Fighting Fear

Confronting phobias and other fears

The Discomfort of Reading about a Feared Illness

A matter of not knowing enough, rather than knowing too much.

Health worriers (sufferers from Health Anxiety) tend to imagine the worst possible illness that would explain the physical symptoms they have. These are often the symptoms of anxiety: headache, stomachache, backache, chest pain, hands shaking, and so on.  Each one of them can be imagined to be a sign of cancer or of a heart attack. Health worriers also notice moles of one sort or another and then worry about malignant melanoma. They worry about multiple sclerosis when they experience trembling or vague shooting pains. And, of course, when they are truly physically ill with an ordinary illness, they may magnify the ordinary symptoms those illnesses cause.  They need to learn how to distinguish these inconsequential symptoms from those that signal the deadly diseases that they are always considering.

They need to know that chest pain over the left side of the chest suggests a chest wall problem and not a heart attack.

They need to learn that gas pains are not an indicator of colon cancer.

They need to learn how to distinguish a malignant melanoma from an ordinary freckle.

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They need to know how to distinguish an ordinary migraine headache from that of a brain tumor.

And so on.

In order to learn what they need to know, they need to go further than consulting a physician. Experience gives ample proof that health worriers cannot be comforted for any length of time by the reassurance of a doctor or by undergoing one more test. They need to know more. Any irrational fear can be countered by a better understanding of the risk—or the absence of risk.  Just as a fear of pigeons, for example, can be overcome by learning that pigeons do not dart at people, but, rather, head in the other direction, the fear of a particular illness can be dispatched by learning more about that illness. Someone worrying that a pain in the left foot is a sign of a heart attack will discover that that connection does not exist.

 It is not possible to know as much as a medical doctor, but it is often possible to know that a particular symptom is not a sign of a particular illness. Reading about the feared illness is integral to a program of treatment for health anxiety. Even the psychological posture of being active in the face of a threat rather than passive helps. But patients complain that reading about that illness worsens their fears. And it does! They will discover that whatever illness they are reading about may have a terrible outcome in the worst cases. It is easy for the health worrier to imagine himself/herself at that extreme. But that fear dissipates with learning still more about that condition. There will appear discrepancies between what the patient is experiencing and the symptoms of that illness. The patient’s progress is similar to that of someone confronting other fears. A person afraid of bridges will have heightened anxiety when he/she first begins to cross bridges. With more and more time on the bridge that fear dissipates.

Still, it is reasonable to consider why this process takes so long—why reading about a serious illness is likely at first to frighten the health worrier, rather than reassure. Here are some of the reasons:

  1. Some symptoms like fatigue are present in all conditions, including generalized anxiety and cancer. Such a symptom does not by itself suggest a serious illness, yet the health worrier is likely to take the symptom as confirmation of the presence of a serious illness. Health worriers are likely to gloss over those defining symptoms of the serious illness that they do not have.
  2. They do not realize that if the particular symptoms they have were to be caused by the disease they dread, many other symptoms that they do not have would have occurred as well. Shortness of breath, for example, is not likely a result of heart failure if it has not been preceded by a great variety of other symptoms.
  3. They think that when they have a little of a symptom, such as enlarged lymph nodes, they are half-way along to developing a serious symptom, such as greatly enlarged lymph nodes. The former are produced by many inconsequential diseases. They are symptoms of little importance.
  4. They are likely to ask the wrong questions of themselves (and their doctors). The question is not whether a terrible disease can cause a particular symptom; it is whether or not that particular symptom should make someone worry about that terrible disease.  For example, someone afraid of AIDS develops a sore throat. He asks his doctor whether or not AIDS can cause a sore throat. The answer is “yes,” but that is beside the point. What he really wants to know is whether or not his sore throat is likely to be caused by AIDS. Given the vast number of sore throats caused by other conditions, the answer is, “no.”
  5. They become afraid if they fall into some category of increased risk of a disease even if the risk is still tiny.  If there is an illness in the family that doubles their risk of getting it from one in a thousand to one in five hundred, this fact should not bother them. Similarly, there are many environmental influences that raise the risk of an illness from teeny to tiny and are not worth worrying about, whatever they have heard to the contrary.
  6. They worry about the stakes of developing a serious illness, rather than the odds. It would be terrible to suffer a ruptured brain aneurysm; but the odds of that happening are very small. When they are reading, they should concentrate on the chances of their developing the illness they fear. A woman who is thirty has a much smaller chance of developing breast cancer than a woman in her seventies.

Health worriers have a tendency to ignore these odds when they read about them. They make judgments on medical matters, particularly on the likelihood of untoward medical events, based on personal experience. Personal experience includes what happened, or what they think happened, to friends or to friends of their friends. Like any other gossip, these accounts tend to be dramatic and exaggerated.

  1. They stop reading prematurely. They need to learn that there are often remedies for the disease that terrifies them. A personal example: thirteen years ago I developed an abdominal cancer “as big as a grapefruit.” I learned that there was a good likelihood that this particular kind of cancer could be cured by surgery. And it was.

Putting the details of exposure therapy to one side, it is obvious that an irrational fear will be dissipated by knowing the truth about the imagined danger even if learning the truth is uncomfortable. Long experience indicates that the discomfort fades over time, and the patient worries less. For example:

A middle-aged woman was preoccupied by the thought of developing breast cancer. She became an expert on the disease. When she heard that in her particular community, the risk of breast cancer was double that of the surrounding towns, she was not troubled. She knew her particular risk at her age moved up from about two percent to four percent. Not enough to worry about. © Fredric Neuman 2013 Follow Dr. Neuman's blog at fredricneumanmd.com/blog/ or ask questions at fredricneumanmd.com/blog/ask-dr-neuman-advice-column/

Fredric Neuman, M.D. is the Director of the Anxiety and Phobia Center at White Plains Hospital.

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