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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.

 

I have been reading all these comments but cannot find anyone that has a fear like mine which makes me believe maybe its not fear and its real. You see, I am convinced i have Bi Polar or psychosis and it totally freaks me out and sends my anxiety out of control. I have been seeing the same psychologist for almost 20 years on and off and i am currently on Lexapro. I really dont know what else to do as i believe my doctor or psyshologist just havent picked up on the fact as i am able to hide it well.

Hi there, my health anxiety has gotten worse over the last two years and as I am in the midst of one of my "phases" as I call it at the moment I am roaming the web to try and make sense of this all. I'm a 23 year old female and this anxiety about my health is like scratched record playing over and over again. I go for weeks and sometimes months without having any issues, but then it hits me like a tonne of bricks again and usually ends up in many doctors visits or trips to the emergency room. I'm so sick of it. I wonder if I will ever get over it? I am going to seek help for it, I feel that it will ruin my life if I dont

my 23 tear old son is obsessed totally consumed thinking he is terminally ill. He has been to his dr twice in April. He was tested for Covid19 and it wS negative. We live in Ohio my mom lives in Arizona she took him there for a month. He will be back June 20th. But has been obsessed out there with his health. I don't know what to do anymore. I am so stressed bc I don't even want to talk to him because that's all its about is he is dying and feels excruciating pain. I yelled at him and said people fought in war and lost their limbs and get up everyday and some have jobs. Thst he needs to stop with this. He has never been sick growing up. Both of my sons have strong immune systems. I am desperate because I don't know how to help him. Please give me advice how to help

It’s like you are inside my head! Everything you said is me to a T. It’s comforting to know my “craziness” is understood by therapists like you and that I am not alone with my health anxiety. It also provides me hope for getting beyond this. Thank you!

The present situation is such that has forced us to stay inside our home. My health anxiety has caused me stomach issue which makes me think that i might have a serious issue in my stomach . Some time a little chest pain makes me tremble with fear. But when i do workouts or play games or go for a walk i heardly have any such issues.

I'm so glad to see I'm not alone in this! I can't tell you how many times I've gone to the ER because of chest tightness, pain, skipped heart beats or something of the like. Every test comes back fine, but I constantly feel like they're missing something! Deep down, I know it's anxiety, but it's so crippling! I feel like I'm losing my mind! I constantly feel like I'm going to have a heart attack and Googling it only makes it worse. I can't stand living like this. I'm currently getting CBT Therapy and I hope through that I can learn how to deal with this. I just had to ER visits in a month timespan. Previous to that I had a holter monitor for 48 hours, an exercise stress test, an EKG, electrocardiogram and x-rays taken, they all came out normal. My Doctor must think I'm a lunatic. 😅

Was mild until coronavirus. Now I am sure I will get it. Mostly stay home. Groceries delivered. When I do go out I wear a mask and sometimes gloves but still sure I will get it. Have sinus issues so that adds to fear.. Constantly taking temp, oxygen and blood pressure. Bought all these gadgets since covid. I am in counseling.

I can totally relate to this. I have a blood pressure monitor, a Pulse Oximeter, a glucose monitor. Just to help convince myself when I'm feeling lightheaded or dreamlike or my heart is palpatating that its just the anxiety. My fear is something happening to me or having something wrong with me and leaving my 4 year old daughter or needing to be away from her due to some serious medical condition. I stress about passing out and then her being all alone. I gained some comfort with that by making a plan and explaining things to her. She knows to got to the neighbors house and say," my mom needs help" and I also spoke with the neighbor who is aware of my anxiety. Now I don't have that as part of the anxiety.

I'm not sure what occurs first. Some weird body sensation that I stress over and that causes the anxiety, or random anxiety attacks occur out of nowhere when i don't even feel stressed, and then that makes me think there must be something wrong because I was feeling great 3 minutes ago. Why would my heart all of a sudden start palpatating.

I don't like living with the fear. I don't like living with the unpredictability of this. I don't like feeling scared to die. This is debilitating. I can't make plans to do things because I never known when I'll have a random anxiety attack. I feel defeated ever time. Its an emotional Rollercoaster when I think I'm getting better and then WHAMMO. It strikes again. I just want to feel normal.

Going to talk to my doctor about this cognitive therapy.

In 2018-my birthday to be exact-I got food poisoning from some bad fish. Going into year three with 'IT', I was certain that this would set off even worse episodes. The shaking, vomiting, and overall malaise was surely something to make this health anxiety even more unbearable.

Yet, strangely, for about four days-maybe longer- there were ZERO episodes. I did not think about dying at all, even with a potentially life-threatening bacterial infection. The phantom bodily sensations were replaced with a legitimate physical ailment that required attention. The inexplicable and unwarranted fear and dread that had consumed me for over two years was nowhere to be found. The only thing wrong with me was that there was ACTUALLY something WRONG with me!!

As my body healed from the infection, I was feeling a real sense of relief. I battled through a particularly nasty, physical illness and for several days I felt great! My old self had returned! Then, like clockwork, IT returned as well! Out of the blue, no warning, no trigger. My mental illness was not done with me!

The theory is this: the subconscious mind lays dormant when we are either fully engaged in something, actually sick, or in a deep sleep. These factors have all been proven to be effective several times. It's seems that mainly when I'm trying to relax, it switches on. I mean that literally: it feels like an actual switch is flipped on and it begins; much like that very first one. Something just went 'click' in the pit of my stomach and it's been that way ever since.

I've managed to develop some rather unorthodox coping mechanisms, such as sitting in front of a fan, lying in the grass (warm months) and having an occasional glass of whiskey (yes, alcohol suppresses it; for me at least). These help on occasion but when it's too overwhelming I just sit and let it pass, which can be anywhere from 10 to 40 min.

I never believed in my wildest dreams or imagination that my subconscious would turn on me like this. However, knowing that this is indeed all mental has provided not only hope but ammunition to destroy this affliction. I don't want to cope, treat, or manage...I want this GONE!

I found a swollen lymph node on the neck, which turned out to be normal, but Dr Google gave me anxiety because of it's stupid results of serious illnesses that happen to be rare. Worst thing i've done lol.

I am also feeling the same way everyone does. M6 anxiety is above all now. Still when i am writing this comment i am feeling i have something serious illness which doctor still not able to find in the reports. After negative/normal reports new symptoms emerges after a day and i am again falling and start thinking endlessly.

An interesting article, nice information shared which is really reliable and useful. I know exactly what you mean! Every time you have a negative thought, try to immediately shut it down by thinking of something/ doing something positive.

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