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by Ken Goodman, LCSW

As she stares at the ceiling, trying to fall asleep, Dina ruminates on one statement from her doctor, “Brain tumors can grow at any time. Come back in six months if you’re concerned.”   She tosses and turns, “Why did he tell me that? If there was nothing wrong, why would he say come back in six months?”  More questions race through her mind, “Why do I keep getting headaches and dizziness? What if the doctors missed something? Why did he tell me to come back if there was nothing wrong?”  Dina feels so anxious she gets out of bed and searches the web for answers.  As she rereads the same articles about symptoms of brain cancer she begins to feel lightheaded.  “Why do I keep feeling this way? Do I really have brain cancer? Is this really happening?”  

The good news is, Dina does not have brain cancer or a brain tumor.  Dina has a health anxiety.  There are two types of health anxieties: Somatic Symptom Disorder and Illness Anxiety Disorder, formally known as hypochondriasis.  Many people with health anxiety are often unable to function or enjoy life due to their fears and preoccupations.   They obsess over bodily functions (breathing, heartbeat), physical oddities (skin blemishes), and physical discomfort (headaches, stomach aches, lightheadedness). They might worry about a specific organ (brain, heart) or a disease they heard about on the news or at work (MS, diabetes).  They are preoccupied with the belief that they have, or are in danger of contracting, a serious illness. Many will purse doctors and tests repeatedly for reassurance, but are reluctant to seek mental health treatment since they believe their condition is medically based.   

Why does health anxiety persist despite reassurance from doctors?

Although some refuse to be examined by their primary care out of fear of discovering the worst, seeking reassurance from doctors, insisting on repeated medical tests, and visits to the ER and urgent care, are more common in health anxiety. Being reassured by the doctor that there is no serious medical illness brings relief -- temporarily.   The vicious cycle quickly resumes as new thoughts and physical sensation surface, followed by interpretations of danger, anxiety, and more visits to doctors to resolve the uncertainty. Soon the cycle ignites again with the next alarming thought.  

The False Alarm

Car alarms are set off when a criminal breaks in but imagine how problematic it would be if the siren blared each time a pedestrian walked by.  The car alarm would be misinterpreting innocent people as dangerous criminals. 
With health anxiety there is the misinterpretation of discomfort and normal bodily sensations as dangerous. The body is very noisy. Healthy human bodies produce all sorts of physical symptoms that might be uncomfortable, unexpected, and unwanted, but not dangerous. 

Normal sensations in the body that can produce fear and worry include changes in visual acuity, heart rate, blood pressure, saliva levels, depth of breathing, balance, and muscle tone,  just to name a few.  These are normal and harmless bodily changes, but when a person believes they are symptoms of a terrible disease, it causes anxiety.  The sensations are real, but the beliefs are false.

Why do people misinterpret sensations in their body and overestimate danger?  

Sometimes misinterpretation is due to assumptions about an illness. For example, “My cousin died of cancer. It’s only a matter of time until I get it.”  Or, “viruses sped easily. People in Africa are dying of Ebola. It could easily spread to the U.S.” People with health anxiety might hold rigid definitions of good health, perhaps believing that any discomfort whatsoever means bad health. 

Anxiety is a protective mechanism and scanning the body for an illness seems like the right thing to do to protect ourselves. However, when we are preoccupied with something, we tend to notice it.  Last month when I was looking to purchase a new car, I suddenly began to notice every car on the road; the make, model, and the color.  Previously, I didn’t pay attention.  Looking for symptoms makes you notice subtle sensations you might otherwise ignore. When you become preoccupied with bodily sensations, those sensations become amplified and last longer. 

This is when it gets tricky.  

Each scan of the body produces uncertainty and doubt, giving the imagination opportunity to create stories.  As you imagine the worst, your body’s alarm system sounds off in the form of symptoms of anxiety (racing heart, tightness in the chest, difficulty breathing, jitters, tingling, lightheadedness, nausea, stomach discomfort, sweating, headaches, etc.) giving your imagination additional fuel to create great works of fiction.   The symptoms are real. The thoughts are false. 

The Most Effective Treatment is Cognitive-Behavioral Therapy

Since it is possible to suffer with anxiety and a serious medical condition, medical problems must be ruled out with a thorough physical exam. Once this is accomplished, Cognitive Behavioral Therapy (CBT) is the most effective treatment for any form of anxiety including health related anxiety.

CBT is a therapy model that focuses on our cognition, the way we think, and our behaviors, the way we act. The main concept behind CBT is that our thoughts about a situation (the fear of ALS) effect how we feel (afraid and anxious) and how we behave (scanning the body, going to the doctor). We tend to assign meaning to specific situations (tingling means we have MS).  It’s not the actual situation causing our anxiety, but the meaning – accurate or not. And, when you have anxiety, you give your thoughts a lot of meaning, and thus, a lot of power.  

CBT aims to help you overcome fears by correcting irrational thoughts and changing problematic behaviors.  By acquiring a certain mindset, you can learn to approach anxious situations differently and learn to tolerate discomfort and uncertainty. Health anxiety can be overcome with the help of a skilled anxiety specialist and CBT.  Find a therapist on the ADAA website.  

Also by Ken Goodman:

Additional Resources:
Health Anxiety Is Way More Than Being A Hypochondriac — And It’s Way More Common Than You Think


About the Author

ADAA_Ken-Goodman-websize-1.jpgKen Goodman, LCSW, treats anxiety and OCD in Los Angeles.  He is the author of The Anxiety Solution Series, a step-by-step audio program, and Break Free from Anxiety, a coloring, self-help book for anxiety sufferers. Ken Goodman is an ADAA Clinical Fellow.

Ken is the producer of The Anxiety Solution Series: Your Guide to Overcoming Panic, Worry, Compulsions and Fear, a step-by-step self-help audio program. 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.

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

Hello Jess. I came across this article and saw your post. I too have skipped beats, some days I have none, others a have a few a day, then other days I may have skipped beats for 3 days constantly all day. If you are the same as me then it feels as if your heart misses a beat, sometimes it thumps hard, other times it may feel like a flutter or a flip flop in the chest. I had a heart monitor on for 78 hours and they said that I had an ectopic heartbeat which most people have they just tend not to notice but someone with an anxiety disorder like myself will focus on that missed beat and wait for the next therefore focusing on and waiting for the next so that I notice them more than someone without an anxiety disorder and with my OCD I will focus on it so much that I convince myself there is something wrong with my heart. My heart recently has been beating in the 50's sometimes and now I'm focused on that and constantly checking and now I'm worried that I have a heart problem again. It's a never ending circle for me. Always focusing on things that others would just dismiss. You are not alone.

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 :(

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

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.

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.

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,

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.

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.

Really suffering with health anxiety thinking I am going to get breast cancer or some type of cancer. This has only started a couple of months ago after my cousin was diagnosed with breast cancer and my Dad is undergoing surgery and investigation for lesions in his lungs. I can’t find a therapist and have just started a low dose of antidepressants. I keep finding lumps on my body and can’t shift the worry I’m next to get cancer

Hi I have a grape sized mass in my left breast that is mobile when pushed I am only 25 years old and I have fear it’s cancer I went to get a mammogram and an ultrasound and it came back benign but I’ve heard so much about things like this being easily missed because of dense breast which I also have so I’ve caused myself so much anxiety I’ve caused upper back pain which I’m thinking it’s caused from a tumour growing cus of course I googled it and I guess breast cancer can cause upper back and should and neck pain so I’ve been constantly crying and worried and my dr says I’m fine but I feel like I can’t agree but then I come across pain from anxiety and it does have some relieve except the pain almost doesn’t ever wanna go away I now have a similar yet smaller flatter mass in my right breast which also is Mobile so is anymore I feel so alone in this because I haven’t came across someone with anything similar other then it being a Fibroadenoma burn in order to know for sure I need to get a done needle aspiration and I heard that can cause other problems like scaring and deform the breast I hope it’s all just in my head but it would be nice if someone else knew where I was coming from with this terrible fear about this particular situation

I can totally relate. I also had a lump. Scans were clear. Trust me if they were worried about anything they would do further tests. After my breast cancer fear I worried about my kidneys then bladder and then lungs. Now l have moved on to stomach and colon and even spinal cancer. It is frustrating and lonely. I too have gone for so many tests. And believe dr missed something. I have pins and needles when I panic. Chronic back pain. Stomach ache. Tremble and completely feel out of it. Reading all these and seeing a general trend with symptoms of health anxiety sufferers makes me feel calmer.

Hi, I’ve been looking for help on the internet for my partner. We’ve just had health tests done and everything was fine however he was still worried. Since yesterday we have learned about health anxiety from google and came across your blog. He believes that all symptoms point towards health anxiety and next step will be cbt.
My question is more about what steps can I do to help him more?

