Scared all the time.

[JosieLouise]

I'm constantly scared. Even when I'm not worrying over any specific symptom, the fear of is always hanging over me. I've started thinking strange thoughts, like if I see a funeral car on my drive to work or accidentally come across an article about cancer, then that means the odds of me getting sick and dying are way higher. I repeat mantras like 'I am not sick' or 'I am not in pain' to try to convince myself I am alright, or even to try and change fate (sounds bizarre but it's what I genuinely think). My therapist thinks my health anxiety is tipping into OCD territory. I can't watch medical documentaries, I can't listen to certain adverts on TV or radio, I can't read certain articles. All of it makes me scared, thinking that it 'means' something.

All I see is illness and death and dying wherever I go.

I'm just so fed up with my stupid brain.

[serendipity1996]

Aw hun, honestly I can empathise with you. Anxiety can honestly be so debilitating. Health anxiety in particular is so tiring and emotionally exhausting, I spend so much time and energy fretting about my health. There's no respite from the obsessive paranoid thoughts, it's like I HAVE to be worried about something, it's absolutely relentless. It's quite isolating as well IMO - I haven't told many of my friends about my health anxiety since I'm worried they would just find it bemusing and tell me to 'get over it'. I know it's ridiculous but I always think that I'm going to turn out to be THAT person who will eventually end up being misdiagnosed by a doctor, or have some rare condition that makes me a medical curiosity. Sorry I just rambled on there but just wanted to say that you're not alone! :)

[MyNameIsTerry]

You are describing a theme in OCD known as Magical Thinking. You make am impossible link, the funeral car to increased odds of death by cancer, then try to mitigate it via a compulsion, the statements or changing the reality to something else.

HA isn't a diagnostic term, it's one sufferers use. OCD is one of the disorders that overlaps into this HA umbrella term. So, what are you diagnosed with? It may be that you do have OCD if they haven't made a proper diagnosis e.g. GP's can be lazy by assuming GAD or diagnose "chronic anxiety" which is not a diagnosis available in the WHO manual.

I have MT as one of my themes. It's a very irrational one and can link into anything, other themes for example.

[JosieLouise]

[QUOTE=MyNameIsTerry;1598574] So, what are you diagnosed with? It may be that you do have OCD if they haven't made a proper diagnosis e.g. GP's can be lazy by assuming GAD or diagnose "chronic anxiety" which is not a diagnosis available in the WHO manual [QUOTE]

My only official diagnosis is Hypochondriasis. Doctors have thrown around GAD a few times as well and I have to admit I've wondered if OCD is a possibility too. And although I'm generally a superstitious person I do feel like the Health anxiety and the magical thinking don't exist without each other. Hmm.

Thank you for your replies.

[rainbow]

I think that health anxiety and ocd go hand in hand. I would never have thought that I had ocd until health anxiety hit me but I definitely have ocd alongside my HA. The compulsion to google, ckeck, ask for reassurance! Definitely ocd.

[Desperate2bnormal:(]

How awful for you. Hope you find peace soon.

[SLA]

The brain doesnt understand negative affirmations. So by saying to yourself "I am not sick" you are really saying to yourself. "I am sick." Your affirmations need to contain positive words.

Also, your brain has primed itself to spot negative situations, and associate false meaning to them.

I was reading a book just on this subject last night, and it was a revelation to me.

I'll write out a longer response soon, and copy some of the key wisom from it.

[MyNameIsTerry]

The brain doesnt understand negative affirmations. So by saying to yourself "I am not sick" you are really saying to yourself. "I am sick." Your affirmations need to contain positive words.

Also, your brain has primed itself to spot negative situations, and associate false meaning to them.

I was reading a book just on this subject last night, and it was a revelation to me.

I'll write out a longer response soon, and copy some of the key wisom from it.

Check out the thread, Words, by Davit on the Panic board. He was a big proponent of positive wording. There are articles about the importance of this in cancelling negatives and how multiples are need and it ties right in with CBT tools like Thought Records and positive "what ifs".

[Danie57]

I don't have much advice. I just wanted to let you know your not alone. What your describing sounds exactly like me. I have good weeks and bad. But it's always hanging around. Worst feeling. Xxx

[JosieLouise]

Thank you for your replies.
So now I'm curious... if my therapist - not a doctor - has told me I have symptoms of OCD does that count as diagnosis? I'm just wondering. And to be honest, sometimes I think being able to legitimately use the term OCD for what I'm experiencing might be far easier for others to understand....

[MyNameIsTerry]

[QUOTE=MyNameIsTerry;1598574] So, what are you diagnosed with? It may be that you do have OCD if they haven't made a proper diagnosis e.g. GP's can be lazy by assuming GAD or diagnose "chronic anxiety" which is not a diagnosis available in the WHO manual [QUOTE]

My only official diagnosis is Hypochondriasis. Doctors have thrown around GAD a few times as well and I have to admit I've wondered if OCD is a possibility too. And although I'm generally a superstitious person I do feel like the Health anxiety and the magical thinking don't exist without each other. Hmm.

Thank you for your replies.

When was that diagnosis made and who made it? The reason I ask is that it is one from the manual they use in the US and the NHS don't use that one. It's not a valid diagnosis to the NHS but there are similar ones.

I know the one used over here quite well and I know there are differences between how these manuals work that could put an American HA sufferer into a different disorder to one in the UK. Plus the manuals not only have differing criteria but also different groupings and disorder names. This grouping issue allows for an "OCD Spectrum" which doesn't exist in the WHO manual used by the NHS.

What I'm driving at is that it could actually be OCD all along but there's not enough to go on in this thread to work that out.

---------- Post added at 22:51 ---------- Previous post was at 22:43 ----------


Thank you for your replies.
So now I'm curious... if my therapist - not a doctor - has told me I have symptoms of OCD does that count as diagnosis? I'm just wondering. And to be honest, sometimes I think being able to legitimately use the term OCD for what I'm experiencing might be far easier for others to understand....

In my opinion, the therapist is more suitably trained. My GP had me as GAD but the therapist be referred me to picked out the OCD in first session.

GP's are not specialists do their knowledge is basic with mental health. Your GP will most likely listen to the therapist. What I don't know without checking is how that relationship works when it comes to diagnosis with the new IAPT. The previous system saw us only seeing CMHT staff who had access to a specialist able GP diagnose in a psychiatrist/psychologist. IAPT are not trained to those levels but they do confer with a supervisor throughout your treatment. I'm not sure whether the supervisor is qualified to diagnose either but I can tell you that if the disorder is such that it is not within the terms of IAPT treatment, they can't diagnose e.g. a personality disorder was one mine was wondering about but she said it was "above her pay grade" (because only CMHT treat those).

[JosieLouise]

When was that diagnosis made and who made it? The reason I ask is that it is one from the manual they use in the US and the NHS don't use that one. It's not a valid diagnosis to the NHS but there are similar ones.

That was at the very beginning of 2010, and I think the actual term used on paper is 'Hypochondriacal Anxiety'. That was made by an adolescent psychiatrist from The Priory.

Although only a few months ago I had an assessment through the NHS and they used the term 'Hypochondriasis'. Bit confusing but I understand what you're saying!

At the moment I feel like any OCD symptoms are related purely to health... is it possible to have such a specific form? When I don't have bad health anxiety I don't seem to have the magical thinking or the compulsions anywhere near as severely. Or maybe there's OCD in other areas of my life and I don't even know it... I'm asking you Terry because you seem very knowledgeable on the subject! :yesyes:

[MyNameIsTerry]

Thanks for your confidence, Josie.

There are 2 major diagnostic manuals, the DSM by the US (currently DSM-V) and the ICD by WHO (currently ICD-11). The DSM-V went live in 2013. The ICD-11 went live in 2015 (draft) for final release in 2018 so the ICD-10 is still used which went live in 1998. (Quite a bit in the mental health draft is the same though with the anxiety disorders from what I've seen).

The ICD is actually the authorised mental health manual in the US (and is the one in the UK too) but the US often use the DSM informally too. I have read some in the UK use the DSM informally too as it contains other information that can be helpful to professionals BUT it shouldn't be used for diagnosis because it differs to the official ICD. For instance, Hypochondriasis is actually called under F45.2 Hypochondriacal disorder. Now, in the DSM-V Hypochondriasis has now been renamed completely as either of Somatic Symptom Disorder and Illness Anxiety Disorder.

