about a month ago and ever since I’ve been having “heart attack symptoms” that I rationally know are anxiety and panic. Every “symptom” can be attributed to something normal, but I still find myself googling like mad every night. CBT is next I believe, because I cannot keep living like this.

I have A Fib and i constantly worry im going to have heart attack or stroke. Stay awake all night for fear of heart attack. It's getting worse every day. Im also afraid to take certain meds because of the terrible side effects. Cant get any relief. Feel trapped in my fear and anxiety.

I have just been diagnosed with afib also and had to have a shock delivered to my heart to get it back into normal sinus rhythm I suffer with health anxiety and OCD big time and when this happened my world came crashing down. I'm taking heart meds, blood thinners, sertraline and diazapam. It's hard but my cardiologist has said it's super common and people live long healthy lives. I take comfort in the thought that I know what i need to do if I have another episode and that I will be ok. It's always in the back of my mind that it may happen again at any moment but I have accepted it and asked my cardiologist 100 questions to ease my mind. Everyone I talk to about it says oh my "mum/sister/friend has that too makes me feel better. Hope you can find some relief in this. X

Hi there!! Just wanted to let you know you’re not alone! About five years ago, I developed a heart arrhythmia that the doctor is assured me was not a danger. Nevertheless it made me extremely stressed out! My doc assured me that it would stop once I stopped worrying about it. It did!! It eventually stopped. Every now and then I feel a skipped beat when I’m stressed or have too much coffee but it’s nothing like it was.

Reassuring to know there are others out there who suffer from the same thing. Also I feel bad because I know how it is. I used to take pre workout and one time took too much, for about 3-4 years afterwards I was always worried about my HR. Even after tests and having a sub 60 HR (I workout a lot) I’m finally over that but now it is other things and I constantly find myself forcing my mind to think logically about why said body part is hurting. It’s very tiresome, but it does help to focus your mind on the activities you’ve done recently that could be the cause. I wish you all good health and hope you find a way to beat back that stupid anxiety !

Trust me, you're not alone... I'm always thinking I'm having a heart attack.... it used to lead to panick attacks.. now I'm able to reroute my thinking as soon as my breath is short. On the upside... just imagine how good the imagination is if it's actually able to think something so silly is happening. Neuroplasticity... replace hose thinking pattern with new ones.... I am healthy and strong :)

I understand how u feel since I had a heart attack two years ago any slight illness miss me feel depresssed or breathless thinking I won’t survive I live in constant fear I know it’s wrong but cannot stop

Is it possivle that your family implanted somehow in your head that your turn would come, because of genetic and that you couldnt get away from it ? I know reassuring you wont work but your chances are very low. Live your life away from these bad influences.

Studying biology in college played a gruesome trick on me. Because of the awareness of all diseases and anatomy, every time something twitches, pulls or hurts I think of the worst disease imaginable. I feel like I don’t deserve to be healthy when so many people around are sick. Health anxiety is very crippling, because I cannot agree with the fact that there is nothing physically wrong... it’s all in my mind. But yet, I don’t trust doctors when they tell me I’m fine, I feel like they missed something, and one day I will be diagnosed with some terminal illness. It feels like I am almost longing for it (which is wrong and crazy, when I think of it), because only then I can justify my constant worries.

Katie,
I’m a newly minted Physician Assistant and I completely understand what you’re going through. I was recently diagnosed with a few things and even though my doctors try to reassure me that I am stable and ok I always feel like they’re missing something. My knowledge in medicine has been my worst enemy and is fueling my health anxiety. Looking into finding a CBT specialist ASAP :(

That last part really hits home! Of course I don't want anything to be wrong with me, but then it's this little voice in my head like let's be right so I can get my "consequences" over with. I can't never just be a little sick it has to be the worse thing imanagable.

I was told that stress and anxiety cause you to get cancer so now I'm afraid that since I worry and am stressed and have anxiety that I'm going to get cancer. My health anxiety is so bad that I just lay and cry all the time. In my family everyone who has passed from cancer, so that makes it worse too. I don't want to get cancer from stress and anxiety. So scared

I feel you.im scared too..i dont want to worry things but i cant control my mind.im taking stilnox to fall sleep beacause i cant sleep i fear that i may have something in my brain.i hope can overcome all of this too.i want tbe strong for my children.IM from philippines You are not alone.

