No More Panic > Articles > Health Anxiety

Health Anxiety

Being anxious about our state of health has been increasing steadily over the past few years.

On the No More Panic message forum recently we've had a surge in people posting about issues that fundamentally stem from being extremely worried about their state of health so we decided that a dedicated page on the subject may be of value to all those in their initial stages of health anxiety and somewhere that those currently suffering may find some comfort.

I'd like to first start with defining Health anxiety. It is often referred to as the newer term for hypochondria but I'm not sure I fully agree that they are exactly the same thing.

  • Hypochondria when someone continuously worries that there is something wrong with their health, even when they are not ill
  • Hypochondria a state in which a person continually worries about their health without having any reason to do so:

These dictionary definitions imply that the person is healthy to start with, with no symptoms and that they worry about what may happen to them in the future be it tomorrow or in 10 years time.

My understanding of health anxiety is that there are already unexplained symptoms and if someone has health anxiety they will get so worked up about what these might be and end up blowing up their symptoms out of all proportion and beyond the average sense of realism.

So maybe health anxiety is an initial overreaction/misinterpretation of a real abnormality whereas hypochondriacs do not have any abnormalities to start with and fully fabricate – by visual imagination, their illnesses.

Let's look at a few recent examples of health anxiety that we've had on the message forum:

I've listed the anxious malady first with the ultimate cause second.

A blood clot in my leg – was a pinched nerve in my knee causing referred pain

Going blind – dry eye syndrome

West Nile Virus – stomach virus

A brain tumour – sinus congestion

I thought I had colon cancer due to bright red stool…turns out I ate too many pistachios! (I didn't know the red dye, dyes everything!)

I thought I had a sinus infection that spread to my brain, turns out it only spread to my ears.

I woke up with numbness in my arm and thought I was having a heart attack; turns out I was sleeping on my arm.

I thought I was bi-polar, schizophrenic, insane and certifiable, turns out I had anxiety.

I thought I had a tropical disease of the worst kind due to bright yellow urine – turns out it was the Vitamin B tablets

I thought I was pregnant or miscarrying (immaculate conception sort) – it was St. Johns wort interacting with my BCP causing break through bleeding

Lung cancer – common cold

Brain tumour – migraine

Fatal heart arrhythmia – common everyday palpitations

Deep vein thrombosis – I'd banged my shin but had forgotten- the bruise the next day was worth it

Fell out of a hammock and thought I must have broken at least 1 bone! No, just got a bit winded that's all!

Came up in a rash all over both legs. Oh no, could I be having an Anaphylaxis shock! No, it was just a heat rash so I sprayed some magicool on – much better!

Fell out of the pool. That's right, fell out not in! Tried to clamber up looking very lady like of course! I thought I could make it but me being a short ass I didn't make it so fell splat on the concrete. Grazing my leg nicely on the way! Oh no, what if the graze turns gangrenous. Guess what – it hasn't and it's healing nicely now!

Last but not least have had a few days with a very dodgy tummy. Oh no could it be salmonella or something! No just a mixture of heat rich food and IBS I think!

Read this excellent post on the Message Forum for some more examples of Health Anxiety …. The Battle that Rages in my Head

Reading these, you may smile or chuckle at a few from your distanced position but to that person at that time they are extremely serious issues. Try substituting one of your worries into the middle of this list and reread it. See how you wince when you come to the one that bothers you and feel a change of emotion as the thoughts and images you associate with this worry flicker through your mind.

Who are prone to getting these

People who worry about other things such as paying the bills, what your neighbour said to the postman, whether your work was up to standard, is your house tidy enough, did your mates like your car?

If you get into angst about anything else then you are more prone to worry about health too.

If you are a negative thinker you will more likely get these concerns – 'Oh it's bound to be me who gets a weird disease – I always get the weird things'. Thus you start thinking only about the weird things and not the obvious ones.

If you have had a period of real fear or indeed a real health worry you are more prone to question any other symptoms that may arise and tend to think of the extremes of what may happen to you.

