Health Anxiety

This information is taken from our book, Overcoming Health Anxiety published by Robinson.

Health anxiety is a condition that consists of a preoccupation with having a serious illness or a fear of developing a serious illness despite medical reassurance. Only a health professional can diagnose you having health anxiety.

Health anxiety is thought to consist a spectrum, so even if you do not fulfil the all the criteria then you may be a person who worries excessively about your health. The psychiatric term for health anxiety is hypochondriasis or hypochondriacal disorder but we will not use the term as it has a pejorative tone. It is derived from Greek and literally means the anatomical area ‘below the cartilage’. This is because it was thought, at one time, that a problem in the guts of a person with hypochondria was, thought to cause various mental disorders. In the 19th century, hypochondria acquired its more specific meaning of fear of disease and preoccupation with one’s health.

The onset of health anxiety can be at any age. However it commonly it starts in adolescence or in young adults. Some people with health anxiety have an excessive worry about an illness, which is usually briefer in duration. However the usual course of health anxiety is to come and go depending on various life stresses. Other people with health anxiety have a long-term or chronic health anxiety. It may be more common in women and occurs in about 5% of patients attending a GP’s surgery.We shall discuss the experience of health anxiety problems in more detail below. Not everyone has the same experience of health anxiety – it partly depends on the severity of your problem and the culture you are from.

 

Physical sensations

The physical sensations that you experience are always real. Only you can tell people what you experience, so don’t let anyone tell you they are imagined or all in your head. However the sensations are often “normal” physiological sensation (like dizziness, tiredness), which are misinterpreted as evidence of a severe illness. Thus a headache may be interpreted as a brain tumour. A lump in one’s body may be interpreted as cancer. Feelings of unreality may be interpreted as a sign of schizophrenia.

Other people might have a long-term illness like epilepsy or diabetes and have symptoms related to their illness but again misinterpret their significance. Physical symptoms can be constant over time or more often change. They can be vague or quite specific.

Intrusive thoughts and images

You may have intrusive thought or images about yourself or others being harmed. The threat might be real or imagined and may be from the past (for example, a memory) present or future. When anxiety dominates the picture, you may be overestimating the degree of danger to yourself or others. Your mind tends to think of all the possible bad things that could occur. This is called ‘catastrophizing’. Your mind will want to know for certain or have a guarantee that you will not die or suffer from a severe illness. This leads to worrying about how to solve non-existent problems and to control as much of your bodily functions or to plan ahead to deal with all the possible problems that do not arise. The natural desire is to escape or avoid situations that are anxiety provoking.  One of problems is that your thoughts become fused with past experiences and accepted as facts in the “here and now”. As a consequence, you develop a pattern of thinking which is like holding a prejudice against information that does not fit with your fears.

You will learn in therapy to notice when you are thinking about yourself in this prejudiced way by prefacing it with “I had a thought that” (for example I had cancer), thus underlining that it’s just a thought or a mental event and not reality. We’ll be emphasizing the importance of recognizing that thoughts about your health are just that – thoughts, not reality. Learning to accept these negative thoughts and images willingly as ‘just thoughts’ and not buying into them is an important part of overcoming health anxiety.

 

Worry

When you have health anxiety, you may be worrying a great deal about your symptoms, in which you are trying to solve non-existent problems. These usually take the form of ’what if …?’ questions. Examples include ‘What if I get cancer?’ or “What if I have heart disease?” “How will my children cope when I have died?”

Brooding

Some people cope by trying to control their thoughts or suppressing them, which can mean they enter your mind more frequently. You might be trying to ‘put right’ or make sense of past events by brooding on them, perhaps mulling over them constantly. You are probably trying to solve problems that cannot be solved or analyse a question that cannot be answered. When you are becoming more depressed, this usually consists of lot of ‘why?’ questions. ‘Why did I take those tablets?’ or ’Why do I feel this way?’. Another favourite is the ‘if only…’ fantasies, as in ’If only I felt better …’. Alternatively, you may be constantly comparing yourself unfavourably with others and making judgements and criticizing yourself. Brooding invariably makes you feel worse as you never resolve the existing questions and may even generate new questions that cannot be answered.

Attentional processes

When you are worried about your health, you become more self-focused on your bodily sensations and feelings and at the same time discarding negative test results. This tends to make you more aware of how you feel makes you more likely to assume that your view of the way you look and the picture in your mind is reality. This in turn interferes with your ability to make simple decisions, pay attention or concentrate on your normal tasks or what people around you are saying. You are likely to be less creative and less able to listen effectively. When severe, it may make you feel more paranoid. Your view of the world now depends on your thoughts and the way it chatters away rather than your experience. In other situations you may be so focussed on monitoring your bodily sensations that you fail to take in the context and find it difficult to concentrate on what others are saying. Treatment involves shifting your attention broadly and more externally towards reality.

Anxiety can produce a variety of physical sensations too, including feeling hot and sweaty, having a racing heart, feeling faint, wobbly or shaky, experiencing muscle tension (for example, headaches), having stomach upsets or diarrhoea, to list a few. These in turn may be further misinterpreted and a vicious circle ensues.

