Health anxiety is, simply, a condition in which certain individuals (“health worriers”) worry too much about their health. They include patients who cross a number of theoretical and diagnostic categories, including generalized anxiety disorder, obsessive-compulsive disorder, and depression; but also, especially, somatization disorder—a condition in which anxious people present with physical symptoms, such as stomach ache, headache and palpitations—and hypochondriasis—a condition marked by the individual’s inclination to respond to physical symptoms by imagining the worst possible illness. The worst possible illnesses are those that might lurk silently but nevertheless, have the potential to kill. They include cancers of various sorts, particularly brain and pancreatic cancers, heart disease, degenerative neurological conditions, such as multiple sclerosis, brain aneurysms, and A.I.D.S. Health anxiety is a common condition that leads to considerable distress and over-utilization of medical services, including laboratory tests and procedures that are likely in the long run to worsen this psychological condition.
Doctors are well-aware of these unhappy persons. They see them every day. Some doctors are likely to be dismissive of their complaints, since their symptoms plainly do not reflect a medical disorder. They speak of such patients derisively as “crocks.” Most doctors, however, are sympathetic. They respond endlessly to the same questions in a vain attempt to reassure their patients. Then they typically do two things that are well-meaning, but likely to aggravate their distress:
Physician need to acknowledge to their patients that these worries reflect an emotional problem which requires particular treatments of an emotional sort.
A. Learn the truth about yourself—the particular physical symptoms you characteristically develop, over and over again, in the face of stress. For example, fatigue, back pain, panic attacks, palpitations, etc. These accustomed complaints are not likely to reflect some new physical disorder.
B. You need to learn about the illnesses you fear. Knowing a little is scary. Knowing a lot is reassuring.
2. Confront your fears. Thinking the unthinkable diminishes fear. (This is an allusion to the “Nightmare Fantasy” in which patients are asked to imagine, in detail, the worst case scenario of their fears. It is possible to desensitize to a fear of illness and death by fantasizing.)
3. Avoid checking and the search for empty reassurance. (Patients are not allowed to ask the same question twice.)
4. Think of the odds against being desperately ill rather than the stakes. (“Wouldn’t it be awful if I died suddenly from a ruptured aneurysm?” “Yes, but what are the chances of that happening?”)
5. Do not seek absolute certainty or safety.
6. Live in a healthy way. (Including principles of eating properly and exercising.)
These summarize to certain “dos” and “don’ts”
Things to do
Things to avoid doing
These principles and practices are elaborated on in detail in “Worried Sick?” which is a description of this program.(c) Fredric Neuman Follow Dr. Neuman's blog at fredricneumanmd.com/blog