Yes, this is a cycle that is often not talked about. Since there's so much attention in media about the bad effects of stress, worry, loneliness etc, that they can cause real disease, a cycle in the mind can be caused by an anxiety disorder sufferer.
You will get thoughts like 'I need to stop this stress or else I'll get a real disease,' which fuels the anxiety. And when symptoms arise, especially new, you might get thoughts that 'so might've been healthy before, but with the years of stress attacks and constant worry, now I could've produced something real, because of exactly that.'
It's a very powerful cycle I struggle with as well. The high blood pressure because of stress, heart rythm disorders because of stress, dizziness because of any of those thinga and the 100s if not 1000s of other possibilities. How to come to terms with that I don't know I try to keep a believe the cycle must stop by replacing destructive with reassuring thoughts, relaxing the body with exercise and therapy, living healthy enough, etc.

Any advice on this I'd gladly hear

Aww. Please try not to worry yourself. It is 100% in your thoughts. Try listening to the podcast “The Anxiety Guy” he has helped me SO MUCH and it’s free on YouTube or the podcast option on an iPhone.

My heart goes out to you Daphney. I suffer from health anxiety but only recently have felt the swoops of depression that can accompany it. I use to think that people should just get up, go for a walk, get excited about their lives, but now I know how crushing these feelings can be. I have been reassured by 3 doctors and more tests and scans and surgery! than I can count that I am healthy. But, I still have twinges in my side and stomach sometimes that eventually leads to the terrible cycle of worry and more symptoms. I am getting better though. I'm gaining some distance and perspective and refuse to let this ruin my beautiful life. A couple things that have helped me were Dr. Elaine Ryan's online health anxiety course. I think it was around $70 but it really gave me some needed perspective. Also, the audiobook (or actual book) Anxious For Nothing by Max Lucado. It's a short Christian book but so spot on and so comforting. Praying for His peace to be with you. N

Thanks for sharing. The internet can certainly be fearmongering and hearing statistics about genetics and doctors asking about familial diseases doesn't help. Lifestyle and perspective are huge and it sounds like you're on top of the former. I am a counsellor and find that people with health or death (existential) anxiety are getting younger and younger. I have clients in their teens. It's amazing what our thoughts can convince us of. CBT, that the article recommends, is also available on self-paced online platforms that might be something to consider.

I used to smoke weed for more than 12 years and when I quitted it all the panic attacks started! At the beginning I was worried about my heart and then it moved to my kidney and so on! This is a great article and I feel so relief to see that I'm not alone and now I understand the necessity to visit a therapist.

Hey I just wanna say, I may be in the same boat. I smoked weed for a long time, with periods of inactivity. Well a few months ago we got into wax pretty hardcore, that is, until I had what I think was a panic attack from it. My mouth died up, my heart went crazy, and I knew something was wrong. I got extremely heavy and almost fainted. Haven't touched wax since. Since then, I've had 3 or 4 partial panic attacks where my head tingles like half my brain is dead, nothing full blown like that first one. I faked out and looked up the symptoms, and sure enough, panic attack was a possibility. Since then, I've kind of laughed them off and they go away quickly.

I've had bouts where I think I have colon cancer, and issues with pain and fatigue all over, especially in my joints. I even had an ultrasound because I thought I had a blood clot in my leg. I can feel the pain, but try to remind myself that it's probably just anxiety, even though my leg still hurts. I've decided to really try to exercise since my sweetheart lifestyle cannot be contributing positively. I'm hoping that will make me a bit better because constant worry is no way to live. But of course, the worry that I did have a clot gives me anxiety to even work out, fearing that could agitate the "clot" and kill me! Life is freaking bizarre. I'm tempted to find some magic mushrooms again, they've always made me feel fantastic for months thereafter. Thanks for reading!

