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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.

 

Its calming to see im not alone in this constant fear of a heart attack. 32 y/o it started last year after a night of drinking and partying. Came home and took a shower to go to bed and when i stepped out my heart went crazy, full on first ever panic attack. I 100% thought i was dying, couldnt get my heart rate to go back down until i passed out after about 25-30 minutes. Ever since then ive convinced myself something is wrong. Went to ER a few times, and cardiologists. All looked good, expect BP is normally at 150/85, but gets up to 180/95 when having anxiety attacks. So doc put me on carvedilol. Daily i stuggle with concentrating on how my chest and back feels. And now i guess from being so tense i have real back and chest pain and tightness, which of course triggers the anxiety creating a vicious cycle. Wondering if anyone else has the constant chest and upper back tightness/soreness and if so how they handle it. Also the random sharp pains in arms, legs, chest etc.

Yes I experience the same thing. Been to multiple doctors and was told I’m fine. Look into seeing a rheumatologist you might have Fibromyalgia. Also go to a Gastroenterologist you may also have GERD. I had an endoscopy done and was told that I had GERD. GERD can mimic a lot of heart Attack symptoms. Shortness of breath, chest pain etc.

I feel the same I have had anxiety since I was 16 I didn’t leave the house for 2 years and it went away and came back and went away now I am 25 just had a baby 6 weeks ago and it has came back horrible but last couple times I notice it’s health anxiety I have I fear something is wrong with my heart have had all tests all came back fine but now I have convinced myself labour has done something h to my heart (most likely just In My head) I started getting etopic beats now and again which has just started a vicious circle of symptoms like tight chest and back and pain breathless etc glad to see im not alone

Jeremy, I am experiencing a lot of the same things you are! I was diagnosed with an irregular heartbeat a few weeks ago and ever since I’ve had extreme panic attacks and anxiety overthinking that my heart is going to give out, despite the fact the docs all say it is ok. I too was placed on carvedilol for this and my hypertension. Have been on it for a week but have lightheadedness and chest and arm shoulder heaviness. You are not alone!

I also get the chest pain/tightness that’ll stick around for days after a panic attack and make me obsess over them even though nothing is really wrong. I get the random sharp pains too, I think it’s just the muscles being mad at us for being so tense.

Always :) and mine started with drinking as well.

Convinced I've damaged my body.

Check out trey jones on YouTube for some good videos on health anxiety and cardiophobia.

You are not alone
Been having tighness and chest pains almost every day
All I think about is I'm having a heart attack
I've done several tests that rule me out of heart attack and even taken aspirin and beta blockers but still not convinced

You are not alone I've had this and other health anxiety fears since I was 19 in 55 now and life is a living hell
All the best to you

My sister was diagnosed with (treatable) cancer a few weeks ago and I have spiralled into an extreme episode of health anxiety. I had a mammogram (clear) but the fixation then went on to skin cancer, cervical cancer and ovarian cancer. I feel like I never have any peace of mind from worrying and can't sleep properly. I constantly look for signs and Google symptoms. It's a living hell. I am starting seeing someone this Monday but don't have much hope

I’ve been dealing with palpitations, fluttering and arrhythmia since I was 18 and it comes and goes but now that I’m older happening more frequently, it’s a living hell

You've done so well tho....i take it you're arrhythmias are not concerning..... i have bad panic/health anxiety at mo...on propanalol..totally understand lots of these comments

It feel good to know that I am not the only person going through this. I have a fear of not being able to breathe. I always feel like I have short breathe . It always happens when I think to myself " what if I cant breathe" then i start feeling a tight chest. I too am feeling that I am not living my life because i always wanna stay indoors and close to hospitals for incase I cant breathe. My life is sad

I can’t shake it. I am in constant fear that something is wrong with my heart. That I am going to have a heart attack or stroke. The really scary thing is I won’t go to the dr. I am deathly afraid they are going to tell me the worst. I am scared of them validating “what I already know”. I completely panic when taking blood pressure and it goes through the roof. I avoid it all together. I want to go to the dr to have a complete physical but I am too afraid. I hate feeling this way. I want a normal life. I avoid doing anything strenuous out of fear. No playing with my 10 yr old son outside, no walking the dog, nothing. This is no way to live but I can’t stop this vicious cycle. I want so bad to feel normal but unfortunately this is my normal.

