Health Anxiety Treatment in Ireland | My Therapist

What is health anxiety?

Health anxiety, previously known as hypochondria, is a condition where you are constantly worried that you could have a serious illness, even when doctors have reassured you that you’re healthy. This worry sticks around even after medical tests and reassurances from doctors show that there’s nothing seriously wrong. Although classed as an anxiety disorder, it shares characteristics of OCD in that you obsess about your health and may carry out compulsions to reassure yourself that you are not ill. This article will help you to understand health anxiety, recognise the symptoms it can produce, as well as looking at possible causes before outlining treatment options.

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How do I know if I have health anxiety?

Health anxiety has particular signs and symptoms, which I shall explain in more detail below, but first, I shall outline the main characteristics of health anxiety, and these are definitely the most common ones that I have seen over the years while working as a psychologist.

Misinterpretation of Bodily Sensations: You might often misinterpret normal bodily sensations or minor symptoms as signs of severe illness. For instance, a simple headache might make you worry that you have a brain tumour. This happens because of a heightened focus on bodily sensations and a tendency to think the worst. Or you could have tummy pains as worry that you have bowel cancer. With health anxiety, your worries always focus on serious illnesses like brain tumours and cancer; you would have health anxiety and be afraid you have a common cold.

It’s common for those with health anxiety to fixate on specific serious diseases such as cancer, brain tumours, or heart disease. For instance, you might worry that a persistent headache is a sign of a brain tumour or that a mole is indicative of skin cancer. These fears can be exacerbated by personal or familial experiences with such illnesses or by extensive media coverage highlighting worst-case scenarios.

A significant aspect of health anxiety involves the fear that doctors might have missed something serious during check-ups or tests. You might find yourself doubting medical reassurances and feeling compelled to seek second or third opinions, which can lead to excessive medical appointments and tests. This cycle of doubt and reassurance-seeking can further entrench your anxiety, making it more challenging to break free from these fears.

The physical symptoms associated with health anxiety can be quite distressing and include headaches, stomachaches, muscle tension, and palpitations. These symptoms can become more pronounced when you are anxious, leading you to believe that something is seriously wrong. For example, a rapid heartbeat caused by anxiety might be interpreted as a sign of heart disease, reinforcing your fears and prompting further medical consultations.

Excessive Worry and Preoccupation: Your fear of illness is persistent and excessive, dominating your thoughts and interfering with daily life. This constant worry can make it hard to focus on work, enjoy leisure activities, or maintain relationships.

Reassurance Seeking: You may frequently seek reassurance from doctors, family, and friends. You might visit multiple doctors, undergo numerous tests, or repeatedly ask loved ones for validation that you’re healthy. However, this reassurance provides only temporary relief, and the anxiety soon returns.

Avoidance Behaviours: To reduce anxiety, you might avoid situations that trigger your health fears, such as medical appointments, hospitals, or contact with sick people. For example, you might skip routine check-ups or avoid visiting loved ones in the hospital to prevent exposure to potential illnesses.

It is in those last two characteristics, the reassurance-seeking and avoidance behaviours, where you can see some similarities with obsessive-compulsive disorder (OCD).

Symptoms

The symptoms you feel are real, but they are not coming from as dark a place as you believe.

Physical symptoms

• Chest pain
• Palpitations
• Headaches
• Tingling
• Numbness
• Sweating
• Fatigue
• Stomach pain
• Muscle pain and tension

This list is not exhaustive, and the physical symptoms are real, but they come from experiencing high anxiety levels, and you can read more about that here.

Emotional Symptoms

Emotional symptoms are a significant aspect of health anxiety and can include:

• Persistent worry and fear about health
• Anxiety and panic attacks
• Feeling overwhelmed
• Intrusive thoughts about illness
• Sadness and low mood
• Irritability and anger
• Frustration and feelings of helplessness
• Low self-esteem
• Convinced they have missed something after being given the all-clear, as you still have the original symptoms, and maybe more, that you went to the doctor about in the first place.
• Feeling worried or anxious.
• Feeling that there is something medically wrong with you.
• Scared that you have un-diagnosed cancer
• Worried that you might have a brain tumour or other type of tumour
• Worried that there is something wrong with your heart
• Worried that you have MS

These emotional symptoms can create a vicious cycle, where increased anxiety leads to more intense physical symptoms, further fuelling your health fears.

Behavioural symptoms

Behavioural symptoms are actions or habits you develop in response to health anxiety, such as:

• Checking and diagnosing yourself on google
• Monitoring your symptoms – for example, checking for lumps and bumps, and being aware of all sensations in your body.
• Seeking reassurance. This can be done on google or asking someone if they had something similar.
• Avoiding people, conversations, or things that you think might ‘trigger’ your anxiety.
• Attending the doctors. Even after you have been given the ‘all clear.’
• Frequently checking your body for signs of illness
• Researching symptoms online (often called “cyberchondria”)
• Repeatedly seeking reassurance from doctors and loved ones
• Avoiding medical appointments or information related to healthExcessive doctor visits and tests
• Constantly talking about health concerns

What causes health anxiety?

Vulnerability factors

When trying to understand how your health anxiety started, an excellent place to start is looking at underlying factors that might have made you more vulnerable to developing health anxiety.

• Did you have an illness as a child that might have made you more alert to symptoms in your body?
• The way you react to physical symptoms may make you more prone to developing health anxiety regarding how you think about the ailment. For example, can you brush it off, or do you go to the worst possible scenario?
• Did you grow up with an overly anxious parent who was excessively concerned about health?
• Did you grow up with a parent or close relative who had severe health conditions?

While the exact cause of health anxiety is unknown, it is believed to result from a complex interplay of biological, psychological, cognitive, and environmental factors.

Biological Factors

1. Genetic Predisposition: A family history of anxiety disorders may increase your susceptibility to health anxiety. Genetic factors can influence the way your brain processes fear and stress, making you more prone to anxiety.
2. Neurochemical Imbalances: Differences in brain chemistry, particularly involving neurotransmitters like serotonin, may contribute to health anxiety. These imbalances can affect mood regulation and anxiety levels. Research suggests that alterations in the functioning of the amygdala, a part of the brain involved in fear processing, may play a role in your health anxiety.

Psychological Factors

1. History of Anxiety Disorders: If you have a history of other anxiety disorders, OCD, or perfectionistic tendencies, you may be more prone to health anxiety. These conditions can create a heightened sensitivity to bodily sensations and a tendency to catastrophise.
2. Past Experiences with Serious Illness: Personal or familial experiences with serious illness can trigger or exacerbate health anxiety. For example, witnessing a loved one battle cancer can lead to heightened fears about developing similar illnesses.
3. Childhood Trauma: Adverse experiences in childhood, such as neglect or abuse, can contribute to the development of health anxiety. These early experiences can create a heightened sense of vulnerability and fear about health and safety.

Cognitive Factors

1. Catastrophic Thinking: This involves interpreting benign sensations or events as much worse than they are. For example, a slight cough might be seen as a sign of lung cancer. Catastrophic thinking is a common cognitive distortion in anxiety disorders.
2. Heightened Sensitivity to Bodily Sensations: Misinterpreting normal bodily functions as signs of illness. Minor aches and pains are often perceived as indicators of serious conditions, leading to increased anxiety and preoccupation with your health.

Environmental Factors

1. Exposure to Extensive Health-Related Media Coverage: Frequent exposure to news about diseases can heighten your health anxiety. Sensationalised media reports about health crises or outbreaks can amplify fears about personal health.
2. Traumatic Health-Related Events: Witnessing or experiencing a traumatic health event can trigger health anxiety. For instance, surviving a severe illness or accident can lead to ongoing fears about health and safety.
3. Social Media and Online Health Information Seeking: Constant exposure to health information and the habit of searching for symptoms online can worsen health anxiety. “Dr. Google” often provides alarming and inaccurate information, leading to increased worry.
4. Major Life Stressors: Events such as job loss, relationship problems, or financial difficulties can exacerbate health anxiety. These stressors can increase overall anxiety levels, making you more susceptible to health fears.

Why doesn’t it go away? 