If you fall into a certain category of thinking pattern such as pure 'black and white thinking' or 'tunnel thinking' then you are more vulnerable to health anxiety.

Should you have a low self esteem, you too are likely to succumb to these worries more, as you may not be assertive in getting help, therefore you may not seek out help to reassure yourself early on – yet you may be increasingly introspective, dwelling on the symptoms.

If you have had a bad experience with illness or poor medical care in your family it is more likely that you will not have trust in your doctor and worry that something has been missed.

So where do these worries originate?

Let's start with our media. On every TV channel there are reality documentaries about health and there are several soaps loosely connected with health care and hospitals.

What makes good television? Drama – so what do we get? – an overload of dramatic scenes. No one on television ever has a heart attack sitting quietly on the sofa after their tea.

Instead – they clutch at their chests – turn bright blue and fall over several bits of furniture as they collapse to the floor whilst nearly, but not quite telling a long lost relative where to find the family jewels.

No one ever has chest pain from a pulled or tense muscle – it's always a heart attack.

Thus we learn to associate all these illnesses and situations with certain signs and symptoms but we never have the full range of possible illnesses and injuries presented to us so we can learn to make an informed guess.

Similarly, all papers and magazines are stuffed full with articles – 'The 10 illnesses doctors always miss' or 'What to look for to save your heart'. It implies that we should self diagnose as our health is in the hands of incompetent doctors.

Again the message is reinforced dramatically – you should be self-responsible – look after yourself – no one else will.

Women's magazines are classics. They all now have an article like 'My doctor misdiagnosed me of X and I nearly died.' Or 'These trivial symptoms may really be early signs of X, Y, or Z disease which could be fatal if left untreated'.

Damn – just as you thought you were getting a handle on it too!!

The original intent to presumably inform and educate the public is totally missed in pursuit of sales and drama. Just reading the article title is enough to spin some folk into a panic attack

Not surprisingly we respond to this and lap it up and take it all to heart. We file away all these bits of information to refer to later should anyone develop a strange symptom such as a headache.

People love to discuss theirs and their neighbours ailments and we pick up snippets from their 'Oh yes – my friends son had a stiff neck too – and you know it turned out to be meningitis and you know – he nearly died. The hospital said he only had minutes to live.' And so on and so forth.

We've all heard them and although it may not apply to us at the time – our memories are wonderful things and it stores it all away and then presents these stories back to us as a memory or dream when it thinks it could be of use.

Why do we dwell on it over and over again?

We are smart people – we strive to find results that we can be reassured with and we will stop at nothing to find this.

So – we know that we do not feel / look right. We troop off to the doctor who has a prod, perhaps runs a test or two and then declares a full healthy bill of health and comments that this may well be anxiety but it is not a fatal illness or life threatening disease.

We go away and ponder on this. 'He says its only anxiety' 'Yes, but I know about being anxious and this is far worse -surely it can't just be that' 'Perhaps I should have another test; – I know I'll google it'.

Imminent disaster. You then put in a search engine – 'chest pain anxious' and you will be faced with millions of pages all shouting out in unison – heart attack. You read a few of them – the colour drains from your face and you feel totally dreadful.

Another example from one of our members: When I looked up 'blood clot in leg', the first text I saw was "amputation may be necessary" – this led almost instantly to a total full blown panic attack as I visualized my leg being sawn off.

The power of suggestion.

We are all used to reading reference material and believing it but we continue to read papers for news even though we know most of it is very biased or exaggerated.

Now, in this situation here you are faced with page after page verifying all your worse nightmares. This suggests to you that your doctor could be wrong – this then starts off another vicious circle of reassurance / worry.

This can take several forms. Some people seek several second medical opinions and insist upon a battery of tests and investigations, some people do the rounds of every complementary therapist in town seeking that miracle cure. Some hound their doctors as regular visitors and some suffer in silence but within themselves are sure that they are getting very ill.

It's hard to know what to do – so you mull it over and over and over.

Your head tells you one thing and your instinct tells you something else.

