According to Harvard Medical School, health anxiety is a relatively common condition, affecting around 4%-5% of people. However, experts believe it may be underreported. Indeed, Dr. Timothy Scarella, instructor in psychiatry at Harvard Medical School says that the percentage could be closer to 12% — or even twice that. That means it could be somewhere between 20-25% i.e. one in four or five people.
As we’ve looked at in several of our previous blogs, the ongoing coronavirus pandemic and associated lockdown have been taking their toll on everyone’s health — especially our mental health. This creates a double whammy, there’s a heightened sense of anxiety in our society and it’s around health.
The initial uncertainty and prolonged lack of social contact will have been causing many to feel stressed and overwhelmed. But this is now being exacerbated by the simple fact that we don’t know when it’s all going to be over.
Then there is the actual threat of the virus and the risk of becoming unwell. With everything that’s going on, the first sign of a cough, runny nose or sore throat could cause alarm bells to ring — even though the chances are it’s not Covid.
Nevertheless, the fear and either irrational or disproportionate thinking that can occur as a result of physical symptoms (at any time, not just during a pandemic) can make matters worse. It’s known as health anxiety and it’s the focus of our post today.
Let’s start by looking at what health anxiety is and how common it is.
What is health anxiety?
Anxiety is when thinking goes from being helpful to being unhelpful. In a nutshell, health anxiety, sometimes also referred to as illness anxiety disorder, is when someone worries excessively that they either are or may become seriously ill.
Health anxiety can occur regardless of whether a person has any physical symptoms or not, although it usually tends to manifest when someone believes that normal body sensations or minor symptoms are signs of severe illness; even though a subsequent medical examination finds nothing seriously wrong.
The anxiety caused by a relatively minor symptom, like tiredness, a stomach ache or a muscle twitching, because the individual thinks it is something more serious can result in life-changing distress.
The health anxiety can also show up as anxiety around significant or major symptoms but there it shows up as disproportionate thinking as in we’re not able to stop thinking about what’s going on with our symptoms and can feel a loss of control in terms of where our focus and attention goes.
How common is health anxiety?
Interestingly health anxiety is unlike many other anxiety disorders in that it appears to affect both men and women equally.
It’s also worth noting that the aforementioned Harvard piece was originally published in September 2018 and subsequently updated in April 2020. While the Covid-19 pandemic was already upon us in April, its full effects perhaps weren’t being felt. Here we are now in October and the end of lockdown still remains unknown. This factor alone will be having a detrimental impact on people’s mental health and will be causing Covid-19-related health anxiety.
In fact, health anxiety in the face of Covid-19 has become so prevalent that it is the subject of a recent World Psychiatric Association (WPA) research paper. Poignantly, the paper highlights how traditional health anxiety often sees sufferers seeking advice from medical personnel because they doubt their own ability to monitor their health properly. With Covid-19, though, doubt surrounding the accuracy of tests means even a negative result will not allay fears.
What does health anxiety feel like?
Health anxiety is when a person thinks that a symptom or sensation is a sign of a much more serious problem. The problem with unhelpful thought patterns is that they only serve to make the situation worse. It’s classic snowballing, where we think a single unhelpful thought which then turns into an avalanche of negativity — much like how a snowball rolls down a mountain, gathering speed and size as it goes, becoming like an avalanche of unhelpful thoughts.
So something like a swollen lymph gland in the neck, which is often a sign that our bodies are trying to deal with an infection, illness or even stress, can spiral to where the person is convinced they have cancer and the prognosis isn’t good. This is the kind of irrational and unhelpful thinking people experiencing health anxiety can exhibit.
Here are the most common symptoms of anxiety :
- Heart pounding
- Shortness of breath
- Dry mouth
- Stomach pains
- Muscle aches/pains
- Inability to relax
- Excessive worry
- Feeling “on edge”
- Vivid dreams
- Mind racing
- Mind going blank
- Difficulty concentrating
- Decreased memory
- Obsessive or compulsive behaviour
- Phobic behaviour
- Avoidance of situations
- Distress in social situations
- Neglecting personal care
- Eating more or less than is usual and necessary
You can read more about snowballing and other unhelpful thought patterns and how to address them in our “What am I making it mean” blog from April.
Where does health anxiety come from?
Health anxiety primarily stems from a lack of trust in your own ability to deal with what’s going on when you have symptoms or unfamiliar physical sensations and a lack of understanding in terms of what that information means. To reduce health anxiety, we need to look across both these fronts as well as have some First Aid for Feelings and practical strategies (see below).
As you’ll know from reading our blogs, here at the Helpful Clinic, we always adopt a 3D approach to health and recovery; one that focuses on biology, psychology and social context, referred to as the BioPsychoSocial model.
It’s important to look especially at both physical and mental health when dealing with health anxiety because the two are so closely linked in this context. That’s because health anxiety usually begins with a physical symptom or sensation that is unfamiliar or scary. And with the social dimension of Covid and how we culturally deal with health this can become a complex experience.
While any symptom should be acknowledged and investigated — after all, feelings are information and it’s better to be curious about them — a proportionate and appropriate approach should always be taken. However, people with health anxiety will often automatically fear the worst and either display signs of denial/dismissal or go into hyper alert, neither of which are helpful.
As we talked about in our last blog (here), it’s important to be aware of the indicators that signify that something is going on. Wether it is your own indicators or the indicators for the people around you — much like the dashboard lights in a car — knowing what to look for and what it means is vital. If you didn’t know what the engine light means, you wouldn’t be able to take appropriate action.
How much do you know about how your body works?
Have you ever stopped to think about how well you know your own body?
Something that’s important to understand is how your body spends some time in a stress state and some time in a maintenance state. The switch between these two states in healthy bodies is effortless, with healthy people able to switch from one to the other as is needed. But people experiencing health anxiety can get stuck in the stress state more of the time. This then in turn ramps up the symptoms which then fuel the anxiety and so you get stuck in a cycle that can be hard to get out of with detrimental impact on both mental and physical health (and can affect your social health).
You can read more about both states and why our bodies switch between the two in this blog.
Consider: what messages do you normally get from your body and how does your body communicate to you? Remember, symptoms and physical sensations are the body’s only way to communicate to you whether things are okay or not? That’s why it can be helpful to treat physical sensations as a language or a way of making sense of things.
With that in mind, how well do you understand your body’s language? Your body only has a limited range of symptoms to let you know what’s going on; aches and pains being classic, common examples.
It’s important to check in with yourself and see how well you understand how your body is communicating to you. While health literacy — which we looked at in our Black health also matters blog — is primarily about being able to access and understand health information, it can also be applied to being able to understand and interpret your own body.
What do symptoms mean?
Part of learning about your body and your health is also to educate yourself on how to recognise different symptoms and what they are telling you. This graph below is an example of how to see at a glance how symptoms and specific sets of symptoms mean different conditions. Knowing what condition you’re dealing with then let’s you know what action to take. If you’re struggling with asthma, it’s unlikely that an anti-histamine will help.
Investing your time and focus in learning about your health and symptoms, you’re placing yourself in the driver’s seat of your experience and can confidently take the most helpful action without going into anxiety or relying solely on health professionals.
Going back to health literacy, if you are informed and literate enough to understand the symptoms of Covid-19, chances are you won’t experience health anxiety if you suddenly get a cough, runny nose or sore throat. But for those who are less informed and aware, such symptoms could immediately trigger unhelpful thoughts and anxiety associated with thinking you have Covid-19.
Get curious and learn your body’s language
Ever considered that the dynamic between you and your body as a communication? Tackling health anxiety isn’t just about educating yourself about symptoms and conditions. It’s also about the quality of the communication between you and your body.
When Peter was small, his family took him on holiday to Moscow. They wanted to know how to get to Red Square, so Peter’s father decided to ask a Russian stranger the way. The problem was that Peter’s dad didn’t speak any Russian, and the stranger obviously couldn’t understand a politely worded “Could you please tell me how to get to the Red Square?” question spoken in English.
