Everything you need to know about Health Anxiety

Everyone worries about their health from time to time, but for about 1 in 20 of the population this is more than a general concern; they are constantly anxious about their health. An estimated 5% of doctor’s appointments are the result of health / illness anxiety / phobia.

Anxiety is a future-oriented state of mind, characterised by feelings of fear, worry or general unease about what might or what may be happening. In the case of health anxiety, those who suffer from it have an obsessional preoccupation with the idea that they are currently or that they will be experiencing a physical illness.

Some people may confuse health anxiety with another disorder concerning health, hypochondria. However, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has replaced the diagnosis of hypochondria with two new diagnostic entities: Somatic Symptom Disorder (SSD), hypochondria, and Illness Anxiety Disorder (IAD), health anxiety.

Hypochondria is marked by a person’s imagination of the physical symptoms of illness. Whilst health anxiety tends to be a person’s misinterpretation of minor or normal body sensations as illness or serious disease symptoms, often despite reassurance by medical professionals that they don’t have an illness.

What is health anxiety?

Health anxiety is an anxiety condition that is often housed within the Obsessive-Compulsive Disorder (OCD) spectrum of disorders. Whilst there are some overlapping symptoms between the two disorders, and it is also possible for someone to be diagnosed with both OCD and health anxiety, they are defined as separate disorders in the DSM-5.

Those who are affected by health anxiety are convinced that harmless physical symptoms are indicators of serious disease or severe medical conditions. They frequently misinterpret physical symptoms of anxiety as a sign of an impending physical health problem.

Health anxiety involves intense anxiety and worry about your health, usually to the point that it produces significant distress or interferes with your day-to-day functioning. Some people may become so consumed by worry that the distress becomes disabling.

Some people with health anxiety have an excessive worry about an illness, which is usually brief 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 long-term or chronic health anxiety.

Most people, most of the time, will not pay much attention to minor discomfort, changes in their bodily functions, bodily noises or minor lumps and bumps that come and go. People with health anxiety believe their health is under threat, and become sensitive to their health in order to protect themselves.

They tend to pay closer attention to sensations or changes in their bodies, noticing things that others would simply not pay any attention to. Unfortunately, focussing on a symptom can sometimes amplify the intensity of the symptom.

Who can suffer from health anxiety?

The onset of health anxiety can be at any age. However, it commonly starts in adolescence or in young adults. It may be more common in women than in men. However, it can affect anyone, and in many people, it seems to worsen with age, or during times of stress. Often for older people, health anxiety may focus on the fear and symptoms of losing their memory or developing dementia.

Causes of health anxiety

The exact cause of health anxiety is not known. Whilst there is some evidence that health anxiety, like all anxiety disorders, may in part be an inherited or biologically based problem, it is generally accepted that several other important factors can increase the likelihood of you developing this problem.

These triggers may include:

• Having family members or others around you experience a serious illness. In circumstances where the illness experienced by a family member has a degree of heritability, we may start to focus on the likelihood that we too will develop the illness as opposed to the chance that we won’t.
• Death of a family member or someone known to you. The death of someone close can increase our awareness of our own mortality and lead us to contemplate these issues. We may associate illness with intense suffering and certain death, which can lead to an increase in our sense of vulnerability and helplessness.
• Having personally experienced a medical problem. Experiencing a medical problem can lead us to be more attentive to our bodily sensations and changes, and alert us to our chances of possible further medical issues.
• Having a family member with health anxiety. If we have grown up observing or listening to others worry about health or frequently checking for signs of illness or injury, we are more likely to use these same coping strategies when we are confronted with health issues or sensations.
• Not understanding how our bodies feel, how illnesses work, or both. This could lead someone to believe that the symptoms in their body are the result of a dangerous illness. This prompts them to search for proof that they do, in fact, have a serious illness. They could find it challenging to tolerate ambiguity regarding unpleasant or strange physical feelings. This could cause them to mistakenly believe that any physical discomfort warrants investigation, leading them to look for proof that they are suffering from a serious illness.
• The media or the internet. Having access to a range of interesting health-related stories and information that may report on the experiences of patients who were misdiagnosed, sometimes despite repeated efforts to seek medical help, can lead us to question our medical care. We might view benign bodily sensations and changes with greater suspicion, and to consider previously ignored and highly unlikely health problems as common.