The code for Hypochondriasis is F45.21, so it's inside the F45.2 which is as follows (where it say Excl, these are not relevant to the category as they are classified elsewhere):

F45.2 Hypochondriacal disorder
The essential feature is a persistent preoccupation with the possibility of having one or more serious and progressive physical disorders. Patients manifest persistent somatic complaints or a persistent preoccupation with their physical appearance. Normal or commonplace sensations and appearances are often interpreted by patients as abnormal and distressing, and attention is usually focused upon only one or two organs or systems of the body. Marked depression and anxiety are often present, and may justify additional diagnoses.
Body dysmorphic disorder
Dysmorphophobia (nondelusional)
Hypochondriacal neurosis
Hypochondriasis
Nosophobia
Excl.:
delusional dysmorphophobia (F22.8)
fixed delusions about bodily functions or shape (F22.-)

Just to add, the main text for the group of ALL Somatoform Disorders (which comes before what I've just posted above) is this:

F45 Somatoform disorders
The main feature is repeated presentation of physical symptoms together with persistent requests for medical investigations, in spite of repeated negative findings and reassurances by doctors that the symptoms have no physical basis. If any physical disorders are present, they do not explain the nature and extent of the symptoms or the distress and preoccupation of the patient.
Excl.:
dissociative disorders (F44.-)
hair-plucking (F98.4)
lalling (F80.0)
lisping (F80.8)
nail-biting (F98.8)
psychological or behavioural factors associated with disorders or diseases classified elsewhere (F54)
sexual dysfunction, not caused by organic disorder or disease (F52.-)
thumb-sucking (F98.8)
tic disorders (in childhood and adolescence) (F95.-)
Tourette syndrome (F95.2)
trichotillomania (F63.3)

So, the Hypochondriasis is a subcode of the Hypochondriacal disorder which allows them to separate it from the others mentioned e.g. BDD was in that too which has very different issues. I was wrong to say they don't use it since it's a subcode, I was getting mixed up with the main coding (the 3 digit ones) and didn't think about the subcoding bit. I was thinking they may have been using the older DSM-IV as I know the NHS mention private professionals informally using the DSM.

Looking at the one your diagnosis falls into it also says "Marked depression and anxiety are often present, and may justify additional diagnoses." That could mean diagnosis of a comorbid disorder like OCD. The issue that can arise is that OCD already has a HA element to it so it's going to be up to person making the diagnosis to determine whether Hypochondriasis is still valid and OCD is added or whether OCD takes over because of a shift in symptoms/behaviours.

The dividing line between OCD and Somatoform Disorders is a complicated one. Since both are obsessive, it might come down to a presence of compulsions making it closer to an OCD diagnosis? Further behaviours, like Magical Thinking, sit firmly in the OCD camp so may sway the diagnosis.

When you look at the description of the various OCD disorders, they are quite vague in terms of theme. They don't care about POCD, HOCD, etc since none of that matters as these themes can shift around and they have never "coded" each theme. It would mean constant updating anyway since the OCD cycle can lend itself to probably anything! This is what they say about OCD:

F42 Obsessive-compulsive disorder
The essential feature is recurrent obsessional thoughts or compulsive acts. Obsessional thoughts are ideas, images, or impulses that enter the patient's mind again and again in a stereotyped form. They are almost invariably distressing and the patient often tries, unsuccessfully, to resist them. They are, however, recognized as his or her own thoughts, even though they are involuntary and often repugnant. Compulsive acts or rituals are stereotyped behaviours that are repeated again and again. They are not inherently enjoyable, nor do they result in the completion of inherently useful tasks. Their function is to prevent some objectively unlikely event, often involving harm to or caused by the patient, which he or she fears might otherwise occur. Usually, this behaviour is recognized by the patient as pointless or ineffectual and repeated attempts are made to resist. Anxiety is almost invariably present. If compulsive acts are resisted the anxiety gets worse.
Incl.:
anankastic neurosis
obsessive-compulsive neurosis
Excl.:
obsessive-compulsive personality (disorder) (F60.5)

F42.0 Predominantly obsessional thoughts or ruminations
These may take the form of ideas, mental images, or impulses to act, which are nearly always distressing to the subject. Sometimes the ideas are an indecisive, endless consideration of alternatives, associated with an inability to make trivial but necessary decisions in day-to-day living. The relationship between obsessional ruminations and depression is particularly close and a diagnosis of obsessive-compulsive disorder should be preferred only if ruminations arise or persist in the absence of a depressive episode.

F42.1 Predominantly compulsive acts [obsessional rituals]
The majority of compulsive acts are concerned with cleaning (particularly handwashing), repeated checking to ensure that a potentially dangerous situation has not been allowed to develop, or orderliness and tidiness. Underlying the overt behaviour is a fear, usually of danger either to or caused by the patient, and the ritual is an ineffectual or symbolic attempt to avert that danger.

F42.2 Mixed obsessional thoughts and acts

F42.8 Other obsessive-compulsive disorders

F42.9 Obsessive-compulsive disorder, unspecified

In the above, Magical Thinking is mentioned where it says "Their function is to prevent some objectively unlikely event, often involving harm to or caused by the patient, which he or she fears might otherwise occur. Usually, this behaviour is recognized by the patient as pointless or ineffectual and repeated attempts are made to resist".

