If you don’t want to miss an article, click subscribe and the notification. (bell dinging) This topic is based on a viewer question from Littleredridingkyle, and he says, “You should do a article on hypochondria/health anxiety. I’m only 15, and mine is ruining my life. I can’t sleep, because I’m afraid my heart will stop, because of some undiagnosed heart problem even though I’ve had many tests and the doctor has repeatedly told me that my heart is fine.” Thanks Littleredridingkyle for this question.
Misinterpretations and Distress
With hypochondriasis, you misinterpret body symptoms, and assume you have a serious disease, even after you’ve been told that you don’t. You may believe that the doctor missed something. You may even believe the anxiety that you have will turn into something more serious, like dying in your sleep, or having a heart attack. In 2013, the newest edition of the Diagnostic and Statistical Manual changed the name from hypochondriasis What is Hypochondria to somatic symptom disorder. Somatic mean body. So it’s a disorder of being over-focused on body symptoms, and too focused on having an illness. People who have this problem know that they have it because they are in a lot of distress. For the purpose of this article, I’m gonna use the older term, hypochondria.
The Cycle of Anxiety and Symptoms
With hypochondria, you become so hyper-aware of your body sensations, that you spend time in your head analyzing symptoms and figuring out what illness it belongs to. You can become so anxious that your body starts making up symptoms that match a disease process that you’re worried about. Until you start having some other body symptom.
The Relentless Search for Answers
Or, the doctor missed something, or there’s some hidden undiscovered problem that medical science just hasn’t been able to detect until your problem advances to the point where you’re close to death, and then they’ll figure it out. In the meantime, you need to do your research, and figure out what this physical problem is that’s gonna kill you or permanently maim you (laser zapping) unless you figure it out. Does this sound familiar?
The Feedback Loop of Symptoms
Your next response is to test your theory that your heart is on the verge of failing, by paying really close attention to every body sensation that has to do with your heart. So, you do another round of research on what it looks like if your heart were in failure. And you get a couple of clues, further reinforcing all of this investigation behavior, and what happens?
The Doctor’s Visit: A Cycle of Doubt
And at this point, you may go to back to the doctor who told you 2 months ago that your heart was fine. But this time you have more symptoms than you had before, like the shortness of breath. And so, you even think you might even see a little bit of swelling in your legs. The doctor checks you and says, your heart is fine. She may even tell you, it’s probably anxiety. And you might feel a little better, especially because you’re at the doctor’s office and your symptoms kinda go away a little bit.So you go home even more anxious now, you can’t trust the medical system, and you’re all on your own; just you and the Internet. And then what happens? You live through the night without dying, like the Reddit guy’s uncle. Your symptoms seem to get a little bit better. And you eventually believe that you’re okay for now, but that’s just now, until crisis level again, but you’ll keep your eye on it.
The Exhaustion of Body Surveillance
So then you do the third type of reinforcing/conditioned behavior, and that’s the constant checking or body surveillance. You keep checking for signs of your heart problem. And you’re gonna be acutely aware of everything you feel, so you know when something is wrong again. And the only thing that can really distract you from this, is having some other body problem, that makes you think you have another condition.
Exploring Treatment Options
Medication for anxiety can help somewhat by calming the anxiety, but it doesn’t really address the thought and behavior cycle. The medications that we would use would be serotonin-enhancing antidepressants like Prozac. What tends to be more helpful is cognitive behavior therapy, or CBT. With CBT, you address your distorted, automatic thoughts that you have about your body sensations because your fears are triggered by body sensations. An example of a distorted thought in hypochondria is that good health means you don’t have much going on with your body. You don’t really feel much at all.
The Framework of Cognitive Behavior Therapy
CBT also addresses the behaviors that you engage in, like the research, and the body surveillance, and the frequent doctor appointments to get reassurance. So what would the CBT look like? First, you wanna get a medical workup, and chances are you’ve had plenty. But if you haven’t, you first want to make sure that you don’t have a physical illness that needs treatment. Just because you worry about your health doesn’t mean that you don’t have a real health problem. The issue is, you assume that any health problem that you have is catastrophic or permanent. So get medical clearance, so that then you can feel free to focus on the problem as an anxiety problem and not as a medical problem.
Finding the Right Therapist
Second, you wanna see a therapist who is trained in, and uses, CBT in their practice. You don’t want to sit around talking about your relationship with your mother. That’s useful for some problems, but that’s not gonna get you very far here. A CBT therapist will most likely be a doctorate level psychologist, or a master’s level therapist, it’s probably not gonna be a psychiatrist. Some psychiatrists do CBT, but many more non-psychiatrists do CBT.
Key Components of CBT
Once you’re in the therapy, here are some components of the therapy. One is education on the illness or illnesses that you’re concerned about. Now, the facts here will come from your medical doctor, but your therapist can help reinforce this information for you. So when you go to the doctor, have questions about your illness concerns written down. Most doctors’ offices are busy, and if you’re anxious, you can easily forget to ask the questions that you have, or feel like your questions are too crazy to ask. But the doctor you’re seeing is the one who needs to address these questions, not the Internet.