I have panic attacks and I always think I make my heart worse when I have one . I take aprazolam 1 mg to stay sane such a bad way to live life don’t know what to do 😞

I am the same.. i lie in bed after a long day at work tossing and turning because the sound of my own heatbeat starts to scare me. I start over listening to every beat and convince myself its going to stop. Then ofcourse the chestpain starts.. i wait for something to happen every day. Its like being a prisoner in your own mind. You arent alone and i hope you are ok.

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.

Ive suffered with this for the last three years it started wen out of the blue i started havin panic attacks. Ive also had tests and theyve come back clear. I defo think its anxiety wen im busy and my minds not fixated on it it will vanish. So to all the people who are worried about this you are not alone.

One night I had the biggest panic attack. Never had one before then, although I did have OCD and childhood trauma, which can lead to anxiety disorders later in life. Anyways, during the panic attack, I thought I was dying. Heart palpitations. Blurred vision. Loss of balance. Frantic pacing. Sweating, yet shivering. Ended up collapsing, which scared me even more. Since then.. every single minor discomfort, that I'm well aware I felt before the panic attack.. feels like something I need to be concerned about. Headache? Brain tumor. Tingling and numbness in my arm? MS. Or a nerve disorder. I know, consciously it's nothing. But my subconscious nags.. and nags.. causing actual symptoms related to stress. Tension headaches, shallow breathing, fatigue and tiredness from bad sleep quality.. and it all happened after that first panic attack, that happened out of nowhere.. nothing about that day was unordinary. Since then I've been to my doctor multiple times. Went to the ER. "If my blood comes back clean I'm okay right?" *goes to webMD* "... not all brain tumors can be diagnosed with a blood test" welp. Time to dwell.
My brain wont focus on the probability. It keeps going to the worst possible outcome. I've never been this way in my life. Until that fateful night.. that one panic attack. God bless any of you going through the same. Every day is hell.

About 4 years ago I had really bad chest pain. Went to the doc they said I was healthy. So went home a few days later I went back ended up have all kinds of tests on my heart because I wasn’t satisfied I kept thinking it was my heart. I went as far as getting a heart cath cuz I swore something was wrong. I constantly think when I have a chest pain I’m having a heart attack I even bought an Apple Watch to keep up with my heart rate. Now I’ve been having headaches and some acid reflux and the doc says I’m fine but I always think the worst. I just want to be normal again and enjoy life not fear it.

This actually saddens me alot. I had a massive panic attack one night out of no where. i thought it was a heart attack.. tests came back fine. I kept thinking every day after i was going to have one even though i wasnt. Got put on strong anxiety meds that helped.. now im starting to feel the same way. Any irregular heart beat, flutter or what not gets me into full panic mode, then i think im going to have a heart attack . im only 25 and i feel like this everyday. hoping to get help soon for it.

I just want to say i came accross your comment there and the EXACT same thing happened to me. Ive always suffered anxiety but this one single attack a few months ago has turned me into a worrying hypochondriac mess. Every day and every night since my mind doesnt stop with all the possibilities that could be wrong with me wether its a heart attack which most days i feel or ms because ive had tingling and numbness on my left side or stroke. It never ends and its exhausting! Its over taking my life now :(

I just thought id reply because your comment stood out to me and is all too familiar.

Kimberley

Clinesha

October 23, 2020

In reply to by Kimberley

Hello i woke up one night i was definitely perfect the day before but i woke up and couldnt breath and had a headache i was scared i got me and my four kids and stormed out i thought i might had the new illness covid which i didnt then after i started with heart racing its would go to the 120s and stay for an 1hour scary i have been to the hospital more than 30 times i know alot for reassurance after im fine then again it happens they put me on all kinds of stress meds im scared to take them because of side effects then after if i get a bad side effect like brain fog or zaps i start feeling oh its a stroke about to happen or cheat pains start oh it a heart attack all test ruled out i wasnt going to die if crazy because as i read everyones for the year 2020 they say that one night hmmm thats really weird let me know what yall think....

Your specific story hit close to home. Out of the blue one night I felt “off” , which I think threw me into a full blow panic attack, followed by all same symptoms as in your description, including the blacking out. I was sure I hate a heart attack - As it turned out I do have skipped hearts beats, which the the local doctor sent me to the ER for the following day, just to make sure, but all my test have been fine - but I’m not the same since that happened. Every tiny feeling puts me in a state of fear that I’m having a stroke, or a Aneurism, or a heart attack. I’ve never been like this and it’s a horrible state to be in.

