Anxiety can be adaptive in nature — preparing us to take action when confronted with real threat. Those with a diagnosis of asthma may become anxious when experiencing shortness of breath, which signals the need to self-administer a bronchodilator medication to prevent respiratory fatigue.
This form of medical attention makes sense, and would not be considered to fall under the category of health anxiety. However, Clinical Health Anxiety refers to excessive health-related fears based on one’s misperception of harmless physiological changes and sensations as indicative of a serious medical condition.
An individual with health anxiety will also perceive themselves as not having the ability to cope with the threat of illness
Over time, the term “Health Anxiety” has come to replace “Hypochondriasis,” primarily because it provides a more meaningful description of the emotional and behavioral manifestations of this condition.
“Hypochondriasis,” on the other hand, derives from the Greek hypo (below) and chondros (cartilage of the breast bone), and was used by ancient Greek physicians to describe unexplained intestinal pain.
The term Health Anxiety is not a specific clinical diagnosis according to the American Psychiatric Association (2013), but instead is used to refer to a collection of symptoms regarding medically unexplained physical complaints, fears regarding illness, and behaviors such as avoidance and reassurance-seeking.
Specifically, Health Anxiety includes the following:
REASSURANCE-SEEKING
Repeated visits to one’s physician to have “symptoms” checked.
“Doctor-Shopping” for the purpose of asking several doctors if a diagnosis is correct.
Repeated internet searches to discover information related to physiological changes.
BODY CHECKING
Repeatedly measuring heart-rate, blood pressure, temperature, etc.
Frequently monitoring levels of dizziness, fatique, or pain.
Repeated inspections of marks, sores, and moles on the skin.
SAFETY BEHAVIORS
Keeping medications on hand at all times.
Staying within close proximity to hospitals, urgent care centers, etc.
Strict adherence to a rigid diet and exercise regimen, due to fear of illness.
AVOIDANCE STRATEGIES
Refusal to attend funerals or visit cemeteries.
Staying away from people with illnesses; typically, cancer.
Refusal to watch TV shows, or read articles, related to people who are sick or dying.
Although there are several theoretical models which explain the development and maintenance of health anxiety, the Biopsychosocial Model has received the most empirical support to date.
This orientation believes that health anxiety develops due to one’s consistent misinterpretations of innocuous bodily sensations as being the result of a serious illness.
Anxiety is then maintained by the reinforcing value obtained from the consequences associated with reassurance-seeking, safety behaviors, and avoidance.
BODY NOISE & HYPER VIGILANCE
The human body changes every second — sounds (stomach grumbling), sensations (tingling in one’s fingers), etc. Most people rarely notice these constant changes. However, those with health anxiety never miss a beat regarding this “body noise,” due to their hyper vigilance.
Once these sensations are noticed, the individual jumps to the conