In an era where a world of information is just a few clicks away, health anxiety has taken on a new dimension. Many of us have experienced moments of worry when seemingly innocuous symptoms trigger thoughts of dire health conditions. Could that persistent headache be a sign of a brain tumour rather than just a consequence of too many late nights? Is that peculiar skin lump a harbinger of melanoma? A quick Google search often exacerbates these worries, leaving us awash in a sea of potential ailments. Fortunately, for most, these fears dissipate once the headache subsides or a reassuring word from a trusted GP alleviates concerns.
In the wake of a devastating global pandemic, there is naturally a greater concern for the health of ourselves and those around us. But for those grappling with health anxiety, this concern is not so easily overcome by rationalising or reassurance. Their fears persist and intensify, and their worry about health is frequent, severe and resistant to the soothing words of medical professionals. Temporary relief is short-lived, as fears and doubts quickly resurface or latch on to a new symptom. Their ceaseless preoccupation with health obstructs their ability to relax and savour life, compelling them to seek perpetual and expensive medical consultations, procedures and tests.
This condition used to be called hypochondriasis and it was often met with derision and misconceptions that it stemmed from attention-seeking or malingering. As our understanding of the condition has deepened, we have become more aware of the profound distress experienced by those afflicted and the incapacitating anxiety underlying their health concerns. The latest version of the Diagnostic and Statistical Manual has also replaced hypochondriasis with two related disorders: illness anxiety disorder and somatic symptom disorder.
In illness anxiety disorder, individuals harbour an overwhelming fear of contracting a severe, potentially life-threatening illness, even in the absence of any significant symptoms. For instance, in the wake of the pandemic a small percentage of the population are so afraid of getting Covid that they can’t function normally. They remain housebound, compulsively sanitise and order everything online. In contrast, those grappling with somatic symptom disorder do manifest subjectively experienced symptoms, such as back pain, breathlessness or heart palpitations, which support their belief that they have a grave illness. However, there is an excessive focus on these symptoms and a catastrophising of their meaning. Instead of attributing their real back pain to tension or their palpitations to panic, they are convinced of sinister ailments like tumours or impending heart attacks. This having been said, the first port of call is of course always to rule out a physical cause before assuming a psychological condition.
Ironically, in a cruel twist of fate, health anxiety fuels itself through the physiological symptoms of anxiety, attentional bias and the nocebo effect. When confronted with fear, the body’s natural response is to trigger the fight-or-flight reaction, eliciting a wide array of somatic symptoms, such as elevated heart rate, shortness of breath, chest pain, sweating, nausea, diarrhoea and dizziness. These somatic responses reinforce the belief that something is seriously amiss, exacerbating anxiety and creating a feedback loop. Furthermore, once we fixate on a symptom, we develop an attentional bias, magnifying its importance and intensifying our experience of it, often neglecting other signs that we are well and healthy.
Health anxiety can also be complicated by the nocebo effect, which operates in the opposite direction of the more familiar placebo effect. It occurs when we read about the symptoms of a possible illness or the negative side effects of a medication and subsequently experience those symptoms or side effects, even when we’ve unknowingly been given a sugar pill rather than the real drug. Clearly our mind exerts a profound influence over our bodily experience.
The advent of Dr Google has had detrimental consequences for health anxiety sufferers, enabling them to delve into endless rabbit holes for every symptom and participate in forums and subreddits where they inadvertently amplify each other’s fears. While their aim is to seek reassurance, the outcome frequently involves heightened anxiety and newfound information that fuels rumination. The escalation in this trend has culminated in the coining of the term cyberchondria.
One of the challenges in treating health anxiety is persuading sufferers that their anxiety, not a physical ailment, is the root issue. While it’s essential to acknowledge the possibility of a physical ailment, and to attempt to rule this out, complete certainty can never be guaranteed. There will always be a minute chance that something has been overlooked and a dreaded illness may lurk in the shadows. Consequently, a crucial facet of treatment involves helping patients to tolerate the reality that life inherently lacks absolute certainty and we have limited control over it.
Treatment also encompasses challenging erroneous thought patterns and relying on empirical evidence for specific outcomes. For example, a vast majority of headaches do not signify brain tumours, so it makes sense to consider more benign causes unless symptoms become severe. Nevertheless, research into death anxiety, a cornerstone of health anxiety, suggests that solely addressing the specific health-related concern, such as a headache, may fail to target underlying existential fears. In this case, the anxiety may simply shift to a different symptom. Consequently, treatment strategies that focus on an acceptance of mortality may prove more effective.
While it can be initially challenging to persuade health anxiety sufferers to seek psychological assistance, most respond well to treatment once they embrace it. Health anxiety exists on a spectrum that encompasses our ordinary apprehensions about illness and death, making it a condition we can all empathise with. Accepting uncertainty and coming to terms with our mortality is a challenge for us all, but an important one to reckon with if we wish to free ourselves from the tyranny of many forms of anxiety, including health anxiety.
• Prof Gill Straker and Dr Jacqui Winship are co-authors of The Talking Cure. Gill also appears on the podcast Three Associating in which relational psychotherapists explore their blind spots
