This blog post focuses on the topic of health anxiety – a sneaky form of anxiety that can show up at any point in life because, after all, our physical bodies can be noisy, ill, confusing to us and/or doctors, and subject to aging, disease, and, eventually, death. It’s estimated that 20-30% of Americans are preoccupied with their health and that one-third of those with chronic illnesses have a high level of health anxiety (6-8% of the US population is diagnosed with a health anxiety disorder). But, what differentiates “normal worry” about health from “preoccupation” from “health anxiety disorder”? Here’s some points to consider:
1) Level of dysfunction: How much does thinking about your health interfere with your life or ability to function? Are you having trouble sleeping at night? Do you avoid going out, socializing, or traveling? Are your relationships being impacted by being avoidant, non-commital, scared, or talking repeatedly about your health? Are you having difficulty concentrating in school or work? Did you have to stop working or going to school because physical symptoms dictated what you did each day?
2) Level of avoidance: Related to the above points, a defining feature of anxiety is behavioral avoidance. For instance, if someone fears having a heart attack because of heart palpitations or an abnormal EKG, he or she might avoid exercising or lifting heavy things to avoid elevating his or her heart rate. For an IBS patient, he or she might avoid going out to eat with friends, drive in a car or be anywhere where the bathroom is not close. Avoidance creates the perception of safety but actually reinforces the fear in the long run.
3) Level of mental rituals: When a thought or singular episode of worry becomes repetitive, cyclical, or prolonged, it can signal pathological health anxiety. What starts out as productive problem-solving (for example, “I have numbness in my left leg, I should call a neurologist to have it checked out”) turns into rumination, which is a form of unproductive stewing that consumes a large degree of time, energy, and focus. Ruminating has 2 goals – to reduce distress or reduce uncertainty – by trying to achieve an “aha” moment of understanding. But, instead, ruminating is a tease – it’s like trying to solve a 1,000 piece puzzle but you’re missing pieces and you don’t even know it; you can’t solve the puzzle and you’ll get more upset the longer you try.
Health anxiety can be treated by a clinical or health psychologist in an outpatient setting, optimally in collaboration with medical providers. It’s important to remember that a person’s experience of physical symptoms and/or sensations is real and of course warrants legitimate medical evaluation before being viewed through a health anxiety lens. A combination of structured “talk therapy” (cognitive-behavioral, motivational interviewing) and exposure therapy targets the thinking and behavior patterns that undermine functioning and good quality of life. Research suggests that psychotherapy is successful in 60-65% of cases and medications for anxiety symptoms aid in 40% of health anxiety cases. This is a reminder that, like any chronic medical condition, there is no one singular solution but that good long-term management requires multiple tools, resources, and providers in the mix.
If you or someone you know is interested in a consultation appointment or treatment for this issue, call our office 732-788-7645 to schedule an appointment with a clinical health psychologist.
Dr. Lauren Gashlin
Health Psychologist