It may resemble a series of medical complaints and check-ups. After all, you are persistent and want the best for your health. When a thorough physical exam does not show anything, maybe you opt for some comprehensive lab tests. You remember walking home each time from the doctor’s office with a resolve to get down to the bottom of things. But now, with amounting evidence for good health, you still find yourself displeased and worried.
About 1 to 5 percent of the population suffers from hypochondria, and the disorder is believed to strike men and women equally. The DSM V defines hypochondria as a preoccupation with the belief that one has an illness, based on a misinterpretation of bodily symptoms. To qualify as hypochondria, this preoccupation must cause distress in a person’s daily life and persist for at least six months — despite medical evidence discounting the perceived illness.
Anxiety occurs as a normal reaction to the perception that a situation is threatening. Thus, hypochondriasis or health anxiety (friendlier label) refers to the excessive fear based on a misperception of bodily sensations as dangerous, needing an urgent medical examination and care. Although we often associate anxiety with a problematic focus, anxiety is inherently a fight or flight response, preparing us to take action against a threat. To this extent, anxiety can be considered a healthy response. It is when anxiety is extreme in relation to the actual degree of threat that the response becomes problematic.
Specific health anxiety triggers vary from client to client and typically will include body sensations as well as intrusive thoughts and images. Most times body sensations are innocuous and are often familiar to many folks. However, to those struggling with health anxiety “body noise” is stressful, escalating the level of anxious arousal with each symptom. The Cognitive Behavioral model of treatment draws its conceptualization from the understanding that automatic (threatening) thoughts are misinterpretations. It is those thoughts in fact, that provoke the anxiety, and not the body noise itself. When treating a client, it is then important to address the misinterpretations that overlay the catastrophic thoughts and to replace them with more realistic beliefs.
When faced with a threat, humans naturally use adaptive responses to either escape or avoid a threat and get to safety. With health anxiety, those behaviors to avoid a threat are used in excess. They could manifest in a number of ways: from doctor visits to medical tests, browsing the web for hours, or just being unable to leave the house in fear that something could go wrong. These anxiety-reducing behaviors work in the short term, but it does not lend to a long-term solution.
So what does treatment look like for health anxiety?
Psychoeducation is a large component and its aim is to educate the client on the problem and provide a rationale for treatment. A clinician might draw a model for how the cycle of anxiety is perpetuated with the use of anxiety-reducing behaviors, and thereafter ask a client to monitor body sensations and threatening thoughts. A client might also choose to consider the evidence for and against his threatening thoughts, which is followed up by an informal discussion of cognitive errors (i.e. emotional reasoning – just because I feel that something is wrong, does not make it fact/true).
The second major component of treatment involves exposure therapy. Exposure is a technique in which a client gradually confronts fear-provoking situations. As of today, exposure techniques seem to have the most robust effect on any phobia symptoms (Furer & Walker, 2005). How does exposure therapy work? In simple behavioral terms with repeated exposure to the same stimulus, a client reaches a level of what is called “desensitization.” Translating this to health anxiety, if a client fears a symptom of a racing heart, a therapist may set up a series of exposures to elevate the client’s heart rate for a minute or so with exposure (i.e. have a patient run in place). By facing feared situations, clients develop healthy coping strategies and are modifying their beliefs about a previously threatening symptom — such as an elevated heart rate. Perhaps more importantly, exposure therapy allows a health-anxious patient to have experience in which he faces feared situations without using safety behaviors, learning that he can tolerate the associated anxiety.
When a thorough medical check-up does not reveal a health issue, it is time to consider a behavioral approach to treatment. Find a cognitive behavioral therapist in your area and learn more about treatment. You may have doubts, but do your doubts outweigh your desire for a better life?