I have same situation like yours. 2014 my father died because of prostate cancer. Had hard time to accept it. In fact until now I still cry whenever I remember him. November 25,2017 I felt a "lump" on my left breast this time anxiety kicks me hard. I cant eat, I cant sleep, I cant function well in my daily life! Googling made it worst. February 2018 I decided to see a doctor to check my breast ang suprisingly the mammosonogram result is negative! I cant believe it so I requested for another mammosonogram in another clinic and it turns out negative again! I hate my self that time. I didn't enjoy the holiday season and my birthday because of my fear that I have breast cancer. I am only 26yrs. old then. Now this time I am suffering again from another episode of health anxiety. Just now I googled why my nipple itching and has dry skin in some small area. As expected the google result says it was paget's disease a rare form of breast ca. I dont know what to think now. I am in the same situation again and I dont like this feeling. It is draining me. I hope it's just another false thought ij my head again.

I can tell you this much, if you let it take a hold on you, you would rather have a terminal illness than live with Anxiety for years. Point being, make peace with the fact that we're all mortal. Here's the irony, we don't live (enjoy life) because we're afraid to die.

What has helped me many times was telling myself that even if it is what I'm imagining it to be, I can handle it. I can beat it, live with it, die with it, who cares?

And never ever ever ever Google your symptoms or even ask friends.

Best of luck and a great life. One more thing, you CAN get rid of Anxiety. Always remember that.

I feel the same way as Erin. I know my thoughts are erratic yet I can’t help them. Meditation helped a lot.. calms the mind from racing thoughts but I haven’t done it in a while and it’s come back. I especially get it when I cut back on carbs( weird ) but I am now looking to seek therapy. I refused before because I thought no one would be able to help this AND I knew if I spoke about it out loud I would have an anxiety attack. I live life pretty normal and have a baby. But no one would know how much this affects me.. I’m scared to have another baby because of this and I shouldn’t be. I’m scared to start a career because I don’t want to have panic attacks in front of people. But this article made me feel that therapists might get it. Maybe there is real long term help.. would love to maybe visit this doc when I visit Cali.

Well you don't smoke you exercise and you eat healthy so you don't have to worry about cancer. How many times you have been sick this year? Well I'm asking because if you as a person don't get sick easily then your body is strong and can fight cancer effectively. Besides why worry about something that might as well never happen to you? Live your life without thinking about things that can kill you and you will not have anything to be afraid of. Are you afraid of car crashes? Because cancer and terminal diseases are not the only thing that cam kill you. You will never know what will be your cause of death so why worry. Just live your life

Panic disorder is essentially when people are prone to panic attacks.

Health anxiety is when people are worried about their health too much.

If when you worry about your health you start to have a panic attack, you probably have both.

Many anxiety disorders come together.

Just reading this and seeing you list off all the things I'm worried about as normal worries makes me feel better. I just started CBT, and this is some useful reassurance when I need it.

Thanks so much but is there any other way to reduce it? Reading this even gave me anxiety but I’m glad I read it... even tho I’m crying right now because now I have anxiety about having anxiety lol! I don’t want to live my life like this forever so is there and easier way to reduce my anxiety? Thanks for the article it made me feel better and for everyone else I hope it did the same

Reading this sounds exactly like what I’m going through right now. I’ve had anxiety lately- haven’t been sleeping all that well and keep looking up articles about how extreme anxiety can in and of itself be an indication of brain tumors or pancreatic cancer. Given that I’m 36 and healthy, with a prior history of anxiety, I’m inclined to believe it’s not cancer and just anxiety. But I still can’t shake the anxious feelings— just generally feeling “out of it”

Can't express how similar my current situation is. Been using the term, "out of it" to describe how I'm feeling to others when they ask how I've been doing. All things considered, I am a healthy 21-year-old, but every "scan" I give my body doesn't seem to shake me out of my funk.

So for almost 2 years now i have been having chest pains been to the ER about 7 times thinking im having a heart attack but everything comes back negitive . I found out i have WpW which causes my heart beat elevated when it gets traped in a chamber. I have seen a specialist 3 times for my heart and they always tell me everything is good. But i have chest pain still. The nurse asked me if my calf was hurting when i was in the ER it wasn't but now it is an added sensation i have been feeling and random arm pains does anyone go rhrough the same things. One really weird thing rhat happens every once and awhile is ill be in about to fall asleep and right as im slipping into sleep i have a electric buzz shock go all through my body freaks me out i start to think my heart stopped i try to tell myself that everything is in my head but it dont really work . The doc. Says i could have GERD . This issue i have is hard and i understand qhat you all are going threw .. anyone have any ideas about why i should do ?? Thank you