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by Ken Goodman, LCSW

Join ADAA member Ken Goodman, LCSW for a LIVE webinar on December 7 -  Health Anxiety Part 2: Learn How to Face Your Fear of Death and Overcome Health Anxiety

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:

LIVE Webinar - December 7, 2020 - Join ADAA member Ken Goodman, LCSW - Health Anxiety Part 2: Learn How to Face Your Fear of Death and Overcome Health Anxiety

Additional Resources:


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, Break Free from Anxiety, a coloring, self-help book for anxiety sufferers, and the Emetophobia Manual, for those who suffer with the fear of vomit.  Ken Goodman is an ADAA board member and Clinical Fellow. Visit Ken's website.

 

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.

You are not alone

September 30, 2020

I've had this since the pandemic happened. I'm still anxious about my health until now and thought I might have brain tumor by looking up online. I don't really know what to do. :((

My son sent me the link to your article. This is the best information and help I have read and listened to about dealing with health anxiety ever. I am a psychiatric nurse so I know about anxiety and CBT but putting interventions into practice on myself was difficult and even my husband who is a psychiatric nurse has tried to tell me what process I should follow with minimal success and much frustration on his part. It is the way you have explained it and particularly about seeing the anxiety as an opponent and separate which I found refreshing and very helpful. At the time I was listening to the webinar I was having a bout of anxiety but whilst listening I felt it disappear. I would just like to thank you and when I next get my pay check I will seriously consider investing in your 12 week programme.

Well, it's been five years to the day that my life and overall well-being took a turn.  This is the day, October 25, that while sitting at home watching a football game, feeling great and not stressed about anything in the world...well, you know the rest.

It seems with every passing year, this thing gets worse.  There are times when I feel like I'm turning a corner, then it comes back with a vengeance.  I wake up with this, spend the day with this, and now-lately moreso than usual-go to bed with this.  My sleep has suffered, the night sweats are brutal, and the dreams...just plain bizarre.  The thoughts just won't go away, my brain will just not turn off.  I don't know what all of this is really about, where it comes from, and why it's coming to the forefront now.  Some old, wayback memories are there, stuff that should have been deleted from the file.  I once heard someone say, 'I'm getting everything'.  That's exactly what it feels like. 

The physical manifestations are just the worst.  I'm now not sure if one is the cause and effect of the other.  The aches, the pains, the palps, the numbness, the heaviness, the shaking, the sweating, the gas, the peeing, the pooping, the weight loss.  An ache or pain in my arm, leg, chest: heart disease, failure or blood clot.  In my gut: colon, bowel, stomach, pancreatic cancer.  That little voice in my head keeps telling me that I have or will have some serious disease, whether it's the aforementioned common ones or something rare with some guy's last name.  The medical experts have not found any.  If anything, I am 'at risk' for diabetes (like everyone else in the world because there is an abundance of accessible sugar-soaked foods), even though after nearly 46 years I still don't have it. 

FIVE YEARS OF THIS!  I keep telling myself if something was going to happen it would have happened already.  For some reason, along with the negative tests and images, this never gives my any kind of solace.  I walk everywhere I go, always have.  Now it seems like a struggle some days, like my body wants to quit. Haven't fallen, haven't fainted...nothing wrong, right?

There is a deep-rooted, unresolved issue there but it won't come out. Something that is just eating away at me, both literally and figuratively.  I have some guilt about not being there for my mother and father when they died.  I spoke to a grief counselor about that, only for her to tell me in so many words that she is not a grief counselor!  HUH? CBT,CBD, SSRI-all tried, all failed.   The medical field will cop out with drug treatment that won't work but will destroy your liver and kidneys in the long run. I praise anyone who is healing with their help, but it just hasn't work for me.

I relate these three events as possible triggers for the intensified episodes:

1. My spouse passed away, a year ago yesterday.  The lead up to that was an extremely stressful period that lasted two months, as she seemed to be recovering physically but her mindset was just worse off that it was when she was admitted.  She kept saying 'kill me, kill me', over and over again.  I had to leave and was so rattled I admitted myself into a hospital.  Of course my BP was thru the roof (something else I'm 'at risk' for) but it was more so the ingrained anxiety that was spiking out of control.  That day, her birthday, we celebrated her and she was alert and coherent. 'Will you raise the bed up?' Those were her last words. When I got up, she suddenly convulsed and became unresponsive.  Her eyes were open.  We all called out to her but nothing.  THOSE F***ING MACHINES DID NOT GO OFF AT ALL!!!  For an hour she slipped in and out.  The heart and lung doctors were baffled, even though they shouldn't have been.  We believe it was a blood clot as she had surgery two days before. Based on what I described what happened to her to people, they agree as they have seen it.  How can a life be snuffed out like that by a tiny clump of blood???  It just wasn't fair.  I wrestle with that image of the life leaving her face quite often.  I've lost so many loved ones prior to this as well: my parents, two of my sisters, my grandmother.  I think my father was the catalyst, as he was my go-to guy and now I have noone to talk to about things, life, etc.  I wasn't there when he died and said I would be.   

2. Now, to something that I thought for sure I would never experience in my lifetime: a pandemic.  I do not consciously fear this, but maybe that troublesome little region of my brain is petrified of it.  I have survived measles, chicken pox, strep, pneumonia, gum infection (jaw looked like a golf ball was stuck in there), food poisoning (read about this from August 2020 under my name).  I've had the flu maybe once and never a shot for it.  I believe I have a rather seasoned immune system, and if I haven't caught it in nearly the year it's been around I won't.  The mask and distancing does indeed help out some. :-) Could it be that I am subconsciously afraid of contracting this?

3. Finally, the death of Chadwick Boseman. This has truly unsettled me, as well as, I'm sure, a lot of people who admired and loved this wonderful man.  It's really depressing that this young, healthy 42 year-old 'kid' died of cancer, and moreso he was fighting it privately to the point we all only found out after his death.  That's where the thoughts begin:  if he can get it, so can I.  The proverbial linchpin of this ridiculous affliction!  I obsess over something someone else has and just KNOW I will get it soon.  It's so bad at times I go far back as 200 years for people that have died either prematurely or from a rare disease! WHAT IS THAT!?

I am afraid.  But of what?  Losing my job and home? No. Fearing I will contract COVID? No.  Fearing someone I love will contract COVID? Of course.  Dying? No.  Dying early and leaving my daughter behind? YES!  She doesn't deserve that, no child does but it happens.  It's not fair!  I take some solace in the fact that the men in my family live long lives. Sure they go thru ailments that come with age as well; but they don't keel over before they're 40...or 50...or even 60!

I knew this would be a long entry but I have noone or nowhere else to share. Please know that I share your pain, and encourage all of you to seek a cure, not a cope! We shouldn't have to go thru this. Our mind is our friend, not our enemy.

I'm only 16 and im terrified of having a brain tumor!! i show some symptoms but those symptoms are symptoms of other more common things.
such as brain fog, depression and anxiety, mood swings, headaches, all are symptoms of a brain tumor, but are also symptoms of normal bad anxiety or waking up on the wrong side of the bed. every time i wake up with brain fog it is worrying for sure!
i hate health anxiety!

The illness you fear may not be the illness you have. Do you worry about cancer, heart attacks, or a brain aneurism? Do you regularly google your symptoms or reexam parts of your body that are concerning? If so, you might have Health Anxiety. ADAA board member, Ken Goodman, LCSW, presents the second of two webinars on this debilitating disorder. In Part One, Ken explained health anxiety and provided tools and a strategy for overcoming it. In Part Two, Ken dives further into the treatment and teaches how to incorporate exposure therapy into recovery. This LIVE webinar will also include a former patient who suffered with fears of ALS and MS. There will be plenty of opportunities to ask Ken questions about your specific fears and query his former patient about her journey to freedom.  It is recommended that you watch Health Anxiety Part One (available at no cost on-demand) before participating in the second webinar.

Please note that registration is required for this live webinar with a $10.00 fee for this event to help ADAA continue to offer this type of educational content.

ADAA professional members - please note that this is webinar for ADAA's public community and is not eligible for CE/CME credits.

The illness you fear may not be the illness you have. Do you worry about cancer, heart attacks, or a brain aneurism? Do you regularly google your symptoms or reexam parts of your body that are concerning? If so, you might have Health Anxiety. ADAA board member, Ken Goodman, LCSW, presents the second of two webinars on this debilitating disorder. In Part One, Ken explained health anxiety and provided tools and a strategy for overcoming it. In Part Two, Ken dives further into the treatment and teaches how to incorporate exposure therapy into recovery. This LIVE webinar will also include a former patient who suffered with fears of ALS and MS. There will be plenty of opportunities to ask Ken questions about your specific fears and query his former patient about her journey to freedom.  It is recommended that you watch Health Anxiety Part One (available at no cost on-demand) before participating in the second webinar.

Please note that registration is required for this live webinar with a $10.00 fee for this event to help ADAA continue to offer this type of educational content.

ADAA professional members - please note that this is webinar for ADAA's public community and is not eligible for CE/CME credits.

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