UNDERSTANDING HEALTH ANXIETY OR: WHY YOUR STOMACH HURTS WHEN YOU GOOGLE PANCREATITIS

There’s an entire subreddit devoted to health anxiety. It’s filled with photographs of moles, red spots, and other things you probably don’t want to see, and questions like:

 

“I was gargling cold water from my tap and accidentally got some up my nose… now I can’t sleep because I’m worried I’ve gotten a brain-eating amoeba. Have I?”

 

The first thing you’ll notice if you ever go read the posts there is that these people are not enjoying their lives. If you do not personally struggle with health anxiety you might be smugly saying to yourself, “you can’t get a brain-eating amoeba just from gargling tap water!”[1] and find the entire thing quite amusing. But I promise you: the person who posted that is not amused. They are suffering.

 

WHAT IS HEALTH ANXIETY?

Health anxiety (formerly hypochondriasis[2]) is the persistent, often overwhelming fear that you have – or will soon develop – a serious illness. The feeling is genuinely awful: most people block out thoughts of their own mortality, saving all their existential angst for really serious crises or for when they wake up at 3 in the morning, like civilized human beings. But people with health anxiety face that existential void sometimes for days or weeks or months at a time as they anticipate upcoming doctor’s visits or lab results – and age doesn’t matter. You can be 15 and still lie awake at night convinced you’re dying; health anxiety is neither kind nor rational.

 

This is exhausting. Not just for the person living it, but for their loved ones, friends, primary care doctors, specialists, urgent care workers, and that one radiologist who still remembers you from the time you demanded a chest CT “just to be safe.”

 

And you probably are safe[3]. But that’s not how it feels.

 

I want to be clear at the outset that people with health anxiety are not experiencing symptoms that are “all in their head.” Their very real physical sensations – as real as any symptom anyone else experiences – are the direct physiological results of a highly activated sympathetic nervous system, and they can make them feel frightened, hopeless, and miserable. The mind-body connection is well-supported in research; it’s why hopeful people recover better from surgeries and have slower disease progression in conditions like HIV and cancer (Ironson et al., 2005). But it’s also why people who are prone to worry about the feelings in their body might feel them more – or actually generate their own quite real and distressing physical symptoms (Chrousos, 2009; Meuret & Ritz (2010); Michopoulos, et al. 2017).

  

IT’S (PROBABLY) NOT A TUMOR

We have to start by remembering that our brain actually does not enjoy torturing us needlessly; as hard as it may be to believe some days, it’s generally trying to help or protect us in a way that was once perhaps useful and even clever under other circumstances. Health anxiety may have started as:

 

Unfinished Business with the Dead or Dying

Tameka’s* mom died of lung cancer at the age of 42, when Tameka was just a teenager. She dreaded turning 40 all of her life, became obsessed with coughing, and demanded chest X-rays and breathing tests starting in her early 20s. She couldn’t even imagine living to be 50; it simply didn’t compute. She was carrying her mom’s story around as though it were her own destiny, even though she’d never smoked a cigarette in her life.

 

If someone close to you died young, or was chronically ill, you may have learned a terrifying lesson from it: “if they didn’t get to live a long life, who am I to take mine for granted?” Or worse, “Maybe I’m next.”

 

You don’t wake up thinking, “I should manifest my father’s early heart attack as a tribute.” But your unconscious might be doing a one-man Shakespeare play in the background – full of ghosts, guilt, and inherited scripts.

 

A Distractor from the Mind

Health anxiety often shows up when we’re feeling or experiencing something we don’t want to. Grief, anger, shame… overwhelming pressure at work… a momentous breakup… the crushing realization that life is unpredictable and perhaps our existence is meaningless…

 

But instead of saying, “I feel scared and overwhelmed” and having to sit with those extremely uncomfortable feelings, our unconscious distracts us: “Don’t you think this weird spot on your fingernail could be nail-bed cancer?”

 

It’s easier to talk about organs than emotions. It feels more concrete. More controllable. We can test for it, measure it, treat it. You can’t get a blood panel for heartbreak or existential despair (yet).

