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by Ken Goodman, LCSW

The illness you fear might not be the illness you have. I recently conducted an online support group for people with all sorts of health fears, from cancer and heart disease to ALS and MS. Each shared their worries about moles on the skin, irregular heart palpitations, and numbness and tingling. Although their specific fears varied, they all had one thing in common; none of them had ever been diagnosed with a series illness and they all related to the following scenario:

Dina felt great after getting a clean bill of health from her physician but as she tried to fall asleep, she dwelled on one statement he made, Tumors can grow at any time. Come back in six months if you’re concerned.  Questions raced through her mind as she tossed and turned, Why did he tell me that? If there was nothing wrong, why would he say come back in six months?  What if he missed something? Why do I keep getting headaches and dizziness? Dina felt so anxious she got out of bed and searched the web for answers.  As she reread the same articles about symptoms of brain cancer, she began to feel lightheaded.  Why do I keep feeling this way? Do I really have brain cancer? Is this really happening? 

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

Why does health anxiety persist despite reassurance from doctors?

Although some refuse to be examined by their physician due to their fear of discovering the worst, seeking reassurance from doctors, insisting on repeated medical tests, and visits to urgent care, are more common in health anxiety. Being reassured by the doctor that there is no serious medical illness brings relief -- temporarily. The vicious cycle quickly resumes as new thoughts and physical sensation surface, followed by googling and self-diagnosis, misinterpretations of news in the media, anxiety, and more visits to doctors to resolve the uncertainty. The cycle ignites with each new alarming thought or symptom. 

The False Alarm

Car alarms are set off when a criminal breaks in but imagine how problematic it would be if the siren blared each time a pedestrian walked by.  The car alarm would be misinterpreting innocent people as dangerous criminals.

With health anxiety there is the misinterpretation of discomfort and normal bodily sensations as dangerous. The body is very noisy. Healthy human bodies produce all sorts of physical symptoms that might be uncomfortable, unexpected, and unwanted, but not dangerous.

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

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

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

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

This is when it gets tricky. 

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

The Most Effective Treatment is Cognitive-Behavioral Therapy

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

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

CBT aims to help you overcome fears by correcting irrational thoughts and changing problematic behaviors.  By acquiring a certain mindset, you can learn to approach anxious situations differently and learn to tolerate discomfort and uncertainty. Illness anxiety can be overcome with the help of a skilled anxiety specialist and CBT.  You can find a therapist in your state on the ADAA website.  And for additional information on Illness Anxiety watch my free ADAA webinar.

This blog post has been updated by the author - June 22, 2020

Additional ADAA Resources by Ken Goodman:

How to Get Over It: Fear of Vomiting - ADAA blog post
Overcoming the Fear of Vomiting - ADAA on-demand webinar
Overcoming the Fear of Driving
- ADAA on-demand webinar
Overcoming the Fear of Driving - ADAA blog post

Additional Resources:
Health Anxiety Is Way More Than Being A Hypochondriac — And It’s Way More Common Than You Think
This Is Why Being Anxious Makes Some People Puke - Article,  Tonic.vice.com, December 6, 2018 


About the Author

Ken Goodman, LCSW, treats anxiety and OCD in Los Angeles. He is the author of The Anxiety Solution Series: Your Guide to Overcoming Panic, Worry, Compulsions and Fear, A Step-by-Step Self-help Audio Program, 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 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 😞

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 !

Trust me, you're not alone... I'm always thinking I'm having a heart attack.... it used to lead to panick attacks.. now I'm able to reroute my thinking as soon as my breath is short. On the upside... just imagine how good the imagination is if it's actually able to think something so silly is happening. Neuroplasticity... replace hose thinking pattern with new ones.... I am healthy and strong :)

Hi Jess.
Just came across this website as I was looking for a self help book on heart health anxiety.
I was diagnosed with ectopic beats, skipping all over the place, jumped beats, missed beats. Was sent to Cardiology and to be fair I had every test done, numerous ecg, heart monitor on for 48 hours, they did this three times over a period of 18 months and two heart scans.I was discharged 2 years ago and its something I have to live with. I,m on bisopropal every day. They still miss,jump, bang, flip. More of a nuisance really but that's what the Cardiologist found. I understand, its hard to accept the professionals diagnosis and just get on with your life. My slight anxiety I,m convinced is to do with the fact I,m now 52 and I can,t just say to myself anymore, oh don,t. be daft, you re only 30 nothing wrong with you. My father had a heart attack and died at age 59, I was 20 at the time and I gave him cpr but I couldn't save him. Maybe the trauma of that has stuck with me subconsciously somehow. I ll buy myself a self help book and hope I can put these irrational thoughts to bed once and for all. We all live in hope !
Good luck to you, I truly believe you will get better,
God bless
Louise.

