Dina 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.
Dina 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.
Dina has a health anxiety (Somatic Symptom Disorder and Illness Anxiety Disorder, formally known as hypochondriasis) which 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 (Aids, diabetes). Unfortunately, many people with health anxiety are reluctant to seek mental health treatment since they believe very strongly that their condition is due to a medical illness.
The False Alarm
The main problem in health anxiety is the misinterpretation of normal bodily sensations as dangerous. Healthy human bodies produce all sorts of physical symptoms that might be uncomfortable (or even 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 now imagine how problematic it would be if it went off every time someone walked 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, just to name a few. These are normal and harmless bodily changes. But when a person misinterprets them as symptoms of some terrible disease, it makes them worry. This explains why medical tests come out negative: the sensations are real, but they are not symptoms of a disease.
Why do people misinterpret sensations in their body and overestimate danger?
Sometimes misinterpretation is due to their assumptions about health and illness. For example, “my cousin died of cancer, so 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.”
When you are looking for something there is a tendency to find it. For example, last month when I was looking to buy a new car, I noticed every car on the road, the make and the color. Prior to that I didn’t pay attention. If you hear a story on the news about a few cases of a serious virus, people with health anxiety might start scanning there body for symptoms of the virus. Looking for symptoms makes you notice subtle sensations you might otherwise ignore. When there is uncertainty, the imagination has room to create stories. And that’s when your body’s alarm sounds off as you imagine the worst.
This is when it gets really tricky.
Symptoms of anxiety produce very real physical symptoms: Dizziness, stomach aches, rapid heartbeat, tingling in the hands and feet, muscle tension, jitteriness, chest pressure and the list goes on. These symptom 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 or not? Answer: you go to the doctor… and then to a therapist.
But why does health anxiety persist 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 the person to rely upon 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, bringing relief….temporarily. Soon the cycle starts again.
The Most Effective Treatment is Cognitive-Behavioral Therapy
Prior to treatment, the possibility of medical problems must be ruled out with a thorough physical exam. Once medical problems are ruled out, 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, 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 (the fear of AIDS) effect how we feel (afraid and anxious) and how we behave (scanning or 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 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 the anxiety and uncertainty.