Sam can’t fall asleep. As she lies in bed, she can’t take her mind off the fear that she has a brain tumor even though her doctors reassure her that everything is fine. What about the headaches she gets for no reason or the periodic dizziness? Surely, there must be something terribly wrong that the doctors are missing.
She feels so anxious that she gets out of bed to check the internet for more information. She reads that some of the symptoms of brain cancer are similar to what she is experiencing, causing her anxiety to heighten and a growing urge to contact her doctor.
Sam has health anxiety, which was once called hypochondriasis; now it includes somatic symptom disorder and illness anxiety disorder. It involves a preoccupation with the belief that one has, or is in danger of developing, a serious illness. Many people with health anxiety are often unable to function or enjoy life due to their fears and preoccupations. They become preoccupied with bodily functions (breathing, heartbeat), minor physical abnormalities (skin blemishes), or physical sensations (headaches, stomach aches). They might worry about a specific organ (their heart) or disease in the news or in their office (Zika, HIV/AIDS, diabetes). And many are reluctant to seek mental health treatment because they believe very strongly that their condition really comes from a medical illness.
The False Alarm
Health anxiety is the misinterpretation of normal bodily sensations as dangerous. Healthy bodies produce all sorts of physical symptoms that might be uncomfortable, painful, unexpected, and otherwise unwanted — but not dangerous.
Picture a car with an alarm system. It’s useful if your car alarm goes off when a criminal is breaking in, but it’s problematic if it goes off every time someone walks by. Your car alarm would be misinterpreting innocent pedestrians as dangerous criminals.
Normal physical symptoms that often produce fear and worry include changes in visual acuity, heart rate and blood pressure, saliva levels, depth of breathing, balance, and muscle tone, to name a few. These are normal and harmless. But when a person misinterprets them as symptoms of some terrible disease, it creates undue worry. This explains why medical tests come out negative: The physical sensations are real, but they are not symptoms of a disease.
Misinterpretation may be due to assumptions about health and illness, such as, “My cousin died of cancer, so it’s only a matter of time for me.” Or, “Viruses spread quickly. Since people in Africa are dying of Ebola, it could easily spread to the United States.” People with health anxiety might hold rigid definitions of good health, perhaps believing that any discomfort means bad health.
If they hear a news story about a few cases of a serious virus, people with health anxiety might start scanning their own bodies for symptoms of the virus. Looking for symptoms makes you notice subtle sensations that you might otherwise ignore. With uncertainty, the imagination has room to create stories. And that’s when your body’s alarm sounds off as you imagine the worst.
It Gets Tricky
Symptoms of anxiety produce very real physical symptoms: Dizziness, stomachaches, rapid heartbeat, tingling in the hands and feet, muscle tension, jitteriness, chest pressure, and the list goes on. These symptoms add fuel to the fire. Now you have real evidence that something is seriously wrong. Or do you? Perhaps it’s anxiety. So how do you know if these symptoms are serious? You go to the doctor… and then to a therapist.
Health anxiety persists despite reassurance from the doctor. Seeking reassurance from doctors, insisting on repeated medical tests, and visits to the ER and urgent care are common if you have health anxiety. This habit leads you to rely on such reassurance to obtain relief from health worries. A vicious cycle develops of noticing a sensation or learning of an illness in the world, misinterpreting it as threatening, then becoming anxious, and finally going to the doctor for reassurance. Reassurance from the doctor reduces the anxiety and brings relief temporarily. Soon the cycle starts again.
Here's Help: Cognitive-Behavioral Therapy
Prior to treatment for health anxiety, medical problems must be ruled out with a thorough physical exam. Cognitive-behavioral therapy (CBT) is the most effective treatment for any form of anxiety, including health anxiety.
CBT is focuses on our cognition, or the way we think, and our behaviors, or the way we act. The main concept behind CBT is that our thoughts about a situation (such as the fear of AIDS) affect how we feel (afraid and anxious) and how we behave (scanning our body, going to the doctor). We tend to assign meaning to specific situations (lightheadedness means we have brain cancer). It’s not the actual situation causing your anxiety, but the meaning, whether 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 the anxiety and uncertainty.
Ken Goodman, LCSW, practices individual and group therapy in Los Angeles to help anxiety sufferers free themselves from debilitating fear. Visit his website. He is the author of The Anxiety Solution Series: Your Guide to Overcoming Panic, Worry, Compulsions and Fear.
Updated September 2016