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Health Anxiety in an Anxious World

May 10, 2023

Anxiety Disorder Worsened by
COVID, Computers

Doris spends every free moment googling various diseases and their symptoms. She devotes hours to online searches, even staying up all night, terrified about what she might discover.

Evan focuses intently on every bodily sensation, continually scanning for signs of illness. His anxiety keeps him from leaving the house.

Trudy has just received a clean bill of health from her doctor. While attempting to fall asleep that night, her mind drifted back to something he said: “Tumors can form at any time.” Ridden with anxiety, she climbs out of bed and begins researching brain cancer. Within an hour, she’s convinced she has it.

None of these patients have ever been diagnosed with a serious illness, yet their suffering is very real. Their common disorder is health anxiety, the preferred term for what used to be called “hypochondria.” They obsessively and irrationally worry about having a serious medical condition. In a sense, these patients are being held hostage by their own bodies.

"I Got That”

Health/illness anxiety is relatively common, affecting some 4% to 5% of the population. But experts suspect the disorder is underreported; the actual figure may be closer to 12% — or even twice that amount.

The condition can be debilitating, leaving its victims unable to function or enjoy life. They obsess over normal bodily functions such as breathing and heartbeat, skin blemishes and other physical irregularities, and any bodily discomfort. They misinterpret normal or benign symptoms as something far more severe.

Or they may display no symptoms at all – until they hear about a specific disease or affliction. These patients may repeatedly pursue medical exams and procedures for reassurance. But they're less likely to seek mental health treatment because they're convinced their symptoms are physically based.

What Is Cyberchondria?

The term “cyberchondria” was coined in the mid-1990s by the British press. It refers to a clinical phenomenon of compulsive online health searches that worsen anxiety or distress.

Cyberchondria is strongly correlated with symptoms of health anxiety, although whether this disorder poses a unique public burden remains unclear. According to researchers at Imperial College London, the condition is leading to a health anxiety epidemic in the United Kingdom.

Source: Comprehensive Psychiatry

A doctor's reassurance provides only temporary relief, then new thoughts and physical sensations emerge, and the cycle repeats itself. It's like having a car alarm go off whenever a pedestrian walks by.

Health anxiety occurs on a spectrum; general anxiety can quickly develop into a full-blown psychosomatic illness. When patients are preoccupied with bodily sensations, those sensations intensify and last longer.

As they imagine the worst, their bodies’ internal alarms create anxiety symptoms: racing heart, difficulty breathing, jitters, lightheadedness, nausea, sweating, headaches. These symptoms then fuel their imaginations, worsening the situation. The thoughts may be false, but the symptoms are real.

Along Comes COVID

For patients already susceptible to illness anxiety, the COVID pandemic threw gasoline on the fire.

Compared to past disease outbreaks, health researchers noted some unique features that made the pandemic particularly troubling for these anxiety sufferers:

The highly transmissible and fatal nature of the virus.

The protocols for self-monitoring, hand and surface sanitization, and social disruption.

The fact that some COVID symptoms, such as shortness of breath, mimic anxiety.

The isolation factor compounded the problem, as homebound sufferers were stripped of their usual coping strategies. In addition, the inescapable news coverage and limitless reports exacerbated pandemic anxiety, as individuals sought out more and more online information.

As the global emergency diminishes, many health officials have declared a shift from pandemic to endemic. But for health anxiety sufferers, it really doesn’t matter.

Physician Guidelines

George Washington University clinical psychologist Dr. Lynne S. Gots offers the following tips for primary care physicians when treating patients with health anxiety:

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Use patient-centered interviewing techniques by asking open-ended questions. Allowing the patient an extra two to three minutes to express his concerns will help build trust with a demographic that is often very mistrustful of doctors.

Schedule longer visits with a health anxiety sufferer. This additional office time will result in fewer calls and emails between appointments.

Schedule follow-up appointments on an agreed-upon timetable. A patient with health anxiety might initially need to visit your office once every four or six weeks to address their concerns. Eventually, as the patient becomes better able to tolerate waiting, the frequency of office visits can decrease.

Order diagnostic procedures and specialist referrals only when clinically indicated. Health anxiety can consume medical resources unnecessarily, even leading to complications from invasive procedures. If the patient’s doubts about a condition persist, ask him to return for a follow-up in one month.

Clearly explain why you think a symptom does not warrant concern. When a patient suffering from health anxiety googles “headache,” he fixates on “brain tumor,” not “eyestrain” as a potential cause.

Speak with the patient in person when discussing test results or medication. It’s better not to rely on other staff or an online patient portal to communicate this information to someone with health anxiety.

Always take the patient’s concerns seriously. Serious illnesses do occur in patients with health anxiety.

Once you've ruled out physical illness, it's time to employ some Cognitive Behavioral Therapy (CBT). CBT has proven to be the most effective treatment for health-related anxiety.

The following video clip demonstrates simple CBT strategies for managing a patient with high health anxiety levels: