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Health Anxiety and Dysfunctional Core Beliefs

Learn how our beliefs about health develop and are reinforced over time.

Key points

  • People with health anxiety (formerly known as hypochondria) have dysfunctional core beliefs about health.
  • Core beliefs influence how individuals interpret day-to-day situations and can lead to thinking errors.
  • People can reshape core beliefs about health with cognitive behavioral therapy or CBT.

People with health anxiety hold dysfunctional beliefs about health and illness. These are known as core beliefs. Core beliefs typically originate early in life through personally significant life experiences. Perhaps you had a health scare or were diagnosed with an illness. Or perhaps you watched a loved one die from a serious disease. Or maybe you felt unsafe in life due to adverse or traumatic experiences and, thus, learned to be on the lookout for potential threats and dangers. Whatever happened to you, these experiences led you to see health and illness in a certain way.

Health anxiety and dysfunctional core beliefs

Researchers have identified many unhelpful core beliefs that are common among people with health anxiety. Here are a few examples:

  • Serious disease is everywhere.
  • Being diagnosed with a medical condition is most likely a death sentence.
  • I must be 100 percent symptom-free in order to be considered healthy and safe.
  • Doctors and tests should be able to provide an explanation for every bodily sensation and symptom.
  • The field of medicine is wholly insufficient and useless.
  • I must be certain at all times that I do not have a disease or will not get a disease.
  • I am vulnerable and likely to be killed by most illnesses.
  • Anxiety symptoms are dangerous.
  • I cannot cope with the idea of dying one day and must do everything I can to stay alive.

How dysfunctional beliefs are strengthened over time

Once you develop these core beliefs, then the process of reinforcement begins. Essentially, you begin to scan your environment and selectively attend to all the pieces of “evidence” that support your belief system.

You may have paid special attention to situations when a loved one or acquaintance struggled with an illness. You might have read all about various diseases online or in medical texts. You might have watched movies or videos on social media or read books about people struggling with illnesses. In general, you likely paid much more attention to the stories about sickness and death than all the people and situations around you representing health and wellness.

As a result of all of this, you developed a very biased and skewed view of health and sickness. How could you not? In the world you have created for yourself, everyone is sick and dying! Your dysfunctional beliefs continue to strengthen over time because they are being reinforced month after month, year after year, through selective attention.

How dysfunctional beliefs impact your daily life

Your dysfunctional beliefs make you worry about illness and, thus, lead you to engage in what is called body vigilance. Body vigilance is when you pay close attention to all your bodily sensations and symptoms. This selective attention makes you notice even more symptoms.

You then misinterpret ambiguous or benign symptoms as being indicative of some potential health problem. This leads you to “catastrophize” or dream up worst-case scenarios about every symptom (e.g., this heart fluttering is the beginning of a heart attack). These conclusions, understandably, increase your anxiety, and then you engage in avoidance or safety behaviors to reduce the anxiety (e.g., googling symptoms, reassurance-seeking, excessive body checking). This further reinforces your dysfunctional beliefs, and then the cycle begins all over again.

How to improve health anxiety

The key to overcoming health anxiety is to disrupt this dysfunctional process. With cognitive behavioral therapy (CBT), we target each of these components. We challenge distorted thoughts with Socratic dialogue or logic-based questions. We engage in exposure exercises to improve one’s tolerance of bodily sensations as well as to reduce the use of safety behaviors and avoidance. We also reshape dysfunctional core beliefs into more accurate and adaptive beliefs.

As I say all of the time, you can overcome health anxiety. But it doesn’t happen overnight. The key is to make small improvements in your thoughts and behaviors each day. CBT to the rescue!

More from Brittney Chesworth Ph.D., LCSW
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