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by Ken Goodman, LCSW

The illness you fear might not be the illness you have. I recently conducted an online support group for people with all sorts of health fears, from cancer and heart disease to ALS and MS. Each shared their worries about moles on the skin, irregular heart palpitations, and numbness and tingling. Although their specific fears varied, they all had one thing in common; none of them had ever been diagnosed with a series illness and they all related to the following scenario:

Dina felt great after getting a clean bill of health from her physician but as she tried to fall asleep, she dwelled on one statement he made, Tumors can grow at any time. Come back in six months if you’re concerned.  Questions raced through her mind as she tossed and turned, Why did he tell me that? If there was nothing wrong, why would he say come back in six months?  What if he missed something? Why do I keep getting headaches and dizziness? Dina felt so anxious she got out of bed and searched the web for answers.  As she reread the same articles about symptoms of brain cancer, she began to feel lightheaded.  Why do I keep feeling this way? Do I really have brain cancer? Is this really happening? 

The good news was, Dina did not have brain cancer or a brain tumor. Dina had 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 physician due to their fear of discovering the worst, seeking reassurance from doctors, insisting on repeated medical tests, and visits to 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 googling and self-diagnosis, misinterpretations of news in the media, anxiety, and more visits to doctors to resolve the uncertainty. The cycle ignites with each new alarming thought or symptom. 

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 (holding out our hands to see if they are trembling). 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. Illness anxiety can be overcome with the help of a skilled anxiety specialist and CBT.  You can find a therapist in your state on the ADAA website.  And for additional information on Illness Anxiety watch my free ADAA webinar.

This blog post has been updated by the author - June 22, 2020

Additional ADAA Resources by Ken Goodman:

How to Get Over It: Fear of Vomiting - ADAA blog post
Overcoming the Fear of Vomiting - ADAA on-demand webinar
Overcoming the Fear of Driving
- ADAA on-demand webinar
Overcoming the Fear of Driving - ADAA blog post

Additional Resources:
Health Anxiety Is Way More Than Being A Hypochondriac — And It’s Way More Common Than You Think
This Is Why Being Anxious Makes Some People Puke - Article,  Tonic.vice.com, December 6, 2018 


About the Author

Ken 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 Ken's 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.

Hi mark here from near Bristol. I think you put that together brilliantly and for 99% of people its so true . Even though i know i am being left to suffer with many afflictions i found it most useful . I think i was poisened initially wirh some rare or possibly unknown mutated tropical infection . I did think many of the doctors were simply incompetent but looking back on over 452 separate individuals from various specilist areas in medicine and well with over 3786 visits in total iv come to realise its simply not in any of these peoples knowledge . It took me time to except that but what can we do you know. I do think something environmentally triggers ones body to experience such problems . Perhaps a virus . Or bacteria. Fungus ect disrupts the neuropathic pathways . Lots of people certainly play on it . Maybe it can be cured in most cases but i ask how many cases are genuine . No no i actualy have asked people this and everyone except a chap names dora said they were sincere. They are also wrong on some occasions which leads to suffering and worse . Any way thank you . I have a meeting with fungal specialist tomorrow . Lets hope hes better than the last few . 19 to be exact but whos counting hay . Ok i am it was 19 . Ok bye thanks

452 I assume people in the medical community(that's a lot of schooling and experience) are all wrong after 3786 visits and I can only imagine how many negative tests results you have gotten. Of course they just weren't looking for the right thing when they did these test but you agreed to take the tests anyway only to find that it was negative(you knew that before taking the test though, so you are really just wasting people time and someone's money). So go see another fungal specialist because the one you see tomorrow(now in the past) didn't give you the death sentence that you so desperately seek.

You push the image of it being rare or unknown so you can continue the process of seeing another person, a doctor, a specialist or another self proclaimed professional so you can totally disregard the findings because your education or experience certainly has you better prepared to know that you have a rare or unknown health condition.

Seriously. I am laying it out to you as someone who has done it before but not anywhere to your extent. Is there something wrong with me? Absolutely! No one is perfect but I refuse to spend life looking for what is wrong anymore. Be careful for what you wish for, you might just find it. If the next person you see says you do have some rare poison in your system, will your journey end or will you dismiss his findings when you don't feel that you are as healthy as you should be? I am betting that you will find a reason in your mind why he/she is wrong so you can continue your quest.