Health anxiety symptoms

Health anxiety is the constant worry that you are ill, or that you are going to get ill.

You may have health anxiety if you:

• Act as if you were already ill, for example, avoiding physical activities.
• Are constantly worrying about your health.
• Avoid anything to do with serious illness, such as medical TV programmes.
• Frequently check your body for signs of illness, such as lumps, tingling or pain.
• Constantly talk about your health and possible illnesses.
• Obsessively look at health information on the internet or in the media usually for reassurance.
• Often ask family or doctors for reassurance that you are not ill.
• Worry that your doctor or medical tests may have missed something.

Those who are affected by health anxiety are convinced that harmless physical sensations are indicators of serious disease or severe medical conditions. For example, a temporary lapse of memory may be the onset of dementia, or a feeling of the chest getting tight is taken for a heart attack, or a headache may be interpreted as a brain tumour.

The physical symptoms of anxiety may replicate symptoms of illness which can be mistaken for signs of serious illness by those who have health anxiety.

The physical sensations that you experience are always real. However, the sensations are often normal physiological sensations such as dizziness and tiredness, which are misinterpreted as evidence of a severe illness. When anxiety dominates the picture, you may be overestimating the degree of risk.

Those with health anxiety may be seeking repeated reassurance from friends or their doctor to find out the cause of their symptoms. When they are dissatisfied by one doctor, they may seek a second and third opinion and so on.

There are a number of beliefs and assumptions that health anxiety sufferers share, such as, but not limited to:

• If the doctor orders a test, then there must be something wrong.
• If I don’t persist, the doctor may miss something important.
• Doctors miss things, so I should see several different doctors until I get a clear diagnosis.
• If I don’t keep checking / having tests, I could miss something really important.
• If I’m not vigilant, an underlying problem could be getting worse.
• I must take all symptoms and bodily changes seriously.
• I must be symptom free to be healthy.
• If the doctor doesn’t know exactly what the problem is, then it must be really serious.

A belief or assumption about health tends to be unhelpful when it is inaccurate and/or inflexible and can lead to people being on “high alert” for signs of illness, making them anxious.

Risk factors of health anxiety

Risk factors for health anxiety disorder may include:

• A serious childhood illness or a parent with a serious illness.
• A time of major life stress.
• A traumatic event, either physical or emotional or both.
• Excessive health-related internet use.
• History of abuse as a child.
• Personality traits, such as having a tendency toward being a worrier.
• Threat of a serious illness that turns out not to be serious.
• Other mental health disorders.

How is health anxiety diagnosed?

If you are concerned about your health, the rational thing to do is see your doctor. If you have experienced some or all of the signs and symptoms detailed above during the last 6 months, then it is likely that you may be affected by health anxiety. Anxiety UK strongly advise that people seek further information and guidance from their GP who will be able to make a formal diagnosis.

You may find it helpful to write down what you want to say to your GP in advance, and take your notes in with you to your appointment. If you are feeling nervous, let your GP know. You could think about taking someone with you to support you, such as a close friend or family member. You may want to book an extended appointment so that you don’t feel rushed.

Your GP will usually perform physical examinations to rule out any health conditions you are concerned about. If you are otherwise healthy, your GP may refer you to a mental healthcare professional who may perform a psychological evaluation. This involves questions about your symptoms, stressful situations, family history, worries, and issues affecting your life, in order for them to make a formal diagnosis of health anxiety.

How to deal with health anxiety

Health anxiety is an obsessive and often irrational worry that may cause difficulties in day-to-day activities such as work, studying, social activities or relationships with others.

Fortunately, there are ways that you can cope with your health anxiety, including:

Changing your focus of attention – People with health anxiety will often focus on a particular part or function of their body. The more they focus on a part of their body, the more they notice physical sensations which can then trigger worrying thoughts.

These initial thoughts can trigger anxiety, in turn causing additional physical sensations. At this point, the person may begin to believe their anxiety response is further evidence of physical symptoms. You can see how this creates a cycle of worrying. This cycle is known as rumination. If you feel yourself becoming too focused on a particular worry, it’s important to redirect your attention to something else.

One of the most straightforward ways of accomplishing this is to turn your focus to an activity, such as:

• Cleaning a room.
• Gardening.
• Doing a crossword puzzle.
• Painting or drawing.
• Going for a walk.

