Health Anxiety

Health Anxiety(HA) – formerly known as hypochondriasis – is a psychological disorder in which people worry excessively about their health, and have intense fear of having one or more serious, life-threatening diseases. The fear leads people to pay too much attention to their bodily sensations and functions, often noticing what they think are abnormalities. Even small, insignificant changes in bodily functioning are considered to be potentially dangerous and signs of serious illness and disease. Friends, family, and especially doctors are often consulted for
reassurance that they do not have the feared disease, or confirmation that they do have it. Consulting with doctors repeatedly is not unusual among people with HA.

What is interesting about this condition – and which makes it challenging to treat – is that people are looking in the wrong place to find relief from their suffering. HA is an anxiety disorder, and should be treated in a psychological setting rather than a medical office. Preoccupation with checking bodily sensations, along with asking for medical reassurance, can actually increase anxiety and patient suffering. The anxiety is closely connected to the HA belief system in which there is a tendency to think pessimistically and to expect catastrophic outcomes about health issues. Fear-based thinking, repeated checking, and asking for reassurance all occur simultaneously to maintain and sometimes increase patient suffering. Patients believe they have to be vigilant and check their bodies in order to detect the feared disease at an early stage so that appropriate treatment can be life saving. While the premise for early detection is valid for certain cardiovascular conditions and some cancers, the preoccupation with what may be happening internally is exaggerated and unrealistic. This tendency to experience ordinary bodily sensations in an exaggerated manner is known as somatosensory amplification.

Occurring in people of all ages and equally in men and women, HA can be intermittent with relatively short episodes of anxiety, or continuous with high levels of discomfort and disruptions of daily life including relationships with other people. Many people also have symptoms of generalized anxiety and/or depression. Within the medical care system HA patients typically request various diagnostic tests. Some doctors order additional tests on the mistaken belief that the test results will reassure the patient and relieve their anxiety.

The causes of health anxiety are not easy to identify with certainty. While there are no direct causative factors that always lead to HA, there are many circumstances that make the emergence of HA more likely to occur. For example, prior experience with serious illness or disease in childhood predisposes people to develop HA later in life. The disease could have occurred either in the HA patient or in a close relative. In both cases the initial experience was emotionally traumatic even if the emotional impact was not recognized at the time. Another predisposing factor for HA is the way in which parents or other caregivers provide health information to their children. Parents of children who later develop HA are often very overprotective and reinforce the message that their child is weak and easily vulnerable to illness and disease with potential catastrophic consequences. Children in these circumstances are taught to pay close attention to their body and physical symptoms even when they are mild. The message given to these children is that something more serious can develop if the minor symptoms are not given proper attention. Precipitating factors include actual physical symptoms that are not serious and usually dissipate on their own even without treatment. Even when doctors are not able to identify with certainty the reason for these symptoms, HA patients need to have a definite explanation in order to relieve their anxiety, Media reports of famous people becoming ill with a particular disease can lead HA patients to immediately worry that they too can have the disease. In many cases a predisposing or precipitating reason for the occurrence of HA cannot be determined.

Treatment of people with HA can occur individually or in a group setting with added individual counseling. The treatment plan is typically individualized to take into account the particular circumstances of each person. However, for most people there are a number of aspects to the treatment program that are applicable to almost all participants, starting with learning to understand how HA originates and is maintained, and ending with changes in thinking and behavior so that HA no longer interferes with everyday life. There are four major aspects of most treatment programs including health anxiety education, cognitive therapy, exposure therapy and response prevention. A more detailed explanation of these aspects of treatment will follow at a later time. To begin, it is most important to realize that health anxiety is a psychological condition and needs to be treated psychologically, not medically.

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