Health Anxiety Hurts

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Illustration by Michael Burmesch

Health anxiety

We used to call it “hypochondriasis,” but now it’s generally referred to as “health anxiety,” a condition affecting up to 12% of us at any given time. It’s normal to feel apprehensive when suffering a significant health issue or while waiting to find out if one’s unexplained symptoms stem from a serious physical malady. However, health anxiety occurs in the absence of a medical diagnosis rather than as a reaction to one. As such, it combines a “What if” mindset with mental catastrophizing.

Alisha illustrated this point. At our first counseling visit, she pronounced herself a “germophobe,” meaning she harbored an irrational fear of disease-causing pathogens. Her mind was like a mental echo chamber, constantly replaying warnings about contracting one type of illness or another, while admonishing her to employ all sorts of preventative measures. For example, after passing a woman in the grocery who was coughing, Alisha (who was masked) left the store, immediately applied hand sanitizer, drove home, used mouthwash and took a supplement claiming to repress respiratory viruses. Unfortunately, her wariness was not confined to communicable diseases alone.

“I had a head cold and woke up dizzy one morning,” she told me. “Right away, I started worrying I might be having a stroke. Ended up in the ER where they said I was fine.”

Cognitive Loop

These kinds of scenarios reflect the vexing Catch-22 faced by those with health anxiety. For instance, while vertigo can be a sign of an impending stroke or even a brain tumor, it can also be a harmless symptom linked with congestion or a minor ear infection. Unless severe, many of us would attribute dizziness to something mundane and transient, only becoming more alarmed if it escalated. However, when one is grappling with health anxiety, relatively harmless explanations for physical symptoms are nonexistent. Instead, the individual mentally leaps to a catastrophic scenario.

Most folks living with health anxiety become stuck in a circuitous cognitive loop that feeds their angst. It goes like this:

• On high alert due to intense body awareness, the person notices physical sensations (pain, tingling, numbness, etc.) or detects something (a lump, rash, etc.) that sets off alarm bells in their brain.
• This creates uncertainty, worry or anxious feelings, sometimes bordering on panic. Catastrophizing takes hold.
• In turn, these feelings cause physiological activation, the classic fight-flight-freeze response to perceived danger. Stress hormones surge, further worsening the perceived symptoms.
• What follows is an obsessive fixation on the physical sensations or area of body concern, characterized by the inability to focus elsewhere or engage in normal activities.
• This persistent rumination further escalates the person’s focus on their physical symptoms which, in turn, ramps up anxiety, and so on. The classic vicious cycle ensues.
• Usually, what results is a chronic condition called the “cycle of reassurance” where the individual struggles to convince themselves their symptoms are not a harbinger of illness and disease, usually with no success. This can involve endless online searches, soliciting opinions from friends, family or health care providers, compulsive body/sensation monitoring and, sometimes, a slew of diagnostic tests. 

Unless you’ve suffered health anxiety, it can be tough to understand just how distressing and debilitating this state of mind becomes. Imagine being constantly on guard for the slightest “off” feeling in your body, interpreting any unpleasant sensations as proof positive that doom and destruction are imminent, and then obsessively searching for information to reassure yourself, but never finding it.

Evidence suggests certain psychological conditions increase the risk of developing health anxiety. Prominent among these is generalized anxiety, the kind that can attach itself to a wide array of perceived threats, including to one’s health. Same for neuroticism, a personality trait characterized by anxiety, worry, depression and self-doubt. Of course, those who experience an actual physical illness or injury that proves frightening, unexpected or traumatic may develop health anxiety regardless of their prior mindset. What to do? Cognitive-Behavioral Therapy (CBT) seems most effective because it addresses this condition’s alarmist, catastrophizing self-talk. In tough cases, medication may be necessary. 

Ironically, through overwrought efforts to safeguard their physical health, those with this condition end up undermining their mental health.