 

A Way to be Seen and Cared For

My client, Mitch* had a mother who was too busy to pay attention to him. But when he broke his arm? Suddenly, she was fully present. He got the flu? She was bringing him soup, a blanket, a Spiderman comic, and some deeply ambivalent love.

 

Over time, a person may have learned that being ill was the safest path to connection; that sickness = love, or at least safety or acceptance. So now, when you're feeling lost, lonely, disconnected... your unconscious helpfully says, “Quick! Maybe something’s wrong with us!” Maybe that means your parent, partner, boss, or best friend will approach you with warmth and concern – which might be exactly what you’re needing.

 

A way to make sure you’re being “good enough”

Sometimes, health anxiety is your inner critic – just dressed in a white lab coat with a stethoscope around its neck. It says, “You didn’t do enough. You’re not trying hard enough. And now… you’re going to pay the ultimate price.”

 

This can look like scrupulosity around health habits: “I had a cookie last night. Time to worry about diabetes for four hours.” Or like an unshakable belief that you're always one wrong move away from disaster, because you deserve it.

 

QUEEN’S GAMBIT, DECLINED

The terrible thoughts and feelings that come with health anxiety aren’t something you can fight with willpower and determination. That’s a mental chess game that never ends: you vs. cancer; you vs. your heart; you vs. the possibility that your brain tumor is cleverly hiding in a way no MRI can possibly detect! 

 

The bottom line – and what makes this so tough – is that it’s actually just… you vs. you. It’s a chess game you can’t win. No matter how much you try to convince yourself with logic and cleverness and stoicism that the facts are pointing to you actually being okay, your opponent is ready with an equally convincing rebuttal. Because they’re as smart as you are, and they know everything that you know, because they ARE you. As Einstein (probably) said, “no problem can be solved by the same mind that created it.”

 

SO WHAT DO WE DO ABOUT IT?

If you’re here because you have health anxiety yourself, you probably want one thing above all else: reassurance.

The bad news is that reassurance is the psychological equivalent of a potato chip: tastes great in the moment, but a) isn’t actually good for you, and b) leaves you hungry for more potato chips. People who seek reassurance from friends, family, and even doctors often find themselves anxious all over again in just a few days (Salkovskis, 1991), which makes friends, family, and even doctors frustrated they can’t help and exhausted from trying.

 

Although I work mainly from a psychodynamic perspective, for people with health anxiety, I draw from a few other modalities I have found incredibly helpful for this particular problem, like Cognitive-Behavioral (CBT), Exposure therapy, and Acceptance and Commitment Therapy (ACT). Here are some things you can do to improve your relationship with your health anxiety:

 

1) Don’t Google anything ever again. Seriously. If you ask Google about your difficulty sleeping, among a number of perfectly reasonable things it will tell you, it will also tell you about fatal familial insomnia[4] and that will be the only thing you remember and focus on. No matter what, no matter how tempting, I promise you that Googling your symptoms will never lead to a decrease in anxiety. Think of it like quitting smoking or gambling. This is your addiction, and it’s not doing you any good.

 

2) Don’t avoid triggers. People with health anxiety often become anxious when they so much as see the word “cancer” or listen to the lengthy list of ridiculous side-effects that accompanies any ad for a new medication. They may change the channel on TV shows where characters are ill, and they may even avoid going to their doctor for fear of getting bad news. But avoiding these triggers reinforces our fear of them, the same way skipping the gym ensures you’ll never get stronger. One therapist had their patient put an alarm on their mobile phone every hour on the hour that said “cancer” until they got accustomed to seeing the word; I’ve suggested fearful patients read books about people who survive terrible illnesses, because we’ve gotten so used to only remembering the tragedies that we forget how many people also endure and recover. And above all: go to the doctor. If there IS something wrong, catching it quickly is your absolute best chance of a positive outcome. If there’s nothing wrong, you’re just teaching yourself that going to the doctor doesn’t always = instant death.