Regardless of the activity, the goal is to pay full attention to what you are doing.

Practising mindfulness – Mindfulness is the practice of paying attention to our thoughts, our surroundings, and our actions in a purposeful way. While the practice is rooted in meditation, it has become increasingly useful in therapy. In fact, the practice of mindfulness-based cognitive therapy (MBCT) has been shown to be highly effective for individuals suffering from health anxiety.

Try the mindfulness 5-4-3-2-1 exercise; look around your current surroundings and identify:

• Five things you can see.
• Four things you can touch.
• Three things you can hear.
• Two things you can smell.
• One thing you can taste.

Going through this exercise helps to ground you in the current moment and in the environment. While simple, it can help pull your focus away from ruminating thoughts. It is also an exercise that can be done anywhere at any time.

Challenging your worrisome thoughts – Thoughts are not facts. They are just thoughts and they don’t have to be true or based in reality. However, when we ponder, we begin to believe our thoughts reflect reality. The problem is not that we are ill but that we think that we are ill; our thoughts can represent our perceived reality. In other words, we accept our thoughts as facts.

Once a thought, for example “There’s something wrong with my heart”, has been identified, you can challenge and reframe it, for example, thinking instead “I’m only telling myself that there is something wrong with my heart.” This process of identifying and challenging takes practice. Remember that your body sends you signals all the time, and these signals sometimes just remind us that we are alive.

Try not to self-diagnose – If you are nervous about a medical condition, you may think seeking out more information, for example searching online, will help alleviate that anxiety. Think back to other times you have done that. Chances are, seeking to fill those holes yourself only made the anxiety worse. If you are concerned about a particular change in your body or symptom, then contact your GP rather than assuming the worst or self-diagnosing.

Helping others to cope with health anxiety should start with encouraging them to visit their GP, if they haven’t already done so. Don’t get frustrated, act judgmentally, or invalidate their feelings when dealing with someone who has health anxiety – it is a very real condition. Encourage their participation in treatment.

In order to best help someone cope with a problem, it is helpful for you to understand the nature of the problem, and some general recommendations for coping with it, so it would be helpful if you could educate yourself about health anxiety.

Be available to talk about the health anxiety with the person that you are trying to help. Hearing repeated concerns about symptoms can be very frustrating, so this requires a lot of patience.

Anxiety can be an overwhelmingly intense experience at times, and can be quite challenging for the anxious person to cope with it on their own, to keep quiet about, or to hide the anxiety. Sometimes the person that you are trying to help will need to share the fact that they are feeling a lot of anxiety or strong impulses. They will need an understanding and compassionate ear.

You can act as a sort of coach for the anxious person to help them learn and practise coping skills, such as recognising and challenging thinking errors. Remember to try to be patient with your loved-one’s anxiety, and with their efforts to manage it. They are not choosing to feel anxious, and they are trying to make sense of their anxiety and cope with it as best they know how.

How is health anxiety treated?

The National Institute for Health and Care Excellence (NICE) recommends two main treatments for health anxiety: Cognitive Behavioural Therapy and medication.

Cognitive Behavioural Therapy (CBT) – This is one of the most effective types of treatment for health anxiety. Generally, CBT helps you to identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to change your behaviour and replace unhelpful beliefs with more realistic and balanced ones. CBT teaches you new skills, and helps you to understand how to react more positively to situations that would usually cause you anxiety. You can refer yourself directly to an NHS talking therapies service without a referral from a GP. You need to be aged 18 or over, although some services offer treatment for young people aged 16 and 17. Children and young people who are not able to access adult talking therapies can get support with mental and emotional problems from their local children and young people’s mental health service.

Your doctor might offer to prescribe you medication to help manage your symptoms, which will usually be a form of anti-depressant Selective Serotonin Re-uptake Inhibitor (SSRI) medications. Whether you are prescribed medication will depend upon your medical history and the severity of your symptoms.

Final thoughts

Sources of help and support for people with health anxiety or for anyone who is supporting someone with health anxiety include:

• Anxiety UK Helpline 03444 775 774.
• No Panic Helpline 0300 772 9844 Youth Line 0333 772 2644.
• Anxiety Care UK 07552877219.
• MIND 0300 123 3393 Young Minds 0808 802 5544.
• No More Panic Chatroom.