End the quest. Accept that you are not perfect. You like many other don't feel perfect but accept that you just feel it more than you are meant to and stop reacting to it. That little pain you feel... everyone feels it but 99.9% of the world ignores it. Be part of the 99.9%. Ignorance is bliss. Denial is hell.

Again I have health anxiety issues that I have largely overcome or learned to live with. I am only immortal for a limited time and I accept that most of the time. I don't know how I ended up on here. I was watching a YouTube video that mentioned health anxiety and people using an illegal drug in small doses to combat it. I wondered if there was any scientific evidence for the comments and ended up reading the above which was very informative.

I am not saying that the feelings will go away overnight but if you can just go an hour without thinking about it you can go a day. If you can ignore it for a day... and so on. Not saying it is easy. It's a process and it begins with you accepting that your brain may just be lying to you...

I’ve been struggling with health anxiety for years since I was young, on and off. It sucks how you think it goes away, but then you know it’s going to hit you right in the face out of nowhere again. An endless cycle. You relish and savour when it isn’t there and isn’t taking over your life for the time being.

I’ve tried everything and to this day, being 29 and still haven’t fully recovered. I don’t think I ever will. but I maintain it. I wish it would just all go away... these obsessive, stupid, thoughts. It’s beyond my control. I question myself why this had to be me and why I can’t just live a normal life and not fear every pain or bodily function... but, I maintain it. That’s all I can do, there is no cure.

I am in no way a unique case and millions of people struggle with mental illnesses, I just thought I’d come forward and share my part and how it’s really taken over my life in some instances. It’s really something you can’t control no matter what dose of Zoloft you’re on. It’ll still always be there.

I just wish one day I’ll overcome it, and it won’t come back. It’ll be nothing but my past, and not my foretold future. I would never wish this illness upon my worst enemy, nor any illness for that fact.

I totally understand. I'm turning 31 next week and I have had panic attacks, anxiety and health anxiety really bad since I was 14 and off and on before that. I have a mom that has had a rare health condition since she was a kid and where she doesn't have an immune system so germs can be dangerous. So, I have always panicked that I could have something too. Also, always panicked about bringing germs home to her. My anxiety has definitely gotten worse as I have gotten older, and has now reached a peak with all the Covid stuff going around. I know that there is a way for all of us to get better. The mind is so powerful with tricking us into anxiety mode, so there has to be a way for us to switch the thinking and make the positive thought pattern stay. We can do this and will grow stronger together!

Wow!!!! Reality Calling; you nailed it when you said “go see another specialist because the one you just saw didn’t give you the death sentence you were desperately seeking”.
So true what we do to ourselves.

We are wasting precious life on our intrusive behaviour.

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

Did u find peace ? I’m struggling like u were I’m 49 single mum of 7 kids and 7 grandkids anxiety is ruining my life I think I’m guna die all the time av constant pain in chest and back it’s never ending there as soon as I open my eyes o oh sleep 3 to 4 hrs a night it’s hrrific all the time

Have you been to a therapist? You should see a therapist and perhaps start a medication. Even am herbal supplement maybe.

hi i am an athlete fit and fine due to anxiety i spoilt my career i always get bad thoughts of some or the other disease is going to come to me due u have any consultancy in Bangalore India if so please let me know

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?

I can totally relate to this too. It all started this year when I got pulsatile tinnitus in my left ear, where I can hear my heart beat. Was convinced it was a tumour. Had headaches during night which turned out to be caffeine withdrawal but all the time I fear a debilitating illness such as MS, Parkinsons or Motor Neuron. These are the ones I fear. I was trembling inside all day yesterday and was convinced it was the start of one of those! Doctor prescribed Sertraline 50mg which I haven't started yet. CBT didn't work for me. Hate this...

Please visit our ADAA peer to peer online forum. You need to subscribe (but it's anonymous).https://healthunlocked.com/anxiety-depression-support?popup=1

Thank you!