If I can suggest a great book on anxiety would be Hope and Help for your nerves by Dr. Claire Weekes. This book saved me years ago. She also has audio version of the books which she reads herself. Just hearing her voice helps me relax in those moment. I know it's very old and some things are outdated but her method are used to this day in CBT and other therapy treatments. Good luck to everyone, you can beat this, although how miserable and impossible you think at this moment

I have severe anxiety each time I find a way of coping with a symptom another more difficult one arises . It started many years ago with the fear of vomiting in public then messing myself in public . Fainting then that died down and came back after a particularly hard 18 months that included 6 deaths in the family illnesses relationship problems and more , with chest related symptoms flattering palpitations missed beats then racing thumping still with the background toilet phobia thing . I be tried everything this time but nothing is working

My health anxiety is all to do with my heart and brain. I feel my heart flutter, pond hard and feels like it misses a beat. I’ve been to a+e over 5 times to be checked and it has always come up clear. The anxiety and panic attacks are hard to cope with but I’m starting cbt therapy and antidepressants, and can only hope for the best. You are not alone!

My heart skips beats or flutter like butterfly’s every single day for the last year! Had ecgs/scans blood test all come back clear. They’ve put it down to anxiety which is great as they actually give me anxiety so it’s just a constant vicious cycle!!!

Have I ever been there! Your comment: ". . . which is great as they actually give me anxiety" made me chuckle . . . not because it's funny, but because I know exactly how you feel - healthy as a horse by all diagnostics (a little overweight), but still feel like the old heart just gonna stop every time it "skips" - I usually just ignore it, but sometimes it starts really going nuts when I have to speak in front of a group (something that used to never bother me . . . sigh), and I think, "well, this is it." I love good conversation and people, but I've been isolating myself because it helps with the fear. Now ain't that something! 55 year old male getting all kinds of research done because he gets weirded out at the weirdest of times and fears fainting (and has NEVER once fainted)! You gotta laugh sometimes!

I have been suffering with palpitations, chest pain, shortness of breath, dizziness, shaking, vertigo, feeling sick I can get up to about 15 palpitations a day which scare the life out of me this is nearly 3 years down the line, I have had so many blood tests heart scans ecgs and mri scans all have come back normal with a slight irregular heartbeat but apparently it’s common for young adults I’m 22 now this started when I was 18, I’ve tried to go to the gym but makes my palpitations worse, I eat healthy but still no change can’t have medication as it effects my heart so stuck in this horrible cycle and recently been diagnosed with depression due to a close friend taking his own life and my anxiety! Any tips on how to stop anxiety would be great!

I wonder if it would help to go to the gym with someone else who suffers from anxiety (or even with someone you trust)? I find it helpful - being with someone who will not judge me IF what I fear will happen actually happens (and it NEVER does!).

I have this too, my heart skips beats and flutters in my chest, I get all kinds of symptoms with it too dizziness, feel like I’m gonna faint, stomach pains, restricted breathing, you name it. I feel like I’m constantly having a heart attack and it scares me and i feel like I always go to the ER. I’m having issues believing it’s just anxiety, it’s been almost a year for me, and every day is a struggle.

Hi Jess, you are not alone. I've been struggling with premature ventricular contractions (PVC's), which feel like "skipped beats", for several years. I'm 65 and retired now. I've been experiencing them as early as 14 years old. I've had all the test done to eliminate any structural damage to my heart. However, they just won't go away. When I die there is one thing I wont miss...PVC"s !!!!!

Paul,

I could not agree more! I never really noticed them (my Cardio doctor said I've probably been having them my entire life) until about 10 years ago. I can handle the "one" punch (well, . . . ) but when they come in series, I'm like - "yep, here it comes!" It is definitely stress-related (life has gotten continually more stressful), and I use them now as a gauge of how stressed I am. I tend to try to correct my thinking - although I cannot find a single subject that seems to "cause" them. I can go a few days without noticing them, but then, it's like they notice that I haven't really missed them so they gang up and come back in spades . . . like 'you ain't gettin' rid of us, big boy!' Oh, well, I wish you the best!

Am going through the same thing, I have health anxiety, to me is the heart, I get chest pain a lot , I been to the er and cardiologist all test results are normal and any little different thing I get on the chest I start to get anxious , I have fibromyalgia, crohns colitis, hypothyroidism, gastrointestinal pain, which they mimic a heart attack, the last time I went to the er the doctor said this recurring pain I felt embarrassed, next day cardiologist told we love to have you here but your is good. Am seen a therapist and h has help me

I understand how u feel since I had a heart attack two years ago any slight illness miss me feel depresssed or breathless thinking I won’t survive I live in constant fear I know it’s wrong but cannot stop

Hi I started getting panic attacks at the gym I worry when my heart rate goes up it won't go down and continue to climb cause cardiac arrest.

Thanks for sharing your story
I’m struggling everyday with my health anxiety constantly think I have a brain tumour I’m terrified to go to doctors it’s ruining my life and family’s life please someone help me

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.

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