Years later, Peter, who struggled with pain and fatigue, as well as feelings of anger and frustration, found this memory helpful in helping him to understand how he himself communicated with his own body. It was as though, through his symptoms and emotions, his feelings were speaking Russian to him and he couldn’t understand. The more he railed at his feelings and shouted, the more they ‘shouted’ back.
Instead of carrying on shouting, Peter decided to learn the language of his feelings and develop his own dictionary.
Have you ever thought about the relationship you have with your body?
Getting curious and learning your body’s language is a helpful step. At the end of the day, your relationship with your body is the only one that’s with you every breath of the way through your whole life. Yet most people have never stopped to consider the kind of relationship they have with their bodies.
Exercise: Describe your relationship with your body in one or two words
What if the roles were reversed, how would your body describe your relationship? Loving? Abusive? One-sided?
The bottom line is if there is little or no trust in the relationship you have with your body, there is much more likelihood of experiencing health anxiety. Take the time to focus now and improve the relationship so you can better trust and move forward in a helpful way with the things you’re feeling anxious about.
It’s important to take some action before health anxiety spirals to the point where it becomes detrimental. This can include getting opinions from clinicians or friends on what originally triggered the health anxiety, be it a shoulder injury, urinary tract infection, whatever.
Some people can become so worried that they don’t take any action and end up avoiding or dismissing their own experience. This rarely helps as it means that the anxiety is more likely to escalate unattended until it bursts and the risk is that whatever was triggering the original anxiety is left unattended and may get worse and need a more invasive or extensive treatment.
A more constructive step is seeking advice and beginning the process of getting the symptom investigated is. Such an approach will boost the chances of nipping it in the bud early on. It can also be helpful to look at unhelpful beliefs or fears and rather than dismiss them, work through them to establish a more helpful belief. This can be hard to do on our own and so talking it through with someone you trust (this could be a professional) is much more likely to be helpful and actually shift the beliefs and the thinking.
How to stop health anxiety symptoms: some useful self-help measures
Fortunately, there are a number of self-help measures that can be beneficial when faced with health anxiety.
Keep a diary
- Make a note of how often you check your body, look up symptoms online and/or contact your GP for reassurance
- Slowly and gradually reduce the number of times you do these things over a week
Check your thinking
- What kind of thoughts are you having?
- Are they helpful?
- What would be more helpful?
Notice your behaviour
- Are you acting differently?
- Some people tumble into despondency, while others enter a state of denial/dismissal or being ‘busy’
Keep yourself active
- Keeping yourself active and resuming as many of your usual activities as is practical can help to take your mind off the symptom, providing some relief from your health anxiety
- Look after the structure of your day so that there’s a consistent and steady rhythm to your day and your week. This includes bedtimes and mealtimes.
Come back to your body
- Do things that make your body feel comforted, like putting on your favourite sweater, snuggling up on the sofa with a hot water bottle, have a bath with Epsom Salts etc.
- Paying attention to your body. This Finding Your Feet meditation on Insight Timer – Mindfulness of finding your feet, is designed to reassure and soothe your body (which will help shift from the stress state to the maintenance state).
Experiment with relaxing
- Use music, movies, views or even going for a walk in nature. Here’s a link to a post from the National Trust about the benefits of walking in nature.
- Take advantage of meditations to help you do this. This meditation: Moving from Stress to Helpful Choices and Action is designed to shift to a more relaxed state .
Thoughts just like feelings are information and that applies to health anxiety. Remember anxiety is thinking that’s become unhelpful as in when a potentially health worry becomes excessive and you’re stuck in the stress response.
Invest in your ultimate relationship
Jon Kabat-Zinn, the creator of Mindfulness Based Stress Reduction (MBSR) titled one of his books Wherever you go – there you are. Your own relationship with yourself and your body is the only relationship that truly lasts your lifetime. Nobody else is with you every moment of every day. Use the time you’ve got and the health anxiety that’s showing up now as an opportunity to learn your body’s language. Learn about yourself, your psychology, your fears and your body’s communications through symptoms and sensations. This way you are in a more informed position the next time a symptom appears. This issue now then becomes an opportunity that will stand you in good stead as you move forward with your health.
Go gently, hold steady, stay the course.
All the best, Thor
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