ADAA Staff

Hi, I have the same, I can hear my heartbeat too in my left ear. I thought the same. Had scans etc. All good. It doesn't really bother me no more. Had health anxiety since I gave birth to my boy 9 years ago. Was doing good, but my stupid doctor put me on 200mg sertraline straight away. Ended up with serotonin syndrome, since then I'm a complete wreck

I suffer from terrible health anxiety just like you guys. It’s torture and I wish I could stop it for myself and everyone of my fellow sufferers

My mother had the same too but I saw her beat it. It’s not impossible.

It took her time and there were many, many set backs, but bit by bit, she did it. I’m sure I will beat mine too. And you will too.

Small wins like being about to overlook just 1 little symptom, cutting a thought pattern short, or not doing a dreaded google.

My grandmother used to say, “your anxiety is like a horse and buggy. You are on the buggy and the horses are your thoughts. The minute those horses get spooked, and if you've let those reins loose, they will shoot off and send you on a wild and turbulent ride. You can’t reach for the reins to pull them to stop because the wild spiraling ride is so rough and bumpy.

Hold those reins tight, if those horses spook, pull back before they get way from you, don’t give those bastards an inch.

Another thought that helps me, is to repeat the following

your are fighting anxiety, you are not fighting cancer (or heart disease or MS or whatever you fear most).

Anyways, I don’t mean to sound preachy or pretend I have the answers (I don’t)

But these 3 thoughts help me (not always) and maybe it’ll help someone else out there too.

1. You’re fighting anxiety, you are not fighting cancer (insert fear)
2. People, just like us, beat health anxiety - you will too.
3. Hold those reins and don’t let those bastard horses bolt.

It’s nice to know that someone is suffering from the very same situation as I am.
The analogy you gave is very helpful. Especially the one about maintaining control over the reigns of the horse.
God bless you <3

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

Hey Zor, just saw your comment. How are you doing? My health anxiety is in high gear right now. It never really goes away although I would do anything to make it stop. Every time I go to the doctor who tries to reassure me I’m ok, it happens again. Those dreaded thoughts. This is horrible. I hope you are doing better!

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

I can so relate! I watched my FIL pass away from lung cancer in April of this year and that's when the health anxiety began for me. I have been to several doctors and the ER and have been told I am fine. Everyday I find a new cancer that I believe I have and I Google it until I am completely convinced that I have it and I'm going to die. This is not life...this is hell. I pray we all find some peace.

In the same situation...ive had scary thoughts about something being wrong with me. I went to the doc and is now waiting on my results. I am soo afraid that i may get bad news. I keep googling and the more i read...the more i get scared. I feel soo alone....i can't sleep and i keep getting nervous all the time. Sometimes i be ok but then my brain keeps making me think negative thoughts. I hope im alright cause i don't like feeling this way.

I WANTED TO REPLY AS I CAN A MILLION TIMES RELATE TO YOU. I DO EXACTLY THE SAME AND IT IS JUST AWFUL AND REALLY AFFECTING MY LIFE. I PRAY FOR PEACE FOR YOU.

Read the message written above. I’m going through a bad bout of ha right now but the book called DARE is really a revelation... I don’t believe counseling cured me in the past but the approach in this book could work for many. Please do it. And my heart goes out to you all as I know how debilitating this ha is. We will get there xx

I also bought this book but fail to see how it helps with health anxiety. It isn’t really addressed anywhere in the book and comes with a caveat that your should also first go to your doctor to rule everything out. Maybe I missed something and hope you can maybe help me find more use in that book. It came across more as an ad for their app which becomes expensive if you want to access anything half decent to help. That being said for me, I am glad that you found help in it

this is so me.im even afraid of touching my skin if theres itchines because of fear of finding a lump.im so afraid niw beacuse my muscle in my abdomen seems to be unproportion same with the muscles from my diap area.it is so bad and annoying i just cried and felt wxhausted afterwards

Hi Lottie,
I never had health anxiety till this year, I'm 43, happily married, beautiful kids etc.. I would always ignore an ache or pain & have a valid reason for it! Then after a stressful, very very busy year 2018. I got ingestion & thought it was a heart attack! & since then every twinge in my chest or a headache is heart attack or brain tumour or stroke! I went to doctor afew times & got checked out & Im fine! I'm healthy! But still the fear of heart attacks / strokes etc. take over when I get an ache or pain! It's really annoying & I do try to rationalise it & breath & get over it! But it's not easy & am hoping it disappears as fast as it came! All the best guys.X

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