"You're braver than you believe, stronger than you seem, and smarter than you think." - Winnie the Pooh
What is health anxiety?
Health anxiety occurs when an individual worries excessively about their health. This can occur whether or not an actual illness is present. Often, individuals feel out of control of their anxiety, which gets in the way of daily life and functioning.
Anxiety and fear are different. Fear is the emotional response to an immediate or imminent threat. This threat can be real or perceived. Anxiety is the anticipation of a future real or perceived threat.
While there is significant overlap between fear and anxiety, the two states do differ. Fear activates body responses designed to help the body move. When people are terrified or afraid, their thoughts are focused on immediate danger and they are more likely to engage in escape behaviors. For example, one young woman seen in our practice described that she became so afraid during a medical visit that she fled the exam room. Notably, this was in response to being offered a medical procedure associated with past medical trauma; the procedure was not actively happening at that moment. However, her brain interpreted the threat as imminent based on past experience. Her thoughts became centered on the need to "get away." She could not access other helpful thoughts such as, "This is only a suggested treatment; this time, I can say no," until after the perceived threat was no longer present. Fear is a prominent feature in panic attacks, which can occur within the context of Panic Disorder or other disorders (e.g. PTSD).
Anxiety is often stress-induced, persistent, and ruminative. While fear responses may dissipate after a threat is no longer present, anxiety lingers. Anxiety disorders differ based on the types of situations that create stress and worry, the types of avoidance behaviors individuals engage in to try to cope, and the content of thoughts and beliefs. For example, a person with Social Anxiety Disorder may avoid social situations and experience thoughts like, "Other people will judge me negatively." A person with Panic Disorder might avoid situations that they think will trigger a panic attack, and experience thoughts such as, "I am going to lose control," or "I am dying."
Anxiety isn't "all in one's head." Anxiety is a mind-body phenomenon; in other words, anxiety can impact the body by causing physical symptoms, and what is going on in the body can trigger and worsen anxiety. For example, a person experiencing chronic pain may worry about their physical condition, which in turn causes their body to become tense and their pain to worsen. This happened to a young man in our practice who frequently woke up with anxious thoughts such as, "What if I can't make it through the day today? What if I disappoint my family because pain makes it impossible to do anything?" In response, his body would begin to brace and his muscles would tense (a readiness response related to movement), which would in turn spike his pain levels.
Anxiety disorders make it harder to engage in healthy behaviors
Whatever triggers anxiety symptoms, they can be highly disruptive. The young man in our previous example was afraid to leave the house, believing that if he were incapacitated by pain help would be unavailable or he would do something to embarrass himself (an example of agoraphobia arising from medical symptoms). This made it harder for him to work or spend time with his family. The young woman who fled the exam room was terrified of medical treatment, and yet leaving her condition untreated worsened her health picture and created additional burdens on her support system, which caused her to feel guilty and ashamed.
Some examples of anxiety disorders that may arise in health contexts include Specific Phobias (e.g. needle or blood phobia), Panic Disorder, or Medication-Induced Anxiety Disorder. Since anxiety and fear each typically result in avoidance coping (avoiding situations associated with the fear in order to avoid the fear itself), individuals who struggle with anxiety disorders may not receive needed medical care. For example, a person with a needle or blood phobia may not tolerate labwork. A person with Panic Disorder or Agoraphobia may avoid going to the hospital. An individual who experiences anxiety as a side effect of a medication may have more limited care options, particularly if the anxiety is debilitating and they cannot identify coping strategies, or their usual healthy coping strategies don't help.
Individuals with anxiety disorders that overlap with physical health concerns often face particular difficulties. Those with heart issues and Panic Disorder, for example, may become afraid to engage in movement (kinesiophobia), even when some form of movement could help address their cardiac condition. These individuals may face multiple concerns such as 1) changes to their heart rate could trigger a panic attack, which they fear will tax their heart 2) changes to their heart rate could trigger a heart attack. Individuals who experience chronic pain may be anxious about movement as well, worrying that it will worsen their pain levels despite knowing or being told that movement could assist in mitigating pain. Due to the mind-body connection, individuals with anxiety disorders often worry that being anxious will make their health worse; they become anxious about their anxiety. When dealing with anxiety and health issues, people often feel very trapped: the behaviors that could help improve their health and reduce their anxiety feel life-threatening and are sources of intense fear.
Anxiety disorders can be confusing
Anxiety disorders can be confusing for patients and their care teams. One reason for this is that many symptoms of anxiety disorders occur within the body. For example, key symptoms of Panic Disorder include accelerated heart rate, palpitations, or a pounding heart, along with sweating, nausea, and shortness of breath. Warning signs of a heart attack include chest discomfort, shortness of breath, sweating and nausea. The symptoms are too close for comfort for many people. As a result, many individuals with Panic Disorder go to the emergency room due to concerns about cardiac issues or other health problems (e.g. seizure disorders).
Another reason for confusion is that underlying health issues, such as hormone changes, medication reactions, or vitamin deficiencies can result in mood changes. Thyroid disease, menopause, and imbalances in cortisol levels are examples of hormone-related issues that can negatively impact an individual's mood and functioning. Many different medications can cause anxiety-like symptoms, too. Some specific classes of medication to watch for include stimulants (e.g. ADHD medications), corticosteroids (used to treat conditions like asthma and allergies), medications containing caffeine (often used for headaches or migraines), thyroid medicines, and seizure drugs. Deficiencies in iron, B12, or vitamin D can also contribute to anxiety symptoms.
Other types of disorders, such as trauma- or stressor-related disorders or somatic symptom disorders, also impact an individual's ability to get needed medical care. These types of disorders are classified differently; they do not fall under the heading of "anxiety disorders," but health anxiety can be a prominent part of the symptom picture for those who struggle with these disorders as well.
How You Can Cope with Health Anxiety
Depending on your unique medical situation, there are several steps that you can take to address health anxiety.
Be kind to yourself. Medical situations are stressful and scary. It is normal and okay to be worried or afraid.
Read your medication warning labels and understand their side effects. If anxiety is a side effect of your medicine, consider whether the benefit of the medicine is worth the cost of taking it. Be compassionate to yourself as you make this decision.
If you can tolerate it, get bloodwork done to rule out underlying medical conditions that could result in new onset or worsening anxiety symptoms.
Talk to your doctor about your symptoms and create a treatment plan. This may include changing some of your medications or adding new medications to assist in managing anxiety.
Consider some form of physical activity. Since our fear response creates the urge to move, allowing the body to move in a way that honors your range of motion may be helpful.
Use gradual exposure to approach what you fear in small, manageable steps. This technique is also known as graded exposure or systematic desensitization. Here are some ways it can look: If independent exercise is scary, start with short walks around the house, with loved ones nearby in case you need support. If going to see a doctor is terrifying (iatrophobia), start with going to peer support groups first, or look for other healing communities that honor your culture and background, but where a physician is not present. If you are afraid of needles, start by looking at pictures of needles for gradually increasing lengths of time, before you move on to more challenging steps like being in the same room as a needle or holding a needle.
Consider psychotherapy. Cognitive Behavioral Therapy is an example of a highly effective treatment for phobias and Panic Disorder. A trained mental health professional can help you take the steps above and support you as you accomplish them. They can also help you identify types of thoughts and behaviors that may be making your anxiety worse, and teach you healthy coping strategies for anxiety.
If you are interested in learning more about ways to address anxiety, reach out to our team today!
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