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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.

 

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!

Same is the case with me ...I don’t think I will be able to recover ....being hypochondriac is sooo scary ...I have all sort of symptoms and sensations.. I keep running to doctors and get tests done but something or the other is always bothering my mind I am not able to control it .. it makes me panicky ... god knows if some day I will be assure of myself and find peace or I will always remain restless .. I am 38 years old and have strong fear of cancer... if only someone can understand and help

I can relate 100% every single twinge or pain I have I automatically assume the worst I’m dying of some terminal illness that the doctors can’t find..
Just recently had quite a lot of deaths in my family so I’m triggered hugely I keep thinking I’m the same I’m going to die of what they have it’s a nightmare it really is it’s hard to control I can’t seem to snap out of it
Nat

I have had a fear of dying since I was 18 because my father died when he was 20. So I thought I would die young as well but I’m 51 now and my anxietyhas gone off the charters in my head. If I feel any little difference in my body I think it’s something that can kill me. Cancer , heart attack etc. I will have like brain fog for two weeks then it will go away, but then after two or three weeks I’ll think about not having brain fog and the next day I will have it. I will pray to god for healing and I will get better then here it comes again. I find out talking to someone really helps me but I wish it would leave my body for good.

I came across your post Chris after suffering yet another anxiety/fear attack myself and it has helped me. No one can imagine the emotional and physical fear suffered unless they have been through it themselves and I almost felt a calmness that I am not alone in this battle. I lost my mother when I was 12 and have had anxiety disorders all my life, I am 63 now and although I have tried to manage to live with it, each time it happens I am overwhelmed with fear. I pray to God for healing and support and for the courage to face the unpleasant symptoms fear brings. I find talking about it does help me and wanted to reply to your post to let you know you are not alone. I do lots of Christian meditation which I find helps bring me peace and comfort and pray you too will find some resolve. Take care.

Josephine

December 27, 2020

In reply to by Linda

Hi i have just read your post it felt like i was reading my own story i lost my mum when i was 19 it felt like my world ended i have lived with anxiety most of my life , i read the last part of your post regarding meditation i would love to be able to find peace an comfort but not sure i could do this as my mind dose not switch off easily i will look in to this though .Your post really helped Thank you i am just a little older then you ,Take care

I am 66 and a Christian too. This anxiety is horrible and then there’s the guilt about not having enough faith in God.
I pray for you to find peace. I am struggling and can’t talk to anyone about my fears.

I hear you...I am 67 and I know exactly where u are because your story is my story too. Love to chat with you

I lost my mother at 15. She had anxiety disorders, what from, I will never know, sadly.. I do know now that the Covid has sent me off into panic and health issues surrounding my anxieties. This is driving me crazy as well as those around me. I wish I could find my calm and that is my quest in 2021. I too am in my early 60's! You are not alone!♥️

I am a 38 yo male, going through the same thing. Health anxiety attacks, an uncontrollable urge to self-diagnose and schedule doctor appointments and getting some short relief, until the next anxiety spike. What I do to break the chain: mindfulness, meditation, having a supportive partner, herbal teas with valerian extract, taking some days off from time to time to relax. I am also doing therapy and it does help. Stay strong and don't let anxiety rule your life. You need to overcome it and learn to live with it. Sending you good vibes and thoughts from Romania.

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.

Hi I have been unwell for a few months . Drs seem to think it is anxiety. Panic attacks tingling insomnia. I now have cellulitis and have developed a number of spots on my stomach. When I blow my nose blood comes out. I had blood tests end Oct that were fine. GP said to ignore the symptoms to though it is hard. Had routine biopsy after colonoscopy last week and GP said if I had a problem with my blood I would have bled after the procedure

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!

Your brain is an amazing organ. What it thinks, you’re body will fallow.
Every time you have a negative thought, try to immediately shut it down by thinking of something/ doing something positive. This could be anything from looking at beautiful clouds, listening to the birds sing, finding a hobby, listening to calming music, going back to the days when times were fun,ect. all have a way of calming your anxiety. It’s hard work at first, but when your brain finally gets the idea that it should never think negatively, especially about health issues, it’s slowly begins to get better. You do not need Adderall to achieve with this. Adderall can be highly addictive and can lead to using other worst drugs in the future.
There is a lot to be said for the power of positive thinking. At first you may have to do it every minute of every day, and then every hour of every day, then every three hours every day and so forth until things get back to some kind of normalcy and you can go live your life as you were intended to. Try very hard not to relapse. I believe that hypochondria is like an addiction.
There will be times in your life when there truly is a physical problem that needs to be dealt with. You need to train your brain to notice the difference between what is real and what is not. This helped me a great deal with my situation. I hope it does with you As well.

Thank you for your info in relation to trying to block out negative thoughts. I have been fighting health anxiety for 30 years, and each time is always different. Some days are easier than others, however I really need to try harder blocking the negative thoughts.

Thanks for your comment it has helped me to start working on my anxiety
The things you said to try were great ideas and I’m going to try them
Thanks again

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

I am going through the same thing at the moment. I am obsessed with the fact that I have either Parkinson’s or MS even though I have had an MRI which has definitely ruled out MS. I have researched Parkinson’s and I am sure I don’t have two out of the three conditions needed to be diagnosed with Parkinson’s but that doesn’t provide me with any solace. I don’t want to go back to the gp again because I am embarrassed and he will most likely dismiss my symptoms as nothing.

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!

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