 

3) Do behavioral experiments on yourself. When you think there’s something wrong with you (“my muscle won’t stop twitching!”), write it down in a journal. Write your best explanation of what you think it is (“neurological disorder!”) and how confident you are in your diagnosis (“9/10!”). Then, track to see what happens. Most of the time, things will disappear and get better on their own; if so, put that in the journal, too. Some things will require a doctor’s visit; write down what the doctor tells you (“it’s fatigue, not a neurological disorder”). Over time, you will develop a lengthy journal to remind you what a terrible physician you are. You are definitely not the best person to diagnose yourself.

 

4) Don’t attach to your thoughts. Remember the chess game? If you play as White, your opponent (Black) knows every move you’re going to make because they’re both you. You can’t win by playing against yourself. Instead, you must practice taking a different perspective: be the chess board. The chess board isn’t trying to win; the chess board isn’t invested in the plays being made. “Ah, I see you’re going for the ‘the doctor ordered the wrong test’ defense again today. Good call!” “Fascinating, you’re countering ‘it’s just a hangnail’ with ‘wanting to Google hangnail cancer’. Classic!” Just because your brain automatically generates these awful thoughts doesn’t mean you have to grab onto any of them and live in them. Let them float right by you, like clouds in the sky or leaves in a stream. It’s okay that your mind wants to play this chess game; don’t try to stop it. But don’t play against it either. Just observe.

 

5) Radical acceptance. Ok. So what if you’re dying? We’re all dying, just at different rates. The real question is: what kind of life do you want to live while you’re still here? Curling up into a ball and worrying about death the entire time doesn’t sound like a good use of your one beautiful, unique chance at existence. Any one of us could die lying asleep in our beds from a cow falling through our ceiling and crushing us.[5] There are no guarantees for anyone, so figure out what kind of life you want to have lived, and make sure you’re living it.

 

WHAT IF YOU’RE NOT DYING (AND THAT’S THE SCARY PART)?

Unlike Freud, his contemporary Adler believed we should look not just at the past, but at what our behavior is doing for us right now. What could someone possibly gain by obsessing about their own demise?  Well, here’s a tough question:

 

What if you’re NOT dying?

 

What now, if there’s no explanation for your pain?

What now, if there’s no excuse not to pursue the life you want?

What now, if you have to face the fact that you’re lonely or purposeless or have unmet potential?

 

Sometimes the fantasy of illness, however horrible, protects us from the terror of agency. Of having to change. To be alive is to live in uncertainty, risk disappointment and failure, face aging, loss, and vulnerability. Sometimes it’s easier to dread dying than to risk actually living – with all the heartbreak and challenge that brings.

 

These are hard questions. And sometimes we aren’t ready to answer them yet. That’s okay. But even acknowledging the question is there can start to shift something.

 

Health anxiety isn’t a sign that you’re broken or dramatic. It’s a sign that somewhere inside, a younger, scared version of you is still trying to keep you alive.  Maybe… it’s time you helped protect them back.

 

Want to dig deeper? 

This is work I do with clients every day:

What am I afraid of losing?

What am I trying to keep safe?

What taught me to fear my own body?

 

The journey is absolutely worth taking. Even if you haven’t snorted a brain-eating amoeba.

 

FOR FURTHER READING on health anxiety, read “Man’s Search for Meaning” (Frankl, 1959) and “Staring at the Sun: Overcoming the Terror of Death” (Yalom, 2008).

 

*Composite example with identifying details changed to protect client confidentiality.

 

[1] OH, YES YOU CAN!

[2] The APA rebranded it because doctors started treating hypochondriacs like they were being dramatic and unnecessarily difficult. Unfortunately, now doctors just think people with "Health Anxiety" are dramatic and unnecessarily difficult.

[3] Don’t quote me on this. I’m not a medical doctor. And it’s also important to remember that even people with health anxiety can actually get sick and need medical care.

[4] Which you absolutely positively should not Google.

[5] True story.