Fear of being ill? How to cope with health anxiety

Society has become health obsessed. Gym memberships, Fitbit purchases, health apps and clean eating are evidence of this drive to be well.

While, in general, this health and wellness boom is a positive shift, all the talk about perfect health is accompanied by obsession, pressure and anxieties. Somebody obsessed about becoming ill is exposed to health information overload in our culture.

People with this condition used to be referred to as hypochondriacs. The Diagnostic and Statistical Manual of Mental Disorders no longer includes hypochondriasis. Currently, illness anxiety disorder or health anxiety refers to the obsessional preoccupation with physical sensations and harmless symptoms. These are misinterpreted as worst case health scenarios, causing panic and distress.

The ultimate fear may be cancer, HIV or having a heart attack.

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A headache is misinterpreted as a sign of a brain tumour.

People afflicted with health anxiety are triggered by their bodies, conversations, something they read, or Dr Google. They tend to engage in excessive body checking, scanning and visits to the GP. Some avoid medics altogether for fear of having their worst fears confirmed. Anxiety about the health of their children or those close to them often features in conjunction with their self-related fears.

In many cases, the elephant in the room is death anxiety.

Awareness of the inevitability of life ending can underlie the fear of one’s health being attacked. Aetiology is a culmination of factors including inheriting parental health worries, past experiences of illness, witnessing or hearing of others who are ill or dying, or just having a nervous disposition. After all, anxiety can attach to many different aspects of living.

In my practice as a counselling psychologist, I have worked with many individuals who present with health anxiety on a spectrum from mild to severe. While most are referred in by their GPs, they tend to find it hard to come to terms with it being psychological. For the majority, its obsessive nature was impairing daily functioning, work and relationships. Seeking constant reassurance from family, friends and the medical profession is also featured.

One person used to wake up every morning scanning his body for sensations or heart palpitations. He reduced his exercise for fear of having a heart attack and focused on his health in conversations. The lines between reality and health anxiety were blurred. Despite having test results coming back clear and more than 10 false alarm heart attacks, he remained unconvinced that his heart was in good shape. He described a little voice in his head telling him that the doctors missed something or that he was a rare medical case. Even the mention of someone having a heart attack triggered panic. The mental loop can kick off with “That could be me”, “Do I have those symptoms?” “My heart is racing”, “I will be found dead” with images of one’s own funeral. The man was mentally and emotionally exhausted with this mental bombardment and adrenaline spikes day in and day out. Over the course of treatment, he learned to accept, understand, challenge and cope with this type of anxiety.

Interventions

1) Talk therapies are effective in helping people learn skills to manage symptoms. Cognitive behavioural therapy explores the fears, questions them and provides response strategies to enjoy a better quality of living. Thorough assessment can identify contributing factors and other issues. If symptoms are debilitating, the GP may prescribe a course of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) to alleviate its severity and provide some respite.

2) Psychoeducation involves becoming the expert and learning about what health anxiety is and how it operates. This is beneficial as it helps the person to understand it fully and see it clearly as anxiety, not reality. Then, when triggered, you can remind yourself it is health anxiety.

3) Tolerating anxiety is an essential part of managing health anxiety. Daily practice of mindfulness helps build resilience and a sturdier baseline. Developing ways to relax and practicing self-care acts as buffers to triggers.

4) Stick with the facts and the evidence such as test results and feedback from the GP, family and friends. They can't all be wrong. Remind yourself of the 20 times previously you thought lumps were cancerous, but you were wrong. Focus on feelings of wellness and parts of your body that feel okay. Develop healthy habits by eating well and having an exercise programme to build up confidence in your good health.

5) Try to reduce seeking reassurance and instead look to yourself for it. Imagine what your GP or a medical expert would say to you. Getting reassurance is short lived and is not an effective strategy. It is wearing for you and those from whom you seek it.

6) Be aware of health anxiety provoking thoughts. Rather than believing them, step back and question them. Explore what your non-anxious side says. Remember, thinking you are seriously ill does not mean that you are. Be patient with yourself as it takes regular practice to retrain your brain.

7) Health anxiety has an obsessional quality so work on staying out of your head. If you are an 'overthinker', this can lead you into this type of psychological territory.

8) Have a menu of healthy distractions to refocus your attention from your body and health. It is harder to obsess about symptoms if you are having a swim in the sea, clearing out a cupboard or engaged in a book.

9) If you are closely involved with someone with a health anxiety, make a pact with them. Agree to refocus them from talking too much about their health and that instead of providing reassurance, you will remind them of strategies.

10) Assess your stress levels as every condition is exacerbated by this. Write a list of stressors, list all possible solutions and develop an action plan.

– Useful resources: mayoclinic.org; Headspace app; and Overcoming Health Anxiety. A self-help guide to Cognitive Behavioral Techniques, Wilson and Veale.