Fighting Fear

Confronting phobias and other fears

Health Worriers and Their Families

Avoiding things that worsen the health worriers' concerns

Family members have considerable influence on any one among them who is troubled by health anxiety, or any other emotional problem, for that matter. They can make things better, or worse.

The following are guidelines for friends and family to follow in coping with someone troubled by health anxiety. 

  1. Do not ridicule the health worrier. Naturally. If health worriers become more distressed for any reason, they react physically as one does usually to stress: with pain, including stomachaches, headaches and backaches, with insomnia, palpitations, loss of appetite, and so on. They are likely then to focus still more fixedly on their physical symptoms. In that respect a human being is like a bell. Struck by any sort of blow, the bell gives off the same sound. A person who is compulsive, for example, becomes more so if depressed or made more anxious than usual by circumstances. A phobic person becomes more phobic. Someone who is paranoid becomes still more suspicious. No matter what upsets a health worrier, whether it is a problem at work, for example, or criticism by a family member, that person is likely to respond by worrying more about his or her health. Besides, being made to feel ridiculous is demoralizing in general. Such a person finds it harder to admit to any weakness and consequently is less likely to identify himself as a health worrier and will be less likely to seek help. It is a good idea, in any case, not to make fun of other people since we are all ridiculous in someone’s eyes.
  2. Do not collaborate with the health worrier’s compulsive checking. Repetitious checking accomplishes nothing. It elicits no useful information and serves only to focus more attention on the health worrier’s fears. Do not express an opinion on whether he or she looks a little better or worse. Do not make a judgment on whether or not a lump or a skin lesion has changed size overnight. Without medical training these judgments are unreliable. Besides, such subtle changes usually have no clinical significance.
  3. Do not offer routine reassurance. Such a remark constitutes an empty formula that neither reassures nor comforts. It is a kind of static, something to say just to say something. This is another form of checking. Telling someone who is frightened not to worry does not work. Empty phrases, such as “You’ll be fine,” or “You look better today,” are not helpful. Resist the health worrier’s prodding to get such reassurance. Explain that the fact that you are not answering is not a sign of indifference, but that you are not supposed to answer. Giving the same responses to the same questions over and over again is not convincing.

 If telling health worriers that they look a little better does not comfort them, telling them that they look a little worse is certainly not a good idea! If you yourself are a health worrier, you may be able to imagine catastrophes that have not yet occurred to them. Do not suggest these to them. Health worriers are much more inclined by point of view to believe in bad news than good. It is best not to comment one way or the other.

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  1. Do not profess a medical opinion. Do not diagnose. Do not propose medical treatments for illnesses you do not understand. Do not recommend particular drugs on the basis of personal experience. A medication that worked for you is not necessarily a good choice for your spouse or your child. You would not suggest to them that they wear your eyeglasses.
  2. Especially do not recommend herbal remedies. Some of them do indeed have pharmacological effects of one sort or another. Because of a quirk of law, no governmental authority analyzes these products. On occasion they have been found to be laced with tranquilizers and other drugs. Herbal concoctions purported to be of one particular type are produced by different manufacturers and have different potencies. Sometimes the potency varies from batch to batch even when produced by the same manufacturer. Herbal products are not harmless! They are also no more “natural” than many drugs, some of which were derived initially from plants or animals. Besides, natural substances are not inherently safer than those made by man.

Not counting the familiar poisons produced by mushrooms and many other plants, ordinary foods, including vegetables, which are on balance good for us, have carcinogens in amounts greatly exceeding those routinely added to foods in the form of preservatives. Preservatives are not in general a reason to avoid vegetables. Each food  product should be judged on its own merits. It is reasonable to avoid those, natural or not, whose effectiveness and whose dangers have not been determined.

There is also sold to the public a class of presumably medicinal agents which are known,   as well as anything can be known, to be ineffective. Among them are homeopathic drugs which are based, literally, on a kind of magic and whose formulation is contrary to fundamental scientific principles.

Do not conclude on the basis of what you have read in newspapers that certain drugs are dangerous or better than or worse than other drugs.  Do not offer these ill-considered opinions to the health worrier, who is likely to react in an exaggerated manner to the drug, or to refuse it altogether at a time when taking it may be important, even critical. Similarly, do not venture negative opinions on certain treatment modalities such as electric shock therapy or other procedures such as Caesarean section as if they are never indicated no matter what the circumstances. Do not repeat absurd generalizations such as “surgeons always like to cut.” Or “Psychiatrists want to keep you in therapy forever.” They make health worriers more afraid of seeking medical help and more distrusting of doctors than they are already.

Do not find fault with the health worrier’s current physician unless you have good reason. If someone develops an illness that is not responding to treatment, it is always reasonable to suggest a second opinion, but do not undermine treatment by suggesting that the health worrier should take less medicine than that which was prescribed, or more, or some other medicine in addition.

In short, make sure you do not complicate treatment by interfering with it. A typical board-certified internist has had four years of medical schooling, four years of additional specialized training and a minimum of two years experience dealing with all the intricacies of medical illness. No lay person can pretend to such well-founded judgment. Do not report to the health-worrier interesting anecdotes of medical catastrophes that have come to your attention. Health worriers are suggestible. They do not need much encouragement to begin wondering whether some rare calamity can happen to them too. Keep in mind that unusual events are just that, unusual. Make that point if you are going to tell such stories.

Try not to draw conclusions from random events in the neighborhood. An illness in a neighbor need not strike in your family even if you ate in the same restaurant or slept over in the neighbor’s home. If two other neighbors developed leukemia, it does not mean that there is some influence-toxic waste, perhaps, or electromagnetic waves from high-tension wires- that is likely to affect someone in your family. Do not promote these rumors. Outbreaks of illness occur in communities from time to time purely as statistical quirks with no other underlying cause.

Do not repeat health tips (warnings) you heard from your grandmother. These old-wives’ tales:

“You’ll get cramps if you swim right after eating lunch.”

“You’ll get sick if you stay up too late studying for an exam.”

“You’ll get sick if you read too much.”

…and countless others add up to the conclusion that many ordinary activities endanger health. This is a message that health worriers have already learned only too well. Excerpted from "Worried Sick?" (c) Fredric Neuman  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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