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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.

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

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

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😭

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.

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.

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.

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.

Hi friend,can you add me to group in Facebook bout' people dealing anxiety,
Jn Samjohntiff ,I have been this for 2years and it sucks.

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

I’ve just been diagnosed with this it’s cripplimg me with anxiety how how old are u ? I’m 39

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 :)

Hi Jess.
Just came across this website as I was looking for a self help book on heart health anxiety.
I was diagnosed with ectopic beats, skipping all over the place, jumped beats, missed beats. Was sent to Cardiology and to be fair I had every test done, numerous ecg, heart monitor on for 48 hours, they did this three times over a period of 18 months and two heart scans.I was discharged 2 years ago and its something I have to live with. I,m on bisopropal every day. They still miss,jump, bang, flip. More of a nuisance really but that's what the Cardiologist found. I understand, its hard to accept the professionals diagnosis and just get on with your life. My slight anxiety I,m convinced is to do with the fact I,m now 52 and I can,t just say to myself anymore, oh don,t. be daft, you re only 30 nothing wrong with you. My father had a heart attack and died at age 59, I was 20 at the time and I gave him cpr but I couldn't save him. Maybe the trauma of that has stuck with me subconsciously somehow. I ll buy myself a self help book and hope I can put these irrational thoughts to bed once and for all. We all live in hope !
Good luck to you, I truly believe you will get better,
God bless
Louise.

I have severe anxiety each time I find a way of coping with a symptom another more difficult one arises . It started many years ago with the fear of vomiting in public then messing myself in public . Fainting then that died down and came back after a particularly hard 18 months that included 6 deaths in the family illnesses relationship problems and more , with chest related symptoms flattering palpitations missed beats then racing thumping still with the background toilet phobia thing . I be tried everything this time but nothing is working

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