If however you are becoming despondent and hopeless about the future, you may feel down or emotionally ’numb’ or feeling that life has lost its fun. These are core symptoms of depression.  In addition you might start to experience sleep problems, lose your appetite and sexual interests. You might be brooding about the past, feel more irritable, and have difficulty concentrating. With depression, people may react by becoming withdrawn and inactive and wanting to avoid situations or activities that are painful.

Behaviours

People with health anxiety use a variety of different mechanisms to cope –which usually make the situation worse in the long term.

When the fear is high, you may either try to avoid, distract yourself from your thoughts and feelings or to escape from or avoid situations that remind you of illness or death. Here health anxiety becomes like an illness phobia. Thus you might avoid going to the doctor because you are convinced you will be given bad news. You might be avoiding people who are ill, hospitals, doctor’s surgeries, funerals, cemeteries, or reading anything about illness in the media. Here you may have magical thinking that believes that thinking about bad events could make them happen.

When your doubts are high, you may be excessively checking in the form of self-examination. Examples include checking whether:

    • you have a lump
    • your heart rate is too fast or blood pressure is too high
    • you are losing excessive weight
    • your nervous system is still normal
    • you can still swallow

 

You might also be checking for information on the internet or in books and in the media. Checking is an example of a “safety seeking behaviour” in which aims to prevent harm and reduce anxiety. People with health anxiety try to adopt ways to improve the way they feel but unfortunately the solutions usually leave them feeling worse and prevent them from testing out their fears. Safety seeking behaviours are a way of “trying too hard” to prevent bad consequences but then the solutions become the problem. We shall look at this more in Chapter x when we look at a psychological understanding of health anxiety.  Needless to say, you have to stop all your safety seeking behaviours if you are to overcome your health anxiety successfully.

You may be seeking repeated reassurance from friends or your doctor to find out the cause of your symptoms. When you are dissatisfied by one doctor, you may seek a second and third opinion and so on. Each doctor may order a new set of tests. Some of these tests may have ambiguous findings leading to further tests. You in turn may become very dismissive or dissatisfied with your doctors. Interestingly doctors also become very frustrated with people with health anxiety and may prefer to refer you on to another doctor (rather than a mental health professional). Health anxiety has an effect on your friends and family as when you are preoccupied with your health, you may appear uninterested and distant. This in turn leads people to be frustrated and fed up with you.

The content of worries, safety behaviours and avoidance behaviour are closely related. When the person has to enter a situation that she normally avoids, then the safety behaviours starts to reduce the potential for harm and discomfort. You may then try to avoid thinking about it by distracting yourself or suppressing the thought.

Is health anxiety linked to other condition?

You may feel demoralised or clinically depressed. Some sufferers restrict their lives to try and protect themselves.

How is the condition likely to progress?

No long term follow studies have been done. Some people with health anxiety  have a chronic condition. If left untreated, then the condition is likely to persist.

What treatments are available?

If you feel that you or a close relative are affected by health anxiety and would like help or more information, contacting your GP is often the easiest way to get help and further treatment. In England you may refer yourself direct to an Increasing Access to Psychological Therapies (IAPT) centre for CBT.

A GP should refer you for cognitive behaviour therapy. This may lead to outpatient treatment at an IAPT centre or, if more serious as an in-patient treatment.

If you’re worried about talking to your GP, consider writing down your concerns and questions. You can:

  • take a friend or family member with you to act as an advocate
  • see another doctor in the practice; or
  • join a new GP practice.

NHS Direct can offer you advice on moving to a new practice. You can visit the website at www.nhsdirect.nhs.uk

There has been very little research or controlled trials on the treatment of health anxiety. The most likely treatments offered are cognitive behaviour therapy (CBT) and medication (SSRI anti-depressants).

What is CBT?

Cognitive behaviour therapy (CBT) is based on a structured programme of self-help, which focuses on the way you think and act. You need to have a good understanding of what keeps your problem going and sometimes on past memories of bad experiences. After this, it is best treated by testing out some of your beliefs, facing up to the situations or activities you are avoiding and to drop all your safety behaviours. It will get easier and your anxiety will tend to reduce.

What about medication?

A type of anti-depressant called an SSRI may be prescribed that can reduce anxiety or treat other problems such as depression.

Does treatment work?

Treatment works for many sufferers if they are prepared to do the homework and to test out some of their worries.

Websites on health anxiety 

There are very few websites for health anxiety to get good information.

OCD Action is national charity in the UK for people with OCD.  There is an excellent Advocacy service. For example here is a list of examples of letters to obtain support to obtain a referral to a specialist service.

Support Groups in OCD

There are no known specific support groups for health anxiety. However there are many support groups for OCD in the UK which will be listed on the OCD Action website. There is one such group that meets at the Priory North London from  7-9pm on the first Sunday of every month.

NHS services

Our specialist clinics for OCD are at the Maudsley Hospital  for out-patients and a residential unit at the Bethlem Royal Hospital, Beckenham, Kent.  A specialist service for adolescents is at the Maudsley Hospital, London

Accredited cognitive behaviour therapists (mainly private) can be searched on CBT UK register but difficult to know their experience in health anxiety.

Books

– Overcoming Health Anxiety by Rob Willson and David Veale published by Robinson. Please consider adding a review on www.amazon.co.uk !

– The Compassionate Mind by Paul Gilbert published by Robinson

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