When concern for your health becomes anxiety
While having some concern about our health is normal and generally helpful, some people are excessively and obsessively preoccupied with their health, to the point where it interferes with their life, including work, study, relationships and daily life, resulting in significant distress.
This is preoccupation with health and illness, and particularly that they have symptoms of a serious illness, is the hallmark of ‘illness anxiety disorder’ or health anxiety. Health anxiety can develop in people that are ‘healthy’, as well as those who have a real medical condition with physical symptoms that are excessively distressing to them (the latter is termed ‘somatic symptom disorder’). However, I will be focusing illness anxiety disorder here.
Of course, with the symptoms of COVID-19 constantly in the media and in the forefront of many people’s minds, anxiety and distress about health has been amplified, and this is particularly so for those who were already preoccupied with their bodily sensations and health.
Some of the main symptoms of illness anxiety disorder include:
· Excessive preoccupation with having or coming down with a serious illness
· There are no, or mild, physical symptoms
· Anxiety persists despite receiving negative results on medical tests and reassurance from medical professionals
· Health-related behaviours such as:
o Repeatedly checking your body for signs of illness
o Either avoiding, or frequently seeking reassurance from, medical professionals
o Searches for information about illness symptoms
o Avoiding situations or stimuli that are perceived as anxiety-provoking
What keeps illness anxiety disorder going?
There are a number of factors that can contribute to keeping us stuck in a health anxiety state. These include cognitive factors, including interpretation of bodily sensations, or worry), and behavioural factors such as checking, avoidance and reassurance-seeking.
Unhelpful thoughts and beliefs
· Misinterpreting harmless bodily sensations as a threat (indicating serious illness) can lead us to pay more attention to those sensations, which can amplify their intensity. This increases anxiety, and then the symptoms of anxiety (e.g. breathlessness, chest tightness/pain, faintness) are interpreted as a further threat and worried about.
· Worry and repetitive thoughts keep the fears ever-present. Intrusive thoughts and images can be upsetting.
· Trying to dismiss or get rid of unwanted thoughts and doubts can make them come back stronger.
· Thoughts about perceived symptoms become distorted or inaccurate, leading to overestimation of the probability of having or developing a serious illness, and underestimation of ability to cope with illness.
Avoidance, reassurance and checking behaviours
· These are things that you do to help you cope when you feel anxious, or to try and prevent feelings of anxiety from occurring.
· For example,
o Avoiding hospitals, medical appointments, sick people, or reminders of illness such as TV or newspapers. Or avoiding anything that gives you bodily sensations that make you anxious, such as exercise, coffee, or specific foods
o Keeping a mobile phone or companion with you, or staying close to hospitals, in case you have a health emergency,
o Information and reassurance seeking, such as repeated medical consultations and tests, searches for information
o Checking. For example, of your body or memory. Checking is unhelpful in that it keeps your focus on your worries, can lead you to see a problem where there isn’t one, increases uncertainty or doubt (leading to more checking!), and can actually lead to symptoms (e.g. constantly feeling an area of the body leads to tenderness or redness).
· Avoidance, reassurance and checking behaviours can feel good and provide relief initially, but in the longer-term they stop you from learning that you can survive without them or whether your fears are real, and they often lead to needing more reassurance and not being able to cope with anxiety symptoms and uncertainty.
Tips for if you find yourself preoccupied with bodily sensations
A core feature of illness anxiety disorder is that harmless bodily sensations are misinterpreted as dangerous and threatening and become a focus of attention. This misinterpretation of sensations is key.
Tip #1: Explore the relationship between your bodily sensation and your focus and anxiety. Notice if your experience of the bodily sensation changes as your anxiety rises and falls, or if your focus on the physical symptom is triggered by anxiety thoughts (e.g triggered by something in the news or hearing about someone else’s illness). Try focusing on your stomach for a minute and noticing any physical sensations (e.g. gurgling, tightness). Had you been aware of these sensations before you focused your attention on them? Did the sensations appear to increase over the time you focused on them? By observing and understanding how attention and your anxiety may impact your experience of physical sensations, you can start to change this relationship.
Tip #2: To further test the connection between bodily sensations, anxiety and attention, try focusing on how a ‘safe’ part of your body feels (e.g. your left thumb), and notice how your attention wanders when the sensations are interpreted as unimportant and ‘safe’.
Tip #3: Learn and practice mindfulness in everyday tasks to learn how to focus your attention on the here and now. Move your attention from your body and its sensations, and focus on whatever everyday task you are doing (e.g. doing the dishes, eating, vacuuming, having a shower). Focus on your senses (what can you see, hear, feel, smell, and taste? notice the details), and gently bring your attention back to the task whenever you notice that your mind has wandered (which is perfectly natural!).
Tip #4: Set aside time to worry. Focusing on worries, including trying to stop worrying, can create more worries and symptoms. One strategy for tackling worries is to postpone them. To do this, decide on a set time, place and length of time (no more than half an hour and not just before bed) that will be your ‘worry time’. Then, when you notice a worry or focus on a symptom, write it down (briefly) to worry about later, and then bring your attention back to whatever you are busy with. Remind yourself that you will be able to come back to your concerns later. When you get to your ‘worry time’, only think about the worries on your list that still seem really important at that time (some things might seem less important or no longer relevant), and do not worry for longer than the time set (you can carry items over to the next day’s worry time if necessary).
Tip #5: Remind yourself that while any anxiety symptoms may feel unpleasant, they cannot not hurt you, and will pass. Try using distress tolerance strategies to get you through the wave of anxiety. For example, use relaxation (e.g. calm breathing) or mindfulness strategies, engage in distracting or soothing activities, or use your senses to ground you in the world around you (what can you see, hear, feel, smell, and taste?).
Of course, while the above tips can be helpful in starting to address illness anxiety disorder, you should still speak with your doctor about any concerning symptoms. If you need guidance as to wen it is appropriate to seek medical attention, it may be helpful to agree on some guidelines with your doctor.
These tips start to address some aspects of health anxiety – the focus on, and misinterpretation of, bodily sensations that often occur. However, the many unique factors experienced by those affected by health anxiety can be addressed successfully and more fully through individualised psychotherapy approaches, such as Cognitive Behavioural Therapy (CBT).