So, if you think back, what do you think? Have you been focussing on a couple of physical worries (like the cancers) and chasing diagnosis to then believe it incorrect and more tests needed? Or have you been obsessing and completing compulsions to mitigate risks or something bad happening?

I always find the crossover between Somatoform and OCD very complicated. It's much easier with other OCD themes! The whole reassurance-seeking behaviour in HA can fall into those Somatoforms with chasing & ignoring results/opinions but it's also a well known OCD compulsion often seen in themes such as ROCD! I've seen quite a lot of ROCD threads and they all chase reassurance, and then find holes in it all and ask again & again, just like the HA threads. It could be that the reduction in anxiety from the reassurance sways to OCD but I am guessing here as I don't understand enough about the Somatoform side to be sure on that. The persistent nature of the Somatoform sufferer in pursuing tests and why is unclear in the ICD. What I have found from reading medical professionals sites (Steve Seay has excellent articles for OCD) is that the OCD person is worrying about getting something whereas the Somatoform person is worried they already have it but when you think about the threads on here, there is a lot of crossover between the two. :shrug:

[JosieLouise]

So, if you think back, what do you think? Have you been focussing on a couple of physical worries (like the cancers) and chasing diagnosis to then believe it incorrect and more tests needed? Or have you been obsessing and completing compulsions to mitigate risks or something bad happening?

The persistent nature of the Somatoform sufferer in pursuing tests and why is unclear in the ICD. What I have found from reading medical professionals sites (Steve Seay has excellent articles for OCD) is that the OCD person is worrying about getting something whereas the Somatoform person is worried they already have it but when you think about the threads on here, there is a lot of crossover between the two.

Thank you so much Terry for that very detailed reply! I can definitely see there's a huge grey area here.

If we're going by the ICD-10 I certainly see elements of both HA and OCD in me. I am extremely obsessed with reassurance - mostly via friends, family and good old Dr Google rather than actual GPs - but still, I'm more concerned with being sure I don't have something rather than convinced I do have it as in Somatoform it seems. I don't chase tests or diagnosis - if anything I'm afraid of them. If I'm not getting any worrying symptoms, I'm fixated on making sure it stays that way.

I'm aware that OCD requires both the Obsession and the cancelling Compulsion, but I can't always identify both in me. Some are very clear (eg. I 'm worried about developing cancer so I routinely check my body for lumps, and once I start checking I find it harder to stop - the thought being that if I don't continue to check something will develop). Another one would be feeling a pain somewhere in my body, then mentally trying to 'think away' the pain by repeating words in my head like "I am not in pain" or "I am not sick." But some are harder to identify, like when I see an article about cancer I somehow get into my head that if I read it, I will be put at more risk of cancer myself. So I suppose avoidance is the compulsion there?

Either way it's all very interesting.

[MyNameIsTerry]

To be honest, Josie, the more you keep explaining how your anxiety works, the more it points to OCD more than a Somatoform Disorder in my opinion. The particular Somatoform Disorder they have diagnosed is based on chasing tests and medical opinions for a small number of specific, and named, physical illnesses. There are other Somatoform Disorders, so I will paste them in later so you can see the rest of the group and hopefully see they don't apply to you (I can't say for sure without reading them thoroughly again, but I suspect this will be the case).

Being afraid of the tests could easily fit into GAD too but can be OCD. The majority of people who post in here seem to want to see a doctor but there are a small number of HA sufferers who do anything to avoid tests due to anxiety increase of them or worry over the results. Of course, many have the worry over waiting for results but they are usually more willing to approach a doctor in the first place.

OCD can be more O or C or mixed. When it's more O, there will still be C's but they tend to be "mental" compulsions (also known as "covert" compulsions). This just means they are not easy observed by other parties and even the sufferer. Examples can be reassurance-seeking, self questioning/analysis, "testing" which is a bit of a different one (I can explain that, if needed), mental statements, etc. Even if the OCD is more C, there are still O's driving it. Mixed OCD just means the O and the C are not strong enough to tilt the balance in favour of one over the other in terms of diagnosis.

Feeling a pain in your body, mentally thinking it away with "I am not in pain" can be a compulsion. Some people are doing this as result of CBT i.e. this is just pain, it's just anxiety, I am fine. That's different. If the need to think "I am not in pain" feels quite automatic to you, it's a compulsion. It may also come in the feeling of an urge.

