Health Anxiety

I took a poll some time ago gauging if health anxiety as of late has been heightened, and the answer was a resounding – YES! I thought it may be useful to provide tangible ideas to help soften some of these sensations.

First and foremost – what is health anxiety?

Health anxiety is typically broken down into two categories: somatic symptom disorder and illness anxiety disorder. The first involves focusing on physical symptoms (ie chest pain, dizziness, shortness of breath) that then result in distress and intrusive thoughts of feelings. The second  is a persistent fear of having a serious or life-threatening illness despite few or no symptoms.

Oftentimes the symptoms of each result in an obsession over bodily functions, physical changes or sensations (ie skin blemishes, rashes, headaches, stomach aches, dizziness, chest pain). Fears are associated with an organ or particular diagnosis with a predominant emphasis on already having or contracting a serious illness.

First and foremost, I never advocate for ignoring these symptoms. The sooner you can ask for help from your provider the better. There are some things in medicine that are known as “red flags,” meaning you should seek help imminently – more about that in this post.

As a provider, I start the appointments by first listening to symptoms, and then triaging based on number of symptoms. Often it takes more than one appointment to properly address each concern, so close follow up is important here. In brief, the first appointment is dedicated to listening and potentially lab work or an EKG (depending upon if it’s the first time a patient is presenting with health anxiety. Repeated testing for similar concerns often doesn’t help and can perpetuate symptoms). The second appointment is reviewing lab work in detail and providing detailed recommendations and/or referrals. The subsequent appointments are typically check-ins to see how things are going.

Rather than making this post about my experience as a provider, I wanted to dedicate a bit more space to reviewing why these symptoms may occur. I came across this blog post by Ken Goodman, a therapist specializing in OCD and anxiety and I thought the metaphor was poignant.

“Car alarms are set off when someone breaks in but imagine how problematic it would be if the siren blared each time a pedestrian walked by.  The car alarm would be misinterpreting signals.

With health anxiety there is the misinterpretation of discomfort and normal bodily sensations as dangerous. The body is very noisy. Healthy human bodies produce all sorts of physical symptoms that might be uncomfortable, unexpected, and unwanted, but not dangerous.

Normal sensations in the body that can produce fear and worry include changes in visual acuity, heart rate, blood pressure, saliva levels, depth of breathing, balance, and muscle tone, just to name a few. These are normal and harmless bodily changes, but when a person believes they are symptoms of a terrible disease, it causes anxiety. The sensations are real, but the beliefs are false.”

How I explain this to patients – the initial symptom causes a shift in the nervous system from parasympathetic (rest and digest) to sympathetic (fight, flight, freeze). Your body interprets something non-harmful as harmful and then the cycle continues – the heart beats faster, breath continues to get more shallow – and what may have started as a whisper of a symptom turns into a roar. And then BECAUSE you’re already wary about that symptom, you begin to notice it more and more. It can be quite a crippling and paralyzing experience.

Research has shown that the most effective treatment is cognitive behavioral therapy. This is a modality of therapy that many clinicians use. CBT aims to recognize and challenge irrational thoughts sooner to then overcome fears and address maladaptive behaviors. Check out this post to help navigate finding a therapist.

While finding a therapist can be somewhat of a longer process right now, there are some things you can do in the moment to help with health anxiety.

1. Challenge the thought. Remind yourself that thoughts are not facts. Start noticing your thoughts and identifying which ones are negative. When stuck in a negative thought cycle, it’s difficult to have perspective and identify how our thoughts are affecting us. And further, repeatedly thinking these thoughts solidifies them as “truth” in the mind. Gaining a bit of distance from the thought and challenging it can be quite helpful! For example, if you have a thought like “there’s something wrong with my heart”, you can reframe it by instead thinking “I’m only experiencing a small discomfort in my chest in this moment.”
2. Get busy. Try to take your mind off the thought (and to avoid spiraling into a WebMD black hole), do something that utilizes your hands and brain. Clean out a cabinet, vacuum, make a new recipe, try an art project like painting or sewing, do a crossword, get outside for a walk. By shifting attention to something else, often the noise of anxiety dims.
3. Tap into mindfulness. Mindfulness focuses on the current moment, rather than being consumed by things of the past or future. Deep breathing, listening to music, or trying a guided meditation can all be powerful acts of reminding yourself to be present.
4. Stop googling your symptoms.
5. Do something every day that actively improves your health. Sleeping and waking at the same time, eating meals regularly, moving your body in a way you find joyful, staying hydrated – all of these really help mitigate health anxiety! Sticking to a routine is also quite helpful.
6. Do something in the moment to help ground. Vagal nerve stimulation is always wonderful (think: singing, humming, screaming, laughing, or putting an ice pack directly on your chest)!

I also polled from you and got such wonderful and thoughtful responses!! Including them all here!

• make a list of ways that I can/have care for my body. Use a mantra such as “I am okay right now and that can be enough.”
• Using Just Answer – paid a doc to calm my mind despite knowing the answer
• I did CBT for health anxiety – it was helpful!
• I focus on my breath or watch TV to distract my mind
• I try to remind myself m body will always find her way back to baseline
• I do yoga, walke, read
• As with feelings, aches, and pains – they come and go, I check in and spend time in gratitude for my body
• I try to be more mindful of nutrition choices
• I slow down when I am able. I workout at least 30min/day
• My boyfriend no longer lets me use Dr. Google so he does and consoles me that I’m fine
• I try to focus on what I can control
• Positive self talk, knowing I’ll get through it, always have, and I’m smart enough to make good decisions. Breathing through it and feeling the feels.
• Taking way more vitamins/nutrient dense foods.
• My therapist recommended I focus on what I can control to stay healthy. Then try to release the fear and know that if I do get sick I’ve done all I can to protect myself.
• therapy and medication helps!
• Therapy and schedule and canceling appointments with my PCP because I’m too busy being a PCP myself.
• therapy!
• Drinking water like a fiend and taking vitamin C.
• Go for a walk outside even if it’s cold, call a friend/family member to snap out of it.
• I try not to google it and call my mom for reassurance that I’m okay.
• CBT exercises can be super helpful for me!
• Movement, nourishing food, more mindfulness!
• I take more immune support supplements and whole foods for peace of mind.
• Carry a thermometer in my purse. I also notice I feel way better after drinking water.
• Exercise to feel strong in the moment so when things pop up later I remember what I did!
• I try to give myself the day to see how it goes then contact my provider if it’s something. that lasts or I can’t stop thinking about. I’ll also talk to one of my parents about it and get their opinion.
• I take magnesium at night and deep breathing. 2 minutes, 2x daily.
• I try to count or think of all the ways I KNOW I’m healthy.
• Talking it out / getting reassurance from friends and family.
• Talk to someone who is calm/not an overreaction about it!
• Reasoning with myself and exercising help me!
• I try to distract myself (call a friend, go on a walk).
• Try to avoid the internet.
• I exercise, drink water, take vitamins and do things that make me feel healthier. Anything to make me feel like I’m contributing to my immune system’s fight!
• I say to myself, “huh, interesting. I wonder what else this could be from.”
• Therapy, meds, massage, yoga, acupuncture, walks, cry.
• In therapy, working a lot on remembering times that my body felt wrong.
• Distract myself and see how I actually feel when I’m not 100% thinking about symptoms.