This all teaches your brain that it's an important issue and lodges it in your mind to be brought up every time you get a symptom or even a few quiet moments where you're not fully concentrating on something else.

This then develops into a habit or even a hobby and this is made even worse when the feelings or symptoms reoccur confirming your worst fears.

Health service differences

In the UK all health care is coordinated and managed by our family doctors (General Practitioners) except emergency trips to accident and emergency and any telephone health advice sought via the national helpline of NHS Direct.

All care and treatment is free but we are all aware that there are budget implications. Even if you want to see a consultant privately, most times you need a GP referral.

In the USA, most people have health insurance via their employment – a Health Maintenance Organization (HMO) plan that requires a referral from their primary care doctor for any tests and visits to specialists.

It can sometimes be easy to get many tests looking for physical maladies because doctors in the USA fear malpractice lawsuits. Doctors would rather order a "rule out" test than chance a missed or wrong diagnosis and a possible lawsuit.

For anxiety sufferers this means that providing you can 'talk their talk' you can put pressure on your doctor into arranging further tests for you. Many of the USA based self help forums are adding to this by advising members what tests to ask for next.

It is also crucial to understand that those sufferers who have no longer got health insurance through losing their jobs or falling on hard times will not get anything paid for and will have to pay the full price for any consultations and medications and this can be extremely costly.

In the UK, the GP can be considered a gatekeeper and if you have not got a good working relationship with your doctor it is easy to fall into thinking you are being denied referrals to specialists or further treatments either because you don't get on with them or because of budget reasons.

We have had instances on the forum where members have been told by their GP that there were not any Cognitive Behavioural Therapy (CBT) services in their town only for us to do some investigative work to find there were CBT services locally.

On the positive side your GP gets to know you, there is continuity of care, observation of progress and they know whether they can manage this within the surgery or whether to refer you to a specialist team or for an investigation. It does stop the merry go round of searching for a miracle cure and can be highly effective for the majority of patients but some patients can feel trapped by the system.

A second opinion can be sought from another partner in the practice if need be if you are really unhappy about your doctor contact.

What to do?

There are ways that are very effective in overcoming health anxiety but in order for them to be effective it needs some effort and compliance from the sufferer.

1. Recognition

The first one is purely to recognise that you do have a tendency to over react and jump to conclusions. Think about other aspects of your life – do you jump to conclusions or guess what someone is going to say or how someone feels?

Are you usually several steps ahead in planning things than others? Do you have fast mental agility?

Think of the colour yellow for 30 seconds. I was asked that once and by the time 30 seconds was up I'd been through sand, sun, parasol, daffodils, primroses, tulips, yellow jasmine, yellow paint, painting bib, nursery wallpaper, yellow kiddy mackintosh and gumboots, solero ice-cream, lemons, banana, cheese, yellow peppers etc.

I'm sure many of you can follow my train of thought. The woman who asked me was astounded – I just asked you to think of plain yellow.

It did show me that my ability to dance with images was very swift and powerful and often the images flowed into each other before my logical thoughts had time to catch up and filter the thoughts that were useful from the ones that were not helpful and sparked off fear.

2. Accept

Accept that you do overreact and jump to conclusions and that at this time it is just how you are. With some work and time you can curb these thought processes and catch yourself before you start.

3. Rationalize

With health anxiety you may get a twinge in your chest- aghhh is it worse? what could it be? – angina, heart attack, saw it on Casualty – there it is again – bit worse – what else could it be? I read in paper about silent heart attacks – could it be that? – more pain- it is worse aaaghh – must be a heart attack.

This train of thought coupled with the powerful images that we've seen/imagined and now flashback at you fills us with terror.

As a direct result, we are likely to get a degree of anxiety appearing as the body cannot tell the difference between imagined fear or real live present fear until our thoughts catch up and start to rationalize and control them.

So in order to get control of this you need to slow down your images and thoughts and let your rational thoughts catch up and work your way through each image rationalizing imagined and over reactive ones from true ones.

These are examples of 'catastrophising' thinking and 'all or none' thinking patterns and these will respond to CBT therapy. It's likely that if you have these thinking patterns for your health you also may be developing them for other areas in your life.

4. Distract

Distract yourself completely away from that topic altogether and go and get deeply involved in something else.

5. Educate yourself

Finally, I know that Internet surfing has increased health anxiety many fold, as people google in one or two symptoms and are amazed and subsequently horrified and then panic at what comes out. Certain illnesses are high profile so if you put in chest pain you will get zillions of sites on heart attacks but it is only down on page 34 of the listings that there is one suggesting pleurisy as an example.

If you are naturally a very inquisitive person and like to get to the bottom of things, then educate yourself well and not just in short bursts courtesy of Websites. A little knowledge is a very dangerous thing.

If you are truly obsessively worried about some illness, research it properly – contact the support group – there is always one – and get the booklets and ask to be put in contact with a sufferer and make the effort to speak to them and discuss your issues. Study it in depth objectively – not just surfing from site to site picking out tiny bits surrounding one or two anecdotal symptoms and making what you read fit your profile.

Alternatively, if you just cannot stop surfing, it can be a worthwhile exercise to turn the exercise on its head and put into Google the same symptoms and something you really know you don't have and see just how common these symptoms are. i.e. You may have been putting in headache, dizziness, tingling and getting out brain tumour so try putting in head injury or congenital illness and see how many of these also have your set of symptoms.

Then make a list of questions for your doctor and go and see them with your reasoning and have a real discussion about it.

Years ago people didn't collectively worry so much about their health as they didn't know what could be round the corner and even if they did, there was not so much information, hype or doubt in the public domain, most knowledge had to come via the doctor and hospitals and they were trusted and didn't scaremonger.

Health anxiety is a constant inner worry about the state of our health. As children we always feel fine unless we really don't, at which point we either cry or tell someone who helps make it better and day to day most averagely healthy people are not aware of what is going on within our bodies at all – they just work and we feel fine !

But the body is a living thing made up of 10000000's of bits, from individual cells each doing their own thing, to the most elaborate chain of events that make your arm move etc and just like any complex structure we creak occasionally and things are different from day to day responding to our needs and in response to what we're asking it to do.

Mostly these are ok sensations and feelings and ones that we would not even have noticed pre anxiety and they would have just passed us by and disappeared but when we focus on things it brings them to life and they stay liking the attention.

Animals respond by instinct as do we, we touch the bit that hurts, a mum always rubs things better, we know when we need fuel, we know when we're tired BUT we also know how to think logically and rationally and problem solve just as we do everyday as we go about our everyday business.

Humans have far more resources and options to use should we think we need them which is where we differ from animals who may know they feel unwell but apart from lying quietly or going to seek out a special grass do no have many options open to them to improve their situation so they have to accept what what is going on. My cats have never meowed to get in their baskets with a 'to the vet please' look.

With human health anxiety, somewhere along the line something happens or you read, see, hear about someone whom something tragically/ dramatically has happened to and you make that first connection- what if that was me ? That could have been me ! I get that !

This train of thought then gets transferred onto certain things that you feel within your body and you teach yourself to question everything unusual and immediately jump to the worst extreme conclusion that you know about. What used to be a headache is now a brain tumour, what used to be a cold is now pneumonia.

It is clear to me as a health care professional that all these extreme ailments everyone jumps to conclusions about are all fuelled by the power of suggestion, hear say and media as there are many much more dangerous illnesses out there that I never see mentioned on here and don't ever seem to come up even with all the googling that goes on which will always bring you up something dramatic and critical that fits one or two random symptoms. Google is not a doctor and just matches random symptoms and cannot begin to assess you for a full clinical picture which involves several body systems, a medical history and how you clinically present.

Anxiety and panic does bring with it a whole host of symptoms that can seem completely unconnected, which add to the worry that first brought on the anxiety so a roundabout situation can be reached very quickly and from there every single body symptom is analysed and a conclusion reached within minutes- usually a negative one at that.

I want to ask you to think about keeping logical and rational each time a symptom hits. Before jumping to any conclusion try to ask yourself –

What is the probability of this being imminently life threatening for me ?

If you are a young adult, in good health generally, low risk factors, no previously known related illness and reasonably fit :

– the odds and probability of a chest pain being a life threatening cardiac event is extremely low indeed.

– the odds of being a bit breathless turning into a respiratory distress incident are also extremely low.

Adding onto that the knowledge that you have anxiety which can cause chest pain, breathlessness makes the probability and odds even lower.

Adding onto that that the body when anxious produces chemicals that have a protective effect on the heart = even a lower risk still.

The human body is built too well, it has a variety of safety measures incorporated in it to keep you safe.

Time scales

When you next get a symptom and you assess it as not being imminently life threatening.

Think of the time scales involved whilst you're getting worked up.

If you get a headache and think its a brain tumour – this is not imminently life threatening within the next few hours.

You have lots of time on your hands to assess yourself , monitor your symptoms and seek medical advice.

Try to learn to pace your worrying keeping it to the facts you know now – a simple headache – not seeing images of you on your death bed surrounded by orphans – which is how our thoughts yet again are leading the way to panic.

Energy follows thought

This is not to say that incidents never happen – as is often asked 'What if this time its for real ?'

It's true things do happen. Unfortunately, you are the only person that can make that judgement of how much risk you are prepared to live with as far as your health is concerned or what you're prepared to do to lower your risk, by keeping blood pressure and weight within guidelines, eating healthily, exercising to reduce cancer rates etc

So you can end up worrying, knowing that you are a higher risk than you could be or you can decide that somewhere in all this you will take reasonable precautions with your health, getting help and advice and treatment where needed but will put your life in the hands of fate/God etc and just do your best day to day.

When I was acute I mainly worked with the comparison theory.

Have I had this before this bad ? If the answer was yes, it was dismissed as fast as possible with a lot of JFDI'ing and often finding distractions.

If the answer was a No:

Is it possibly anxiety related or am I truly ill ? Think slowly and rationally about what may have caused it ? What are the implications of it within a couple of hours or so ? Does it get any better with distraction ? What can I do to try to make it better myself ? Who shall I tell ?

If my life wasn't imminently in danger i.e.

  • A) airway – going blue,
  • B) breathing – still going in and out and
  • C) Circulation – not bleeding, heart still going but I felt really awful i.e. dizzy.

I would give it 30 minutes and review and if really necessary and I was on my own go and seek out company – neighbours – for a chat, phone a friend – for a natter, Tesco's for a sit, services so someone could see me. I usually didn't tell them I was struggling but just used the distraction well and most often I would see a rapid improvement in how I felt, so yet another episode chalked up to experience and put away for reference !!

No one ever said that getting over anxiety and panic was easy. I know it's not – but it can be achieved.

(Reproduced with kind permission of "No Panic". Please do not copy this article without their prior permission.) By Margaret Hawkins

ILLNESS & DEATH PHOBIAS

People who have illness phobia are looking constantly for reassurance from their doctor or the accident and emergency staff at the local hospital and they tend to bombard personal friends and family with references as to how awful they are feeling. Reassurance is transient and even x-rays, scans and other investigations will not convince them that nothing is amiss. They are sure that somewhere along the line something has been overlooked and possibly a mistake has been made in their particular case. It is all gloom and doom in their eyes.

Then there are the real physical signs that they can look at and wonder and worry about. "What is that little spot on my leg? It has been there for ages and hasn't altered. I wonder if it is cancerous." "Oh my goodness, my partner has a mark on his penis. Is it a sign of a venereal disease? Oh hell it might be AIDS. I can't cope, I think I shall go mad." "I keep getting headaches all the time, that's not normal, is it? What if it's a brain tumour? Will I die?

