Improving our understanding of health anxiety

Health Anxiety occurs when the fear of being ill or becoming ill interferes with daily life. Throughout the course of my career, I have specialised in the assessment and treatment of health anxiety whilst campaigning to encourage understanding about the condition itself. Although health anxiety is becoming more recognised within health care and primary care practitioners, there still exists some fundamental assumptions about the condition which remain untrue.

Stigmatisation

The classification of health anxiety was previously referred to as hypochondriasis, meaning that many of us are familiar with the insult “you’re just being a hypochondriac”. Unfortunately, the stigma associated with this term has meant that health anxiety as a disorder is frequently ignored or treated as a personality type rather than the reality of its debilitating anxious symptoms.

Health anxiety sub-types

Health anxiety is a term used to collectively categorise two main sub-types of disorders: illness anxiety and somatic symptom disorder. Illness anxiety relates to the belief that a person will develop a specific illness such as HIV, cancer or multiple sclerosis.

Somatic symptom disorders on the other hand are typically related to the catastrophe misinterpretation of physical sensations (such as the belief that back pain is a symptom of a deadly illness.)

Symptoms of health anxiety

To understand health anxiety as a disorder, we first have to identify the symptoms of a disorder. It is important to remember that the majority of us will experience some worry about our health – we are all human after all.

For individuals with health anxiety, the term ‘disorder’ categorises a persistent and amplified worry that interrupts daily tasks, activities and interactions.

I have seen first-hand the challenges that individuals living with health anxiety experience, from making excuses not to attend events, to being unable to sleep at night due to constantly thinking about the worst possibilities of their health. Typically, health anxiety presents itself in different ways for most people, however, there are common symptoms within most including:

• constantly thinking or worrying about your health
• frequently checking for bodily changes including lumps, moles or painful areas
• seeking reassurance from friends or family that you are not ill
• concerns that medical professionals have missed something in their tests
• avoiding medical-related TV programmes, news articles or posters
• obsessively reading forums online or ‘Googling’ symptoms

Treatment

Within my practice, I have seen individuals progress from debilitating health anxiety symptoms to the ability to brush off negative thoughts within a fraction of a second. My main approach is cognitive behavioural therapy (CBT), a talking therapy that supports individuals in understanding, identifying and challenging their health beliefs.

It is important to remember that the goal of CBT is not to ‘completely stop worrying or thinking about my health’. From time to time it is important to be concerned about our health, and most importantly we don’t have control of what thoughts ‘pop into our head’. Try your hardest not to think about a pink elephant and you will quickly realise that the more we try not to think about something… the more we think about it. This is why within CBT, it is important to weigh up the evidence both for and against our thoughts and reach a more rational outcome that supports us in living a life that is aligned to our goals.

My top tips

When addressing health anxiety, there are three main components that I emphasise to clients:

1. Identify what helps you to relax and use this to combat the anxiety

There is a range of relaxation techniques that you can utilise in order to reduce anxiety. My personal favourite is 4-7-8 breathing (this is where we breathe in through our nose for 4 seconds, hold for 7 seconds and slowly exhale for 8 seconds)*.

What this allows us to do is activate the calming regions of our brain, helping to reduce the fear response that we experience.

2. Limit, and where possible, alleviate internet searching

A particularly strong maintaining factor for health anxiety is unverified information that can be found online. By limiting the time spent searching for symptoms of particular conditions, we begin to put out the anxiety’s fuse. If you feel that you need to search online, always try to use verified sources such as the NHS website.

3. Challenge your beliefs by asking ‘what is the evidence?’

Finally, it is important to begin to question some of our existing beliefs. There are many ways that we do this in CBT, however the most simple is to write down firstly what your main anxious thought is. An example could be “I think that my headache is a brain tumour”. Then write down what facts or evidence suggests that this thought is true, and the facts or evidence that suggests this thought is false. Finally, remove any statements that you have written down that are opinions rather than facts.

This process should allow you to understand whether the thoughts you are experiencing are constructed by our opinion or the true facts. Most often with health anxiety, once we have written down the facts, we will gradually understand that there is no strong basis for the worries that you are experiencing.

If you believe that you are experiencing health anxiety or feel that your symptoms are getting in the way of your day-to-day life, feel free to send me a message and we can discuss how we could work to support you moving forward. Alternatively, get in touch with your GP or healthcare provider to share your concerns and begin your recovery from health anxiety. 

*If you have any concerns about using breathing techniques always consult with your GP prior to using the exercise.