Health anxiety is more than just worrying about your health

Do you ever wonder what is that painful niggle and could it be something serious?

Evidence has shown that health anxiety seems to be on the increase ever since Covid (National Institute for Health, 2023). This isn’t surprising considering the strong messages around health that the world had to grapple with particularly in the initial stages of Covid. Throw in the uncertainty around Covid’s impact at the beginning of the pandemic and you have the makings of a traumatic global health event.

But what is health anxiety and how does it manifest?

Maybe a more familiar term is hypochondria. However, this historical term belittles the experience of some people who suffer acute worry around their health and views them as an “attention seekers” or fantasists. In 2013, the American Psychiatric Association formally adopted the term "illness anxiety disorder" to describe people with disproportionate and debilitating concerns about their health. In the medical literature, health anxiety is often used as an alternative term.

In terms of how it manifests, some people think they have a life-threatening condition. They believe “something is wrong!”. They go to the doctor to seek reassurance and even if get reassurance they think the doctor has missed something. Something has changed, they feel different. Why can’t they explain it? This can lead to searching on Google for hours on end researching their symptoms and falling increasingly into despair. People with health anxiety even exacerbate their symptoms and adopt avoidance techniques such as cancelling plans and avoiding contact with other people. This can ultimately lead to withdrawal from their normal lives and depression.

How can therapy help?

Therapists can get into the mindset of the health anxiety sufferers by imagining what it must be like to experience that anxiety. An example is someone who suffers from frequent headaches might interrupt that as a brain tumour; IBS might be construed as colon cancer; palpitations as a heart attack. To the health anxiety sufferer, the worst-case scenario is this is what they believe they have.  The automatic response is to catastrophise. The “what if…..” which can provoke fear and acute anxiety.

Therapy can be used to reframe the automatic belief about the symptoms. What alternative could be more benign?  What more rational explanation could there be? Tense muscles could result from sleeping awkwardly. Back ache could be poor posture. The therapist isn’t diagnosing, but presenting that there might NOT be the worst-case scenario. Additionally, the client could be going through some emotional trauma that contributes. The therapist can help them to seek a sense of control by looking at what else is going on in their lives. If they are feeling overwhelmed and tense, what coping strategies do they have? This is not to detract from genuine concerns over health where evidence that suggests the client should treat advice and treatment, but those concerns are based in reality rather than the automatic belief that something terrible is wrong.

Another strategy could be to challenge the client in terms of what is fact and is imagined. For example, if the client interprets their sore throat as throat cancer, what evidence and facts do they have to support this. Could it be proven in a court of law? Empathic questioning in this way gives the client the permission to question whether their health anxiety has any foundation based in fact. We need to give the logical part of our brain more power by focusing on what are medical facts rather than the possibles promoted by Google in our imagination. In the latter situation, the emotional brain of the health anxiety sufferer will react to triggers which lead to inaccurate conclusions.

We may have come a long way from dismissing the "hypochondriac" as a sad attention seeker – but many are still facing their anxieties alone without receiving the support and help really need.