These kinds of thoughts are normal and most people at some point worry about a symptom that to them is unusual but they deal with it by seeing their G.P. or going to the appropriate diagnostic clinic. Others who are suffering from anxiety will be fearful and restless. They become constantly aware of their bodies and how they are functioning. "My lips look very blue this morning and my heart seems to be racing, I hope I'm not going to have a heart attack." The ever present anxiety and resulting tension can produce other symptoms such as pains in the stomach; contractions of the intestines too, are not uncommon. All this reinforces the negative thinking and the terror of the imagined consequences. How do we deal with these worries? We have to start looking at the problem logically. If we have been told that all is well but just can't accept the fact, then we must look at the part we are playing in prolonging our lack of belief. Are we exaggerating? The answer to this is 'More than likely.' Are we forever thinking 'What if this symptom gets worse and the doctor still tells me there is nothing to worry about?' What shall I do then? It might be an idea to write down the most horrendous outcome that you can think of and start to question the probabilities of it happening.

After making a list, go through it methodically and answer each question. I think you will find that most of your replies could be regarded as highly imaginative, not a true representation of the facts or reality. Let us take headaches as an example. You have had them frequently, so much so that you have been to see your G.P. He/she has tried to explain to you that it is not surprising that you have headaches because you are anxious and perhaps in a difficult situation at home or at work. "You must try and relax more." he/she might say. They may even offer some form of medication, which may or may not help. After a week of wondering whether your headaches will be cured you realise that, unfortunately, they are still a daily occurrence. Now what, you begin to get more worried so back to the G.P. you go. This time you are so uptight and so insistent that something must be radically wrong, that to make absolutely sure, the doctor arranges a consultation and X-ray at the hospital. Instead of thinking that you will be in good hands and will get a definite diagnosis, you start to think that you must be really ill. You forget that it was you that insisted that there was unquestionably something wrong and to give reassurance your doctor obliged you by arranging the visit to the consultant. You begin to imagine that you are being sent there because the doctor is unsure of what is causing your headaches. At this stage you are so tense isn't it likely that you are actually exacerbating the problem by your exaggerated and negative thinking?

Go through your list again and this time, take each statement that you have made and examine it thoroughly. Isn't it true that nearly everyone in the world has a headache at some point? They don't all die from a brain tumour do they? Even if the headaches are very, very bad and the sufferer has been sent for an examination, the diagnosis of a brain tumour is relatively rare considering the vast numbers of the population. Try to undermine all your negative thoughts with facts not imagined possibilities. You are suffering from anxiety and the headaches are caused by tension. These will disappear as you apply your relaxation techniques and you become less introspective. Change you negative thoughts to positive ones as you become more relaxed and in control of your situation and start to enjoy your life again.

Most people don't like the thought of dying. It's an unknown quantity, something that can't be measured or related to any other situation that we experience. The one thing that I do know is that I have never met anyone yet who remembers their actual birth! Being born is a natural process and so don't you think that death might be too? Prior to passing into unconsciousness you are still alive and functioning. What is it that you're afraid of? Is it pain or discomfort? You have most probably experienced both and coped. At this point you are still in this world and able to make known your needs. When you slip into unconsciousness that is the actual moment of death and you will not be aware. This cannot be so terrifying because you have been doing something similar all of your life. Slipping into unconsciousness is just like the experience of going to sleep. You are not afraid of that are you? You know that one moment you are alert and the next you are asleep. Yet you are not aware of this moment happening. Going to sleep is an unconscious act. You can't actually make yourself go to sleep. Sleep is normal, like sneezing when you have a head cold, you expect it to happen. Sleeping is nature's way of renewing and recharging our minds and bodies so that we can live a healthy life. When we come to the end, the winding down is not some traumatic event but an expected conclusion, as natural as birth. Quite literally we are freed from control or knowledge. Sleep releases us from all our doubts and fears, anxiety is gone. It is only when we are awake and conscious that our fears return. We have lived with the unknown every moment, every day of our lives since we were born and dealt with all that has been thrown at us, so there is no reason to think that death will be any different.

If you happen to have a religious belief then that can be of great comfort. Faith and prayer brings hope and alleviates the distress of parting from loved ones. Do bear in mind that dying is as natural as being born and that nothing about the experience will register on your consciousness. Live your life to the full and accept death as a normal conclusion to human existence, similar to all things in creation that have an allotted time span.