Your story sounds exactly like mine. One day about 3 years ago (I’m
46 now) out of nowhere I had a panic attack that sent me to the ER. There was nothing that I could pinpoint that made it come on. Since then I have been to the ER 3 times fully believing that I was going to die from a heart attack. Now I find myself laying awake at night thinking that every little pain or faster than usual heartbeat means I’m going to die. Even though I’ve never been diagnosed with anything expect anxiety. I’m So sorry that you go through this. I know exactly how you feel 😞

this is what exactly happend to me i have never been right since i took my first one and healthy anxiety makes it worse i panic over the smallest thing or pain i feel in my body i end up jumping to conclusions and end up searching symptoms and panic more . its good to hear someone is on the same line as me

Hi
For those with skipped beats. A low level of magnesium within the system often shows itself as skipped heartbeats. People are often very pleased to hear that something so simple can rectify this frightening symptom. It is a muscle relaxant which also helps regulate. The heart is a muscle and dependant upon magnesium. Hope that may help. Obviously medical supervision is required too.

You are definitely NOT alone. If you have a Facebook account there are some virtual support groups there, once you find the right one, it can be a big help. You'll be amazed at how many others are just like you, like us.

My mother died about a month ago and ever since I’ve been having “heart attack symptoms” that I rationally know are anxiety and panic. Every “symptom” can be attributed to something normal, but I still find myself googling like mad every night. CBT is next I believe, because I cannot keep living like this.

Once my father died i start feeling the same thing that i am having a heart disease im going to have a heart attack... went to doctor so many time ... but they said everything is fine just anxiety.... but even adter knowing this brain is not accepting... feeling so tired of this ... its been 4 years now

Dear same situation is here i am also worried all the time that i am having heart attack this fear has ruined my life..God bless you

My dad died of a massive heart attack and ever since then i have been getting bad anxiety and panic attacks at night i cant sleep my mind just keeps running i start feel chest pain and arm pain in my mind i keep thinking im haveing a heart attack and then i have headache feel dizzy and think im going to have a stroke im going to die i dont enjoy singing at church any more because i stand up and start sweating feeling shaky and feel like im gonaa pas out i have been to the doctor about 4 times and they tell me that everything is fine and blood work comes out clear its just taking over my life i just whant to cry because i cant take it no more i cant even get sleep i toss and turn at night and in the morning i feel exhausted i have no energy cant even go no where or drive with out getting anxiety or panic 😭

Hi friend,can you add me to group in Facebook bout' people dealing anxiety,
Jn Samjohntiff ,I have been this for 2years and it sucks.

I have A Fib and i constantly worry im going to have heart attack or stroke. Stay awake all night for fear of heart attack. It's getting worse every day. Im also afraid to take certain meds because of the terrible side effects. Cant get any relief. Feel trapped in my fear and anxiety.

I have just been diagnosed with afib also and had to have a shock delivered to my heart to get it back into normal sinus rhythm I suffer with health anxiety and OCD big time and when this happened my world came crashing down. I'm taking heart meds, blood thinners, sertraline and diazapam. It's hard but my cardiologist has said it's super common and people live long healthy lives. I take comfort in the thought that I know what i need to do if I have another episode and that I will be ok. It's always in the back of my mind that it may happen again at any moment but I have accepted it and asked my cardiologist 100 questions to ease my mind. Everyone I talk to about it says oh my "mum/sister/friend has that too makes me feel better. Hope you can find some relief in this. X

I’ve just been diagnosed with this it’s cripplimg me with anxiety how how old are u ? I’m 39

Hi there!! Just wanted to let you know you’re not alone! About five years ago, I developed a heart arrhythmia that the doctor is assured me was not a danger. Nevertheless it made me extremely stressed out! My doc assured me that it would stop once I stopped worrying about it. It did!! It eventually stopped. Every now and then I feel a skipped beat when I’m stressed or have too much coffee but it’s nothing like it was.

Reassuring to know there are others out there who suffer from the same thing. Also I feel bad because I know how it is. I used to take pre workout and one time took too much, for about 3-4 years afterwards I was always worried about my HR. Even after tests and having a sub 60 HR (I workout a lot) I’m finally over that but now it is other things and I constantly find myself forcing my mind to think logically about why said body part is hurting. It’s very tiresome, but it does help to focus your mind on the activities you’ve done recently that could be the cause. I wish you all good health and hope you find a way to beat back that stupid anxiety !

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