There are many different types of anxiety presentations, panic, generalised anxiety, social anxiety and Obsessive Compulsive Disorder to name a few. However health anxiety is a common anxiety presentation that is too often missed. No doubt you know some person who has a beaten path to their GP’s door. Every little pain or ache is checked out. A headache could be a brain tumour!
Most often if there are multiple visits to the GP in the absence of any serious physical issue then Health anxiety could be considered. Those experiencing health anxiety have an obsessional preoccupation with the idea or the thought that they are currently (or will be) experiencing a physical illness. The most common health anxieties tend to centre on conditions such as cancer, HIV, AIDs, tumours, MS, etc. However, the person experiencing health anxiety or illness phobia may fixate on any type of illness. This condition is also known as hypochondriasis. I am not a fan of this diagnosis as it’s labelling and judgemental and doesn’t help the person get to a solution for their anxiety difficulty.
Take Sean for instance, he was referred by his insightful GP after multiple tests for multiple potential illnesses. Sean thought that harmless physical symptoms are always indicators of serious disease or severe medical conditions. For example, when Sean thought that their chest is getting tight, they may believe that they are having a heart attack. Those with health anxiety frequently misinterpret physical symptoms of anxiety as a sign of an impending physical health problem.
The individual with health anxiety has a ‘super-scanner’ at work where they are scanning their body for any signs that they are developing a physical illness. For example, a person experiencing health anxiety may interpret their headache as a brain tumour. Some people who have this condition may link non physical problems to having a serious illness. An example of this is may be someone who forgets where they have put their phone or their house keys believing that this means that they have Alzheimer’s disease.
I have met some people who experience this type of anxiety disorder and are so convinced that they have a certain physical illness, that all of their focus will be placed on obtaining a diagnosis. They will go to as many doctors as they can and if they do not receive confirmation of a diagnosis, they may continue to seek second, third and fourth opinions from other doctors. In such instances, many different tests (such as MRI, echocardiograms and in some cases even exploratory surgery) are requested by the person experiencing the health anxiety. Unfortunately, these tests are often not enough to convince them that they are not physically ill and tragically this pathway is taken time and time again. It is important to remember that repeated visits are due to the fact the sufferer fully believes that they are experiencing a physical illness, rather than due to attention seeking behaviours.
Many people experiencing health anxiety or illness phobia will spend a large amount of their time carrying out excessive checking behaviours where they will look for marks, lumps, sores and rashes on their body which may indicate the onset of a physical illness. These checking behaviours also include asking friends and family members to assist them in checking.
Media campaigns on specific physical illnesses can also cause problems for people experiencing health and illness anxiety. Often, watching programmes relating to physical illness or reading about specific conditions may lead those affected to feel that they have experienced symptoms of that specific condition.
Here a person may have an obsessional preoccupation with the idea that they are experiencing a physical illness. While some people will have a beaten path to the GP to seek reassurance others more often men may refuse to go to the doctor for fear that they will get the worst possible news (i.e. that their suspicion of having a physical medical disorder will be confirmed). Therefore, instead of becoming overly focused on the feared illness, they will avoid any reminders relating to symptoms of the illness and will stay away from people who may be ill. Additionally, they may try to avoid any places where there are likely to be people who are ill such as hospitals and doctors surgeries.
If you can answer YES to most of the questions you may be experiencing health anxiety. During the past 6 months:
- Have you experienced a preoccupation with having a serious illness due to bodily symptoms that has been ongoing for at least six months?
- Have you felt distressed due to this preoccupation?
- Have you found that this preoccupation impacts negatively on all areas of life including, family life, social life and work?
- Have you felt that you have needed to carry out constant self examination and self diagnosis?
- Have you experienced disbelief over a diagnosis from a doctor or felt that you are unconvinced by your doctor’s reassurances that you are fine?
- Do you constantly need reassurance from doctors, family and friends that you are fine, even if you don’t really believe what you are being told?
The treatment for Health anxiety is that of Cognitive Behavioural Therapy. Initially a good assessment is required. Reading my articles you will see that a key question I ask is ‘what keeps the problem going’? Health anxiety is kept going by fear based thoughts and behaviours such as checking and reassurance seeking. If you imagine your health anxiety as a muscle this thinking and behavioural patterns only serves to strengthen this muscle. Tackling the anxiety thoughts are a key step. A persons thoughts are central to the feeling you experience. If you have the thought ‘oh there is that headache again, I know I had a scan but I bet there is a tumour there, it was missed by the doctors’. In challenging this thought a person is asked to bring the thought to court and explore the evidence for and against the thought by using some crucial questions. For example; Is this thought a fact or my opinion? Am I discounting any evidence – e.g. what advice has my doctor given me. Am I engaged in ‘catastrophic’ thinking? What advice would I give to my best friend if they had this thought? In effect with CBT we are trying to generate more ‘logical’ ways of tackling the catastrophic thinking whereby a routine headache is twisted into a brain tumour or a twinge in the chest is seen as a cardiac problem.
In addition the reassurance seeking behaviour of getting repeated medical check ups is something that requires some intervention. Stress reduction and management tools such as progressive muscular relaxation and abdominal breathing exercises and then stopping this check up visits. This helps reduce the anxiety.
So let’s get thing into perspective, it’s about getting on top your health anxiety, so that you can be truly free.