Health Anxiety and Pathophobia

Do you have a fear of death? Or of becoming sick? Let's take a look at health anxiety, hypochondria, and pathophobia.

Symptoms of hypochondria, or health anxiety disorder, involve a preoccupation with the idea of being potentially ill or seriously ill. This assessment is also usually made by the patient based on normal bodily sensations (such as a noisy stomach), or benign signs (such as a minor rash). Hypochondria can become a debilitating obsessive problem and inhibit people in many ways. It can also consume their daily lives almost fully and drag friends, colleagues, health professionals and family into their phobia.

Health anxiety disorder, sometimes called hypochondriasis, involves worrying excessively about becoming seriously ill, and it may not be based on any actual symptoms at all, but on perceived symptoms or fears. Patients may believe that normal body sensations or minor symptoms are signs of a severe illness, even though a thorough medical exam may not reveal any medical condition whatsoever. Patients can experience extreme anxiety in the belief that bodily sensations, such as muscle twitching or fatigue, are confirmation of a specific or serious illness. This excessive anxiety — rather than the physical symptom itself — results in severe distress that can disrupt a patient’s life. This disorder can become a long-term condition that fluctuates in severity and chronicity. It may increase with age or during times of stress.

Symptoms of Health Anxiety

• Being preoccupied with having or getting a serious disease or health condition
• Worrying that minor symptoms or body sensations are indications of a serious illness
• Being easily alarmed about your health status
• Finding little or no reassurance from visits to your doctor or negative test results
• Worrying excessively about a specific medical condition or your risk of developing a medical condition, because it runs in your family
• High levels of distress about possible illnesses make it hard for you to function
• Repeatedly checking your body for signs of illness or disease
• Frequently making medical appointments for reassurance — or avoiding medical care for fear of being diagnosed with a serious illness

A Modern Disease

In the modern era of healthy lifestyles and increased medicalisation, society has improved the health of most nations without question. Taking care of your own health and taking responsibility for your physical wellbeing is admirable and effective if managed properly, but the obsessive focus on continual medical check-ups, over-exercising to avoid illness, and hyper-vigilance to any kind of physical fluctuation can have the direct and opposite effect and can contribute to the establishment of an obsessive disorder. The excessive monitoring of our own health and wellbeing can eventually provoke a real sense of us losing control. It can lead to excessive fear and panic attacks.

The Hopeless Search for the Inevitable

What seems like the most surprising thing in the case of hypochondria is that with every negative diagnosis the patient receives following their continual health checks, the patient becomes trapped in an ongoing spiral of hypochondriacal thoughts and obsessions. More often than not, the patient responds with disbelief that there is nothing sinister happening within them. With many patients, we can also observe them attending repeat check-ups, one after another, to the point where they begin to doubt the very specialist consultant they are seeing. These patients often seek an ever better consultant and even more accurate tests over and over again. This continual and obsessive search for dangerous or threatening symptoms, initially beginning with self-symptom monitoring, then involving a procession of medical consultations and diagnostic tests over the course of a few months, leads the person to create a generalised phobic disorder based on the fear of being sick or suffering a long and painful death.

Evolution of the Problem

The patient’s continual attempts to solve their problem through attempting to control their own health develops firstly from a series of obsessive doubts associated with their health and wellbeing. Subsequent to this comes an increased self-monitoring of their symptoms and perceived physiological alteration, and later, through the continual reiteration of diagnostic tests, they construct a truly phobic ‘certainty’ that they have an illness. As with many doubts, the reiteration of the doubt shifts it from a doubt to a certainty, a certainty that is even more real than ‘reality’ (Watzlawick, 1974).

At this point the patient is trapped like the fly in the bottle, going around and around over and over again in ever decreasing circles. Every failed attempt at solving the problem increases the problem at hand. These days, patients will most often seek information via the internet or ‘Dr Google,’ with each vague symptom described on the internet being translated into a true certainty that they suffer from the described disease.

Pathophobia and Hypochondria: The Distinction

What basically differentiates a pathophobic patient from a hypochondriac is that the pathophobic is usually obsessed with a specific form of threat to their health. The hypochondriac, on the other hand, will panic at the slightest alteration of their body, turning even the slightest pain into a sure sign of a serious organic disease. The true irony is that the hypochondriac’s continual fight with the slightest feeling of illness is that it may actually lower their immune system, to the point where they become the architect of their own sickness.

Failed Attempts at a Solution

• Continual self-monitoring of the body. The effect of this attempted solution is the paradoxical effect that the patients' "control of their symptoms and fear leads them to lose control." The person falls prey to an obsessive fixation that pushes them to control something that is not controllable and in doing so, their control becomes dysfunctional and triggers the vicious circle that builds the disorder.
• Medical consultations. Beginning as an attempt at prevention, this continual search for better and more complete diagnostic investigations with the most sophisticated technology, at first calms and reassures the patient, yet risks confirming their very problem because the fact that no medical investigation is infallible or 100 percent certain will introduce a doubt that can only be extinguished by further medical tests. And so on it goes in a vicious, obsessive circle.
• Talking to others. It may well be good to talk about our concerns and after all ‘a problem shared is a problem halved’, but this common sense wisdom does not function in a positive way for health anxiety. It is instead decidedly counterproductive, because it serves to feed the hypochondriacal disorder.