Video taken from my online course for health anxiety

Health anxiety will not go away on its’ own if you are unintentionally helping to maintain it.

At the start of this article, I stated that health anxiety shares characteristics of OCD in terms of obsessions and compulsions. The compulsions help in the short term but eventually keep you stuck with concerns about your health.

For example, if you have a headache and your mind jumps to the conclusion that it might be a brain tumour, it is understandable if you Google brain tumour symptoms.

This googling or seeking reassurance is a compulsion in that you feel compelled to do something to ease the fear that you might have a brain tumour. Compulsions like this only make you more anxious and further down a rabbit hole. Just like OCD, you need to learn to stop any compulsive behaviours to stop the cycle.

In addition, the more you worry about having an illness, the more likely you are to have similar thoughts in the future, as you are unknowingly ‘teaching’ your brain to do this. You are forming pathways in your brain, which I shall explain in the following video.

Diagnosis and Differential Diagnosis

Ruling Out Physical Illness

A thorough medical exam and necessary tests are crucial to exclude underlying medical conditions. It’s important to ensure that the physical symptoms you experience are not due to a genuine medical issue.

DSM-5 Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides specific criteria for diagnosing illness anxiety disorder, emphasising the following:

• Excessive worry about illness
• Minimal or mild somatic symptoms
• High health anxiety
• Disproportionate health-related behaviours
• Duration of at least six months

These criteria help distinguish health anxiety from normal health concerns and other anxiety disorders.

Types of Illness Anxiety Disorder

1. Care-Seeking Type: You may frequently visit doctors, undergo tests, and seek procedures despite reassurance that you are healthy. This type is characterised by a relentless pursuit of medical validation.
2. Care-Avoidant Type: You might avoid medical care due to fear of discovering a serious illness. You may skip routine check-ups and avoid discussing health-related topics.

Distinguishing from Other Conditions

1. Somatic Symptom Disorder: While both conditions involve health anxieties, you would experience significant and distressing physical symptoms that dominate your life.
2. Obsessive-Compulsive Disorder (OCD): Health anxieties in OCD typically involve intrusive thoughts about specific illnesses and compulsive behaviours to alleviate those fears, such as repetitive checking or cleaning rituals.
3. Generalised Anxiety Disorder (GAD): Health concerns are just one aspect of worry in GAD, whereas they are the primary focus in health anxiety. GAD involves chronic and excessive worry about various life domains.
4. Body Dysmorphic Disorder: This condition focuses on perceived flaws in physical appearance, not fear of illness. If you have body dysmorphic disorder, you are preoccupied with imagined or minor defects in your appearance.

Treatment and Management

The goal of treatment is to manage your anxiety and improve your daily functioning. A combination of therapies, medications, and lifestyle changes is often most effective.

Psychotherapy

Psychotherapy, particularly Cognitive Behavioural Therapy (CBT), is often considered the first-line treatment for health anxiety.

1. Cognitive Behavioural Therapy (CBT): CBT helps you identify, challenge, and change negative thought patterns and develop healthier coping mechanisms.
   • Identifying and Challenging Irrational Thoughts: CBT helps you recognise and challenge catastrophic thinking patterns. For example, instead of thinking “This headache must be a brain tumour,” you learn to consider more likely explanations.
   • Developing Balanced Thinking: CBT encourages balanced thinking by examining evidence for and against your health fears. This process helps you develop a more realistic perspective on your health.
   • Behavioural Techniques:
     • Exposure and Response Prevention (ERP): ERP involves gradual exposure to health-related triggers without engaging in compulsive behaviours. For example, you might be encouraged to visit a doctor’s office without repeatedly seeking reassurance.
     • Limiting Reassurance-Seeking: CBT helps you reduce the frequency of reassurance-seeking behaviours, which can reinforce health anxiety.
2. Other Therapies:
   • Mindfulness-Based Cognitive Therapy (MBCT): Combines mindfulness strategies with cognitive therapy to help you stay present and reduce anxiety about potential future illnesses.
   • Acceptance and Commitment Therapy (ACT): Focuses on accepting your thoughts and feelings and committing to values-driven actions, helping you live a fulfilling life despite your health anxiety.
   • Group Therapy: Provides support and reduces feelings of isolation by connecting you with others who have similar experiences.

Medication

Medication may be considered in some cases, particularly for severe anxiety.

1. Antidepressants: SSRIs (e.g., fluoxetine) and SNRIs (e.g., venlafaxine) are commonly prescribed to help manage your anxiety and mood.
2. Benzodiazepines: Used for short-term relief. It’s crucial to be aware of the potential for dependence and withdrawal with benzodiazepines.

Lifestyle Modifications

Lifestyle changes can complement therapy and medication, helping you manage your health anxiety more effectively.

1. Regular Exercise: Physical activity can reduce anxiety and improve your overall well-being.
2. Balanced Diet: Eating a healthy diet can positively impact your mood and energy levels.
3. Adequate Sleep: Ensuring you get enough rest is essential for managing anxiety and maintaining good health.
4. Stress Reduction Techniques: Practices like deep breathing, meditation, and yoga can help you relax and reduce your overall anxiety levels.

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How do I get over health anxiety?

Please note if you meet with a mental health professional, the correct diagnosis is illness anxiety disorder. The name was changed in the latest edition of DSM-5, a manual used for diagnosis.

Start with meeting a licensed mental health professional or your local GP who can help with diagnosis.

How is it diagnosed?

• A medical doctor will rule out physical illness.
• Your mental health professional will assess to ensure that another condition cannot better explain your symptoms before diagnosis is given.

The HSE and NHS mention some self-help strategies to use, and I agree with starting with self-help as it follows a stepped care approach to treatment, where you begin with self-help and, if necessary, then meet with a therapist for face-to-face therapy.

The model of therapy most commonly used is Cognitive Behavioural Therapy.

Finding a Suitable Therapist

Finding the right therapist is crucial for effectively managing health anxiety. Here’s how to go about it:

1. Qualifications and Experience: Look for a therapist who is qualified and has experience in treating anxiety disorders, particularly health anxiety. Therapists with a background in Cognitive Behavioural Therapy (CBT) are often well-suited for this.
2. Specialisation: Some therapists specialise in anxiety disorders and may have additional training in health anxiety or illness anxiety disorder. Ask about their experience and success rates with similar cases.
3. Comfort and Trust: It’s essential to feel comfortable and trust your therapist. The therapeutic relationship is a key component of successful treatment. Don’t hesitate to meet with a few different therapists to find the right fit.
4. Recommendations: Seek recommendations from your GP, friends, or family members who have had positive experiences with therapists. Online reviews and directories can also provide useful information.

Why It’s Important

Choosing the right therapist can make a significant difference in your treatment outcome. A skilled therapist will help you navigate your health fears, develop coping strategies, and reduce your anxiety. Early and effective intervention can prevent your condition from worsening and improve your overall quality of life.

How I Can Help

As a psychologist, my role is to guide you through understanding and managing your health anxiety. Through evidence-based therapies like CBT, we can work together to challenge your irrational thoughts, develop healthier behaviours, and build resilience against anxiety. My aim is to provide you with the tools and support you need to regain control of your life and reduce the impact of health anxiety.

Outlook

Health anxiety can be a debilitating condition, but practical ways such as CBT can help you overcome it.

References

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
2. Nolen-Hoeksema, S. (2014). Abnormal Psychology (6th ed.). McGraw-Hill Education.
3. Salkovskis, P. M. (1996). The Cognitive Approach to Anxiety: Threat Beliefs, Safety-Seeking Behavior, and the Special Case of Health Anxiety and Obsession. In P. M. Salkovskis (Ed.), Frontiers of Cognitive Therapy. Guilford Press.
4. Abramowitz, J. S., Olatunji, B. O., & Deacon, B. J. (2007). Health Anxiety, Hypochondriasis, and the Anxiety Disorders. Behavior Therapy, 38(1), 48-63.
5. Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105-117.
6. Furer, P., Walker, J. R., & Stein, M. B. (2007). Treating Health Anxiety and Fear of Death: A Practitioner’s Guide. Springer.