Treatment, exposure therapy, is never easy, but it is usually successful. I noticed, however, that even after treatment a number of the patients seen in the Anxiety and Phobia Center were still sometimes symptomatic in other ways. Some patients still had an exaggerated fear of illness. This condition, which we called health anxiety, involved patients that carried a number of different diagnoses:
Hypochondriasis—which is the tendency to imagine the worst possible illness given a certain set of symptoms.
Somatization disorder—which is the tendency to express emotional distress by physical symptoms, headaches, stomach aches, and so on.
Obsessive-compulsive disorder—one aspect of which is the fear of contamination, or of germs.
Depression often overlaps with the problems mentioned above.
Over time, we developed the following scale, which can be used to diagnose the condition. Patients who are severely troubled by this condition are likely to answer yes to all but a few of these questions. In further blogs, I will elaborate on treatment.
The Anxiety & Phobia Center
White Plains Hospital Center
Chief Complaint ______________
Tentative Diagnosis _______________
HEALTH ANXIETY SCALE
Do you feel that you are likely to get sick more frequently than others, or are likely to get sicker than others when you do get sick?
Do you think a lot about the possibility of getting illnesses that run in your family?
When you develop physical symptoms, do you immediately contemplate the most serious illnesses that could explain these symptoms?
Do you often think how terrible it would be for you or your children if you were to die prematurely?
Are you under the impression that it is very important to get to a doctor at the first sign of getting sick?
Do you visit doctors much more frequently than you really need to in order to be reassured about your health?
Do you avoid doctors because you are frightened about what they might discover?
Do you leave the doctor's office sometimes unsure of what he said or meant because you were nervous when he spoke to you?
Although you know medical opinions can never be certain, do you nevertheless ask your doctor questions such as "are you sure I don't have ... cancer ... or AIDS ... or high blood pressure, etc.?" Is it hard for the doctor to reassure you?
Do you ask what the cause of a symptom is even when the doctor has told you that that symptom is inconsequential?
Do you ask your doctor to do medical tests in order "to be sure" even if the doctor is not otherwise inclined to order such tests?
Do you worry for days ahead of time about routine tests such as a mammogram?
Do you worry when a laboratory test result falls outside the normal range?
Do you hesitate to take prescribed medicines because of concern about side effects?
Are you more sensitive to medication than other people?
Are you more inclined to take "natural" substances, such as herbs, rather than prescribed medicines?
Do you worry when you have trouble sleeping or if your bowels are irregular?
Do you check parts of your body over and over again looking for an abnormality such as a lump?Do you often suffer palpitations?
Do you ask other people, such as a spouse, whether you are looking a little better today or a little worse?
Do you worry about germs or about catching someone else's illness?
Do you worry about very unlikely diseases such as a brain aneurysm that tend to lurk silently and may suddenly kill you?
Are you preoccupied much of the time with thoughts of becoming ill or dying, to the point, sometimes, where family members feel obligated to reassure you?
Do you feel your health worries are foolish?
Read Dr. Neuman’s blog at www.fredricneumanmd.com/blog