1. What is Health Anxiety?
It is common and normal to occasionally worry about your health and some of us might also have to deal with serious medical conditions. However, people who suffer with health anxiety tend to worry obsessively about their health and for these people the worry process itself becomes a problem. It is not unusual that people with health anxiety either have a medical condition that causes a preoccupation with health-increased worry, or they may have medically unexplained symptoms that are causing them to worry about their health. People with health anxiety commonly believe that harmless physical symptoms are signs of severe medical conditions or the development of a serious and possibly life-threatening disease. In summary, health anxiety can be characterized by having fears of experiencing serious illness now or sometime in the future.
2. Causes, signs and symptoms
There are a number of reasons why someone may suffer from health anxiety. First of all, health anxiety can be inherited from parents, and this genetic predisposition sets the stage for health anxiety to occur. However, there are also other factors that contribute to the development of health anxiety such as being exposed to a serious disease or experiencing a physical illness that results in increased contact with hospitals or medical staff. Undergoing stressful life events such as an illness or death in your own or a family close to your own family may also trigger health anxiety. Personality factors and other mental health disorders (e.g. depression, generalised anxiety disorder, etc) and environmental pressure at work or home may also cause the development of health anxiety. Health anxiety affects the way we feel, the way we think, the way we behave and how our body reacts. When someone is suffering from health anxiety, they feel anxious, worried, tense, stressed, detached and have feelings that something awful is going to happen to their health. Health anxiety can also have an effect on cognition by altering the way we think and this can result in the development of thinking distortions. Common thinking distortions observed in individuals with health anxiety includes:
- Catastrophic thinking, where the individual will imagine the worst case scenario happening regardless of the facts of the situation.
- Emotional reasoning, where the individual will assume that because they feel a certain way the way they are thinking must be true.
- Selective attention, where the individual only pays attention to certain types of evidence and disregards everything else.
- Predicting the future, where the individual is jumping to conclusions based on assumptions and opinions.
Many people who experience health anxiety also report experiencing intrusive thoughts about their own or others’ health. People who experience health anxiety also regularly report a number of physical symptoms, including difficulties concentrating, restlessness, tension, sleep disturbance, tiredness and fatigue, chest and stomach pain, accelerated heart rate, numbness in fingers, a racing mind and difficulties breathing. Due to the unpleasant symptoms of health anxiety it is not unusual that sufferers alter their behaviour in an attempt to alleviate anxiety. Common behavioural changes include compulsive checking of signs and symptoms of ill health, reassurance seeking, and avoidance of feared situations, places, or objects that may trigger the health anxiety (e.g. exercising, making GP or hospital appointments, TV programmes with medical content). People who suffer from health anxiety might also portray irritable behaviour, have difficulties relaxing, and experience changes in appetite and increase the consumption of tobacco and alcohol.
Health anxiety can be diagnosed when an individual has a persistent belief for a minimum of six months, that they have at least two serious physical diseases. The preoccupation with the above belief must also cause persistent distress and interference with personal functioning in daily living, including leading the individual to seek regular investigations and medical treatment. The individual will also persistently refuse medical advice that there is no sufficient physical cause for abnormalities or physical symptoms, except for short periods immediately after or during a medical examination.
Health anxiety is normally treated with psychotherapy, medication, or both. Choice of treatment depends on the severity of the disorder, and individual choice. In some cases, self-help books or leaflets may be helpful. Psychologists provide different techniques and therapies which can include relaxation techniques (i.e. mindfulness meditation), others provide psychoeducation. According to the National Institute for Health Care Excellence (NICE) the recommended psychotherapy for health anxiety is Cognitive Behavioural Therapy (CBT). This is a type of therapy that focuses on the connection between thoughts, emotions and behaviour and teaches the person new ways of thinking and behaving that may help in reducing worry and anxiety linked with physical health symptoms. CBT highlights what makes the symptoms worse, and looks at developing methods of coping with the symptoms. Health anxiety can also be treated through the use of medication and your GP will be able to provide you with guidance on what medication to take. At present two types of medications are commonly used to treat health anxiety– antidepressants and anti-anxiety medications. Some of these medications start working immediately whilst others take several weeks to start working. Common to all medication is that it may cause side effects and some medication should not be taken for prolonged periods of time.