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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.

 

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

My health anxiety is all to do with my heart and brain. I feel my heart flutter, pond hard and feels like it misses a beat. I’ve been to a+e over 5 times to be checked and it has always come up clear. The anxiety and panic attacks are hard to cope with but I’m starting cbt therapy and antidepressants, and can only hope for the best. You are not alone!

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.

Thank you so much I came accross this site. This helps a lot. I've been dealing health anxiety since both my parents died on sickness. I realized that there are a lot others not only me dealing with this situation. I'm not feeling alone now. Thank you so much and hoping that other s experiencing anxiety would also feel releived

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

I think I'm heading your way. My daughter was born 5 years ago and i was fine. My mother died 4 years ago, i was fine. I had a heart attack 3 years ago, I was fine. My father nearly passed away through heart failure 2 years ago, I was fine. 7 months ago it started and now I feel not too dissimilar to you. It is frickin hell!

Yup! I work as a healthcare professional, specifically around neurological disorders so I have everything going. My dad passed away from pancreatic cancer so obviously I’m next. I have aches and pains so that means bone cancer/RA! It’s crazy. I know I’m irrational but I just can’t shake it.
It started post my husband becoming very ill and requiring a lot of surgery. He’s great now but my brain is broken. I’ve had CBT before and it worked for a while. Now I’m regressing a little.

I can here for the same reason. I had my son and not long after I watch my aunt lose her battle with cancer( it was deviating). Also the Lady that raised me passed away the same week. I've gotten myself sick going in and out of the ER. Getting an ambulance for a panic attack and constant body examinations. I feel like it's taken over my life and robbed my kids from their mother. I'm hoping once life gets more simpler that I will worry less. Hope you've been able to over come your obstacles since then.

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

Dude I know exactly what you’re talking about. Right before I go to sleep I feel that exact same thing. I have to scare myself awake 3 to 4 times in order to realize it isn’t something serious to go to sleep. I am constantly EXAUSTED. I’m talking to the point where I feel like I am going to pass out ALL day. I have this constant pressure in my head and it feel like my head is being slightly squeezed all day. I have weird arm pains and tingly/numb feelings in my hands. I constantly worry about my heart rate because it is always beating fast. I get random muscle spasms all over my body. I always have stomach aches. My throat gets sore a lot. I don’t know WHAT the hell it is but it is ruining my life. What are ALL of your symptoms,

I have the same thing! First I was worried about my heart... had scans done everything is fine. Now it’s my brain. Have a squeezing feeling/ throbbing , probably stress. Barely sleep at night. Takes me forever to fall asleep. I can’t nap during the day because everytime I doze off I get that electric buzz also. Feel like I’m not even living life anymore.

Wow its such a relief reading that I am not alone and am suffering alot of the same physical anxiety symptoms as others out there. Just reading this article and the comments has calmed me so much. I get intense chest (currently sharp random pains on the left side), fatigue, digestive issues, sweating, tingling in arms, back pain and extreme fatigue. I am only 21, have a family history of anxiety and have had heart tests etc. come back clear but regardless the illogical thoughts come back. Accepting that I am healthy and my symptoms (no matter how intense they seem) are anxiety related and giving up caffeine really help! I have a college degree in Psychology and yet due to the physical nature of the symptoms it took me quite a while to even realise it could be anxiety. Hope you're all doing well!

Totally agree with you, I’m 25 and was diagnosed with Generalized Anxiety Disorder, OCD, illness Anxiety Disorder and Depression. I’ve had every symptom you can possible think of. Heart palpitations, twitching, tremors, shortness of breath, electric zaps through my neck etc. I’ve been on meds and since then mos of my symptoms have gone. Now and then I feel a symptom or two. Calming my mind has been difficult but as you’d know it’s a process! Stay strong, you are not alone.

Hey I also get this zapping like pain in my neck. Always on the left side only every now and again but sometimes it feels like it hasn’t been to long since it happened before it happens again. Like a real sharp shooting pain and it stops me in my track for a few seconds. I was just wondering if you ever found out what this was or if it was just related to the anxiety? Thanks

I also suffer with severe chest pain every day!! Iv has it since last November! I also get pains down my arm aswell iv had blood test, echo scan on my heart and it’s all come back clear !!!! I feel so drained!!! And alone

I am going through exactly same symptoms. 3 months back my father had a heart attack since that night I have been checking my blood pressure regularly. It's slightly elevated since then. I am 100% sure it is anxiety related as my cholesterol levels is nornal, stress ecg came normal, also a non smoker. It gives me a relief that there are others feeling the same symptoms

I literally have the exact same feelings when falling asleep where you getbthe electric buzz sensations they terrify me , currently sat typing this with an anxious feeling and mild pains in my left side of the chest , it’s always in the same place but I’ve had countless tests and everything has always come back ok I’ve been given medication to combat the physical symptoms of my anxiety but I’m too scared to take them because they make your symptoms worse for the first couple of weeks I’ve had cbt and it does work for a while but I fall back into the same pattern hopefully one day I’ll stop feeling like I’m having a heart attack or a stroke.

I have the exact same thing my chest hurts and when I sleep I do that sometimes not all the time but some nights I do all my chest and catscan came back clear but my chest hurts and random arm pain too.. the dr also told me I could have GERD I was going to the hospital back to back for months until I got a doctor who ran me through the mill with catscan blood urine pep X-ray and everything came back good all thanks to god.. it’s a struggle but this won’t stop me I keep pushing everyday I take deep breaths I won’t give up I’m glad I’m not alone but u can do this have faith god is real don’t give up

I’ve had the same problems for the past 3 months, I constantly feel worried about my heart as I keep getting chest discomfort along with muscle aches in my arm and lower legs. It started with breathing difficulties but I was diagnosed with asthma in which the inhalers provided have improved my breathing. However I still feel as if I have an underlying issue, I feel nervous and uneasy pretty much all day, everyday. I’ve been to the doctors around 10 times since this started and every check they do they tell me everything seems fine, I’ve had a chest x ray, ecg and blood tests and they’ve all came back clear. I thought getting these results would give me peace of mind but for some reason I just can’t accept it. It worsens when I lay down I feel like my body is constantly racing and my hearts beating harder than it should. I really want to overcome this anxiety as I’m not my normal self and feeling unable to do anything.

My nephew was misdiagnosed with asthma and he went back to dr. With his mom because he wasn’t getting better, but worse. Like you, he still felt uneasy and nervous and laying down was worse. Got the right diagnosis of anxiety and he was given meds and is feeling much better. Thought I’d share this info with you because the stories are so similar. Talk to your dr. Hope you feel better soon.