But in a more fundamental way, no one is trapped in an airplane any more than he would be in a movie theater. He can move up and down the aisles. He can go talk to someone else, or go to the bathroom. Indeed, modern air travel is like sitting in a movable movie theater.
Still, there usually comes a time, after repeated panic attacks in different settings, that the fear of such attacks fade away; and the phobic person is cured. And yet after helping such patients to recover, it became clear to workers in our clinic that some patients continued to have other irrational fears. They were afraid of physical illness, usually a fatal illness, afraid of drugs and, sometimes, afraid of doctors. A few said they were afraid of dying, others said they were afraid of being dead. We called them “health worriers” and their condition, “health anxiety.”
It turns out they did not fit comfortably into conventional diagnostic categories. Some were especially afraid of germs; and they had symptoms of obsessive-compulsive disorder. Others had physical symptoms whenever they were anxious. They developed headaches or stomach aches, or any sort of pain—or a fast heart beat or a wobbly feeling. They fulfilled the criteria of “somatization disorder.” More typically, some of these patients, in the face of relatively ordinary physical symptoms, jumped to the conclusion that they had a very serious illness. The most common conditions were those that were insidious, without much in the way of symptoms, but which could kill nevertheless. Examples include brain or pancreatic cancer, H.I.V. , heart attacks, or multiple sclerosis. These patients could be diagnosed as hypochondriacs. But most of our patients overlapped these categories. The one common denominator they shared was their recognition that they worried too much about their health, and sometimes about the health of others in their families. It turned out that many of them shared certain ideas:
Finally, they imagined their health as precarious.
These ideas and others had to be attacked for such patients to feel less afraid once and for all. Just as the panicky patient has to learn not to fear the panic attacks, the health worrier has to learn how to approach illness realistically. As it often does in other emotional disorders, treatment comes down to testing out the world in certain ways—by confronting one’s fears. There are a number of things to do, and other things to avoid doing. For example, the patient cannot search out endlessly for reassurance. One more test will not comfort, any more than washing one’s hands compulsively and endlessly makes the obsessional person feel clean at last. Treatment summarizes to a kind of exposure therapy. It is the treatment of certain bad ideas. (These matters are discussed more fully in “Worried Sick?”) (c) Fredric Neuman Follow Dr. Neuman's blog at fredricneumanmd.com/blog