If you see an article about cancer and then your mind is telling you that you are now at a higher risk because of reading it, that's Magical Thinking. Then a compulsion will come to mitigate the risk. Many HA sufferers can't watch the adverts or read articles but it's where you have compulsions which will show it as OCD more. So, what do you do when you see them? Does it spark your mantras/statements? It starts off the thinking about increasing your chances and then what comes next? It may be a mental compulsion that you are not aware of if your mantras/statements don't happen.

Avoidance is something common across the board with anxiety disorders, it's a basic response to the fear. It's probably less a compulsion though and more a behaviour since you will not seek to engage in the compulsion of avoiding, it will just be something that you do all day i.e. I don't buy any more magazines, I want watch certain channels, etc. If it were compulsion, it would be a triggered response to something like with your mantras/statements or when you feel the urge to seek out reassurance.

I think your therapist needs to reassess all this. It doesn't seem to be fitting Somatoform Disorder, it definitely would fit OCD though.

[JosieLouise]

Being afraid of the tests could easily fit into GAD too but can be OCD. The majority of people who post in here seem to want to see a doctor but there are a small number of HA sufferers who do anything to avoid tests due to anxiety increase of them or worry over the results. Of course, many have the worry over waiting for results but they are
usually more willing to approach a doctor in the first place.

When I'm worried about a symptom, I do feel the need to rush to the doctor but only because I know I will more than likely be reassured and then that will reduce my anxiety. My biggest fears are both a) going to the doctor and being sent for tests/having to wait for results and b) not going to the doctor and have something progress and get worse. It's a massive Catch-22 in my brain.


Feeling a pain in your body, mentally thinking it away with "I am not in pain" can be a compulsion. Some people are doing this as result of CBT i.e. this is just pain, it's just anxiety, I am fine. That's different. If the need to think "I am not in pain" feels quite automatic to you, it's a compulsion. It may also come in the feeling of an urge.

If you see an article about cancer and then your mind is telling you that you are now at a higher risk because of reading it, that's Magical Thinking... So, what do you do when you see them? Does it spark your mantras/statements? It starts off the thinking about increasing your chances and then what comes next? It may be a mental compulsion that you are not aware of if your mantras/statements don't happen.

I had a situation today, actually. I was in Starbucks and saw a woman who had clearly lost her hair due to chemo and was carrying a Cancer Research bag. I was immediately very uncomfortable and didn't want to look in her direction, and left the shop shortly after. I didn't immediately think 'I saw a woman with cancer, therefore I will get cancer'. That came later as I analysed a bit more. The in-the-moment thought process was more of a fight-or-flight, I need to get away, type of feeling.

I walked back to the car and as I did so, felt a strange dizziness for a couple of seconds, where I felt like my head was floating away from my legs. It passed very quickly. Straight away my brain automatically CBT-ised it. I rationalised the initial thought of 'tumour' to the fact that it was 1pm, I hadn't eaten anything yet, all I'd drunk was 2 cups of coffee, I'd been walking a lot, it was warm, and I was anxious.

Then as I got back to the car, I walked past a woman collecting for Marie Curie. I didn't like the fact I had to walk past her to get to my car. The three triggers together - seeing the woman with cancer, feeling dizzy, woman collecting for cancer charity - was too much for me and I began a mantra ('I am healthy') to try to calm myself down. I didn't feel an uncontrollable urge to do it; there was a very clear thought process there. Analysing it, I thought that by saying this I could prevent myself from having another dizzy spell and whenever I got distracted and stopped saying it, I felt a little more nervous. I'm not sure if I would have done this if I'd only seen the woman in Starbucks and not felt the physical sensation afterwards. Right now I haven't repeated the mantra for a while, but writing about it is making me feel like I want to again.

Generally, after seeing something like an article, or an advert or someone who is ill, I have an increased urge to check my body physically and analyse physical sensations 'just in case'. It triggers the checking. A physical sensation will trigger the mantras as I tend to believe I can prevent it from reoccurring by doing so. I feel like I may engage in other mental compulsions but I can't quite identify exactly what they are.

I'm beginning to feel like OCD fits far more than Somatoform, although when I'm preoccupied with a very physical symptom eg. a lump, more somatic symptoms do creep in as I start believing I have a specific illness.

Once again Terry, thank you for taking the time to explain this all to me.

[SLA]

I wouldn't consider it a diagnosis.

I think there is a little bit of OCD in everyone who suffers with anxiety. Especially health anxiety. Some people obsess over external things like the cleanliness of their house, some obsess over their thoughts, and some obsess over bodily symptoms.

You should be reassured to know that a lot of what you describe I have experienced myself at various points in life. I just chose to obsess over the things I can control, and the things I want to happen. Doing the opposite is what causes anxiety and worry.