Addressing Persistent Pain
Someone in the comments said that she saw multiple doctors, and they ruled out this and ruled that out, but she still had pain. So she asked me in the comments, why was she still having pain? Well, I can’t tell her why she’s still having pain. No one on the Internet can tell her with any accuracy, why she’s having pain. The person who can tell her that is the person who examined her, ran the tests for her, and that would be the person who would say, “You don’t have cancer, because people with cancer have this, this, and this, and you don’t have that. You don’t have a brain tumor because people with brain tumors have this, this, and this. You don’t have that, so that is why you don’t have a brain tumor.” So don’t save your questions for research later. Think of whatever questions that you might have, no matter how extreme they sound, and then ask your doctor about them. Then, take notes on the answers so you can use those answers later in therapy.
Restructuring Distorted Thoughts
Another component of CBT is thought restructuring. And this is gonna be very individual, depending on what your thoughts are. Chances are, your therapist will give you homework assignments for you to write down what your automatic thoughts are regarding your body sensations. And this goes back to the things like: heartburn means a failing heart, or dizziness means you may have a seizure disorder, stomach problems mean you have cancer. The therapist will then help you break down these thoughts into steps to see how you connect the sensation to your conclusion. Then, you will challenge those conclusions with other possibilities. And this is where you can use the medical information that you wrote down from your doctor.
Educating Yourself About Heart Disease
In general, there’s different types of heart disease. This might be something like your doctor might say. There are structural problems like valve defects, or defects of the heart muscle that cause it not to pump properly. These problems can occur at any age, but they are generally seen on heart imaging like an echocardiogram. You might say, “Well, my doctor didn’t do an echocardiogram.” If you have valve problems, or a muscular problem where your heart won’t pump properly, you’re gonna have many more physical signs other than chest burning. In fact, indigestion isn’t a sign of a valve defect. People with valve defects or a stiff heart have some serious physical activity intolerance, and they don’t need to beg their doctor to look at their heart. So if you have a structural problem, chances are it would have been picked up early in childhood or early adulthood.
Understanding Blood Vessel Disease
Another type of heart problem is blood vessel disease. It takes years for your blood vessels to clog up. There are some genetic diseases, though, that cause accelerated plaque formation, but if you had that, there would be other signs and symptoms other than chest burning. And these would be signs that would trigger a doctor to investigate. So this is the kind of education that you would want to get from your doctor about your situation, to know why what you feel isn’t a certain disease. So ask, “Why don’t I have heart disease? Why don’t I have a brain tumor?” And write down those answers to challenge your distorted and catastrophic conclusions that you have.
Addressing Compulsive Behaviors
The last component that I’m gonna talk about Exposure Response Prevention addresses the reinforcing behaviors that you engage in, such as the Internet research, the body checking, the doctor shopping for reassurance. A CBT intervention is exposure response prevention. It’s used for obsessive-compulsive disorder to stop the compulsive behavior, but it can also be used with health anxiety. The idea is to use exercises that your therapist gives you to expose yourself to the anxious thoughts, then not allow you to research or check your symptoms. Sometimes your therapist may use relaxation techniques or other activities, to distract you from engaging in the behaviors.
Searching Help When Therapy Isn’t handy
Are you just doomed? There are self-help books out there on CBT for anxiety and worry. The difference is, is that it’s general help, and it’s not customized for your issues. That’s where the therapist comes in. But here’s a watered-down, self-help version of the CBT. You would still start with getting medical clearance though. That’s very important. Don’t try to diagnose yourself from Internet research.
Preparing for Your Doctor’s Appointment
Before you see your doctor, make a list of your conclusions you draw on your own about each of your physical symptoms. Take this list to the doctor, and get him or her to explain why your conclusions are incorrect. You have to use some judgment though. If you have a two-page list, you need to prioritize the questions, because chances are many of them are repetitive. But that’s okay, you still wanna keep the list anyway; you want to put your thoughts down on paper, that’s always good. Next, write the doctor’s responses on a card, or in a notebook. Then the next time you have a physical symptom, pull out the card and read it.
The Importance of Self-Talk
If you think, yeah but he didn’t know at that time that I also have pain in the shoulder, maybe this is something new.I’m gonna say it as if I’m you. So going back to the new shoulder blade pain, instead of focusing on how the doctor missed something, you can just say something like this to yourself: “I have been checked out by my doctor, my new body symptom does not mean I really have a medical illness. I have anxiety, and this is what I tend to think. Anxiety makes me believe I have something I don’t. I am not more of a medical expert than the people who have seen and examined lots of sick people. I don’t know what sick people look like. I can only say what I look like. So I don’t have a point of comparison to know what the illness I’m concerned about really looks like. The Internet does not give me a complete picture of what it really looks like to have a failing heart.”
Finding Healthy Distractions
Now, as uninformed as this sounds, there is some merit to this. If you’ve never dug holes or thrown dirt, it’s pretty grueling work, and if you have chest burning or a twitching eye muscle that you’re worried is cancer, if you go throw some dirt, the physical exertion and pain in your arm muscles will distract you from the twitching eye muscle. Because remember, random body sensations, that are not clearly connected to anything, are triggers for the anxiety. Lifting something heavy that makes your arm muscles sore makes sense, and that doesn’t usually trigger the anxiety.
Managing Recurring Worry
What if after all that you come back in the house, you get showered up, and then you start back worrying again? Then you will have to brute force make yourself not do research, whatever that takes. Put the phone away, curb yourself from using the computer, and create these conditions ahead of time. Learn how you’re running to keep yourself from pleasing the behaviors and stick to it.
The Effort Required in CBT
One of the things about the CBT approach is it takes effort. This is not gonna passively go away. That’s why taking a pill isn’t
