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Key points
- Health anxiety usually refers to worries about developing a serious illness, or a hyper-focus on symptoms.
- It is common for people to experience somatic sensations at various times; anxiety usually results from hyper-focus and threat perception.
- To reduce health anxiety, see a doctor, manage checking and Googling behaviours, understand baseline risks, and reduce focus on symptoms.
Health anxiety is a strange beast. We are all likely to have difficulties with health at some point in our lives—this is an inevitable function of aging, accidents, and disease vectors (i.e., germs). Some of us become very highly anxious about health and what symptoms might mean and some of us are able to accept the realities of illness and age and don’t carry the same level of anxiety.
I have noticed that people who experience intense health anxiety often have concurrent fears of death, and have a level of dissatisfaction with their life. Clinically, this makes intuitive sense—if you are unhappy with your life and feel like you have not experienced all you wish to, you are likely to be fearful of dying and will be hyper-aware of any threat to your health and life. For some people, the fear of illness sits around the possibility of experiencing disability or pain, not death. For other people, they are not worried about developing a serious illness, but tend to become hyper-aware of any symptoms and focused on the symptoms themselves (this is what the DSM-V calls somatic symptom disorder).
Health anxiety is very common, but has taken on special meaning over the past year as we have all battled this pandemic. As I write this, I have family in India who are struggling with managing a new, and highly infectious wave of COVID-19 infections. Approximately 1 in 3 people have been found to be infectious in New Delhi. It would be almost impossible to not experience some anxiety under these circumstances. People in the United States, Brazil, the United Kingdom, and swathes of Europe will be very familiar with these feelings. In one way or another, we have all experienced health anxiety this past year, the difference perhaps only lying in the degree.
General guidelines to managing health anxiety
Typically, when managing health anxiety—we work with four simple principles:
1. Get any symptoms assessed by a single, qualified medical professional.
No doctor shopping, no self-testing, and no alternative medicine practitioners (if it worked, it would just be called medicine). We never want to attribute symptoms to “just anxiety” and should always get them assessed first so we know that there is no organic basis for the symptoms we may be experiencing.
2. Stop Googling your symptoms and checking your body.
Remember the skewed nature of google and social media—only people who had a headache and ended up with a brain tumour will post on forums and social media, the vast majority who had a headache and just a headache will say nothing. Your sample will be skewed toward the anomalous and severe and you will think that this is normal. Many people with health anxiety also engage in checking behaviours (e.g., poking their stomach or trying to palpate lumps). Remember that the average layperson has no training in assessing the body and checking just makes any symptoms more salient (i.e., important) and may actually amplify any pain (i.e., what do you think would happen if you kept pushing at a spot on your stomach, or compulsively clearing your throat?).
3. Remember that all bodies have various somatic symptoms at various points.
It is normal for us to have various somatic experiences at any given time, including aches, pains, swelling, and tingling. Health anxiety often relates to noticing and paying more attention to what these symptoms mean, than the average person without health anxiety would. One of the exercises I often do with clients with health anxiety involves stopping to scan the body and noticing any sensations that may be present. This helps clients identify that the average, healthy body will have a range of sensations present at different points in time. This also helps de-sensitise people to experiencing bodily sensation, as people with high levels of health anxiety will typically become distressed when they experience any bodily sensation that may be perceived as associated with illness.
4. Reduce the salience of symptoms.
This generally involves accepting that we all experience various bodily sensations and illness, and working on reducing the focus on the symptoms, and the belief that symptoms are indicative of serious illness. While we will all experience various symptoms, it is more likely than not that our headache will be just a headache, and not a brain tumour (considering the baseline rates of each condition).
However, while these are general guidelines to managing health anxiety, managing health anxiety during a pandemic is very different. During a pandemic, the wolf is quite literally at the door—and managing anxiety will correspondingly require a different approach. I will explore some ways of managing health anxiety during a pandemic in Part 2 of this series.
References
James, A., & Wells, A. (2002). Death beliefs, superstitious beliefs and health anxiety. British Journal of Clinical Psychology, 41(1), 43–53.
Zhang, Y., Zhao, Y., Mao, S., Li, G., & Yuan, Y. (2014). Investigation of health anxiety and its related factors in nursing students. Neuropsychiatric disease and treatment, 10, 1223.
Singh, K., & Brown, R. J. (2014). Health-related Internet habits and health anxiety in university students. Anxiety, Stress, & Coping, 27(5), 542–554.
Witthöft, M., Kerstner, T., Ofer, J., Mier, D., Rist, F., Diener, C., & Bailer, J. (2016). Cognitive biases in pathological health anxiety: The contribution of attention, memory, and evaluation processes. Clinical Psychological Science, 4(3), 464–479.
