This is a topic that people have been asking me to talk about lately. In the last six months, I’ve developed much more an interest in health anxiety. If you had asked me a year ago about it, I would have told you, “I don’t want to get into that!”
But actually, I do want to get into that! So let’s look at health anxiety. What it is, what it isn’t, and how the principles of recovery we talk about all the time apply. Does my book apply to health anxiety? It does, but you have to know how to apply the principles correctly!
WHAT HEALTH ANXIETY IS NOT
This gets confused quite often. For people with panic disorder or agoraphobia, the big problem for them is the panic itself. In these disorders, people learn to be afraid of their own bodies and of the physical symptoms of anxiety. Someone that experiences regular panic attacks may fear that the symptoms of each attack signal death, injury, or permanent incapacitation. That’s very common, but that’s not health anxiety. It’s a fine line. Maybe people get confused and for good reason. People with panic disorder will say, “Oh, I think I have health anxiety too because I’m afraid of my heartbeat.” That’s true, but that is not really health anxiety. That’s just fearing the consequences of panic and anxiety, not an independent health issue.
SO WHAT IS HEALTH ANXIETY?
Health anxiety is an obsession with your health. This is one of the reasons why some clinicians treat it as an OCD subtype even though technically health anxiety is classified as a different disorder in the DSM-V. It is an obsession, and your obsession becomes your health. And, no always your health. It could be the health of a loved one, a family member, a partner, or even a beloved pet. People with health anxiety cannot tolerate being ill in any way. It will set off waves of anxiety and panic if they start to feel ill. They may be aware of what it is and that it’s going to go away in two days, but that doesn’t matter. Being ill in any way will make someone with health anxiety incredibly anxious.
Health anxiety sufferers will also worry about bigger health problems, such as incapacitating diseases, chronic illnesses, or degenerative diseases. Curiously, the specific target of the obsession in terms of specific diseases or illnesses often shifts over time. Nonetheless, the theme always remains the same. Health anxiety is an obsession with health.
THE OBSESSION/COMPULSION CYCLE OF HEALTH ANXIETY
When you have an obsession, that obsession is driven by compulsions. Health anxiety compulsions include:
- Checking for symptoms and changes in one’s body.
- Engaging in excessive medical/health/symptoms research.
- Seeking stories of health problems and health disasters, often precipitated by medical malpractice.
- Reassurance seeking in the form of repetitively seeking medical attention, engaging in even more research, or asking friends, family members and social media contacts about symptoms and feared illnesses.
Ultimately, the compulsions of health anxiety are all focused on one thing: eliminating uncertainty surrounding one’s health. All the rituals, compulsions and safety-seeking behaviors are all designed to reduce the risk of illness, injury, incapacitation of death to zero percent. See the rub? There is no such thing as 100 percent certainty about health. Ever. The drive to get to total certainty – a zero percent chance of being sick – is doomed to fail forever.
Health anxiety is – at its core – an uncertainty intolerance disorder!
Principles Of Recovery From Health Anxiety
The principles of recovery for most disorders are the same. You must intentionally stand in discomfort, fear, uncertainty, vulnerability, anxiety, and even panic. You must to stand in it and face it without resorting to escape or safety rituals in order to learn experientially that you can tolerate that, and that the perceived threat is not real. With health anxiety, the same principles apply.
The thing is, they apply in reverse from what you see me talk and write about so often. An agoraphobic must DO things to learn a new relationship with anxiety. Someone with health anxiety must NOT DO things, in order to achieve the same goal. Resolving health anxiety is about removing the compulsions – the safety and reassurance seeking behaviors and rituals. This is very difficult to do and requires hard work and a willingness to be intentionally uncomfortable and afraid, but it works.
STEP ONE – ACKNOWLEDGING THE DISTORTION AND MAGNIFICATION
Health anxiety will take the same level of uncertainty that all humans face with regard to health, distort it, twist it, and magnify it 100 times over. What most of the population will dismiss as unlikely, a health anxiety sufferer will insist is worthy of inspection, examination, and rumination over. The disorder disallows logic and will insist that any chance of illness greater than zero percent is unacceptable. The first step in recovery form health anxiety, therefore, is to acknowledge this distortion and to stop defending it. There is no forward progress if the health anxiety sufferer continues to insist that a distorted and overly magnified threat is real.
EXPOSURES FOR HEALTH ANXIETY
I am asked often what exposures for health anxiety look like. Generally, it looks like this:
Make a list of all the compulsions you engage in. These are the rituals and habits you turn to when you feel like your health is in jeopardy. Googling symptoms, calling doctors, telling people your symptoms, and scanning your body are the most common health anxiety compulsions.
Order those compulsions from “easiest” to quit to hardest. Yes, they are all hard. But do your best to rank them.
Start working on removing the compulsions one by one from easiest to hardest. This happens hour-by-hour, incrementally. You do not decide to stop Googling forever, then never do it again. Plan to stay away from Google or WebMD for an hour. Then another hour. Then another. This is how we do it.
This will make you VERY uncomfortable, anxious, and afraid. Your job is to allow those feelings and use your relaxation, focus, breathing and mindfulness skills to navigate THROUGH them. You are not trying to prove that you are always going to healthy. You are trying to prove that you can tolerate uncertainty regarding your health. You are learning to relate to that uncertainty in a more realistic way, rather than through the lens of distortion, magnification, and irrational fear.
Continue the process, attacking your compulsions one by one (when possible). Over time and with repetition and practice, you will become desensitized to the idea of health threats. No matter how long you’ve suffered with health anxiety or how “bad” you think yours is, you can recover using the approach.
WHAT ABOUT THERAPY OR PROFESSIONAL HELP?
That is never a bad idea. When seeking professional help with your health anxiety, always look for a therapist that specializes in anxiety disorders. Often an OCD specialist will be especially helpful with health anxiety since principles of ERP (exposure and response prevention) apply.
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