This is real. I have Ben to cbt session it worked intially but it hitted me back so bad. I don't want to be on ssri and also want to get rid of this anxiety.

I suffer from health Anxiety,I have good days and bad days,I’ve had hypnosis and cbt which has definitely helped. I can be fine one day then the next I’m obsessing over a blemish on my face or a mole on my arm or a pain in my chest.its nice to read something that gets me back to reality, and tells me it’s anxiety causing these things.

I am in my 70s and have had health anxiety and every other anxiety along with depression all my life, My first memory was when I was only 3, I've taken every medication and lots of therapy but still suffer to where its crippling and I can't wait to go to sleep
so I don't feel it anymore....It's not been easy being me but I don't give up because of family, I love them dearly and I know they love me, I wish the best for you all, it looks like everyone is on the right track

hitting 70 has escalated symptoms I think the whole aging situation has given so much fuel to my conditions expecting that stuff should be happening and if it does it must be serious I don’t want to waste however much time I have worrying it is debilitating in so many ways

This article really helped me this morning. It has been a ruff couple of days. I can 100% relate when you feel like doctors lied or missed something. In 29 about to turn 30 next week and I have had anxiety since I was in my early 20s. I have been to the doctor every time It gets to a breaking point to make sure I'm not dying. Of course everything comes back fine. Then like others said that stress and worry goes away (temporarily). It makes me feel like I am legit going crazy and belong in a nut house for the thoughts I have. I have to tell myself to STOP and put myself in check. I don't want to be on any medication so I have been trying to stay positive and try not to use Dr.Google as much as possible. Because of the weather going back and forth I have bad sinuses and when that happens my entire face plays into effect and I instantly think theres something wrong with my brain or another organ. Deep down I know it's as simple and harmless ad sinuses and allergies. Sorry for the long post but talking about how I feel and seeing others relate makes me feel so much better. I think anytime I have doubts I will get on here to read everyones comments for a piece of mind.

I didnt Have any anxiety or panic attacks until I unexpectledy lost my son 3 years ago. He lived 3 days in the nicu. It was then a week later when I woke Up from my deep sleep, dizzy, hands tingled, curled up and was lost of breath. It was then when I told My wife I was Having a heart attack and call 911. It was then when I realized how horrible a panic attack was and never wished it on anyone. Indeed I had My panic attack and had no idea how physical those can get. Since then, I’ve had multiple ones and developed health anxiety. I am Healthy, so it says on paper... I’ve bad echo heart stress, MRI on my brain, and among other tests. Everything always commes back fine. I started to take meds and eventually everything has worked out fine.... so fine that after couple of years in feb I felt The need to be off Zoloft and be free. Finally I loved every bit of spring. summer. And fall stress free..... I have No idea what I did, but it felt amazing. Perhaps as one doctor said to me “time heals”. Recently things have started to flare back up. I’ve been having tightness of my chest along with heart palpitations. It’s not pleasant and I am Trying my hardest to know that EVERYTHING is ok!!! I workout A lot, eat beyond healthy and I keep googling. It’s something we all gotta be strong about and not do it. As many mentioned, google only makes it worse! it’s not good, but relieving to myself that we all deal with this constant mayhem and I’m not alone. Hope everyone has a nice holiday. Hang in there people !

Everything you just typed describes me, I had anxiety attacks a couple of times and it felt so bad that I thought I was having a heart attack, went and got a ECG and stress test all came back fine, I’m still feeling very short of breath like I’m not getting enough air in my lungs, doc put me on a puffer incase it’s a little asthma but he thinks it’s 90% anxiety. I’m constantly worrying about my health and that there is something wrong with my heart and I also have become overly aware of my heart beat and it annoys me.

I have the same!!! One panic attack set me off in 2016. Now I’m like crazy aware all of a sudden to my heart. My anxiety is so crippling sometimes. Taking deep breaths and feeling my heart. God bless you! Putting my faith in God and working on giving him my anxieties.

I have Hiv,, so in the beginning 6 years ago I suffered from health anxiety. But it passed.
Then a few. Weeks. Ago it came back with a vengeance, it's. Such a. Strong mind set. Force, I try to. Fight the. Thoughts, keep busy,, to stop the symptoms,at first it was skin bleamishs,fear of cancer, but now it has gone to inside my body, when I have a pain, I just think cancer, but I take medication for hiv. So I tell myself, don't be stupid it's just side affects,and very fit for 54, gym 7 times a week, to control side affects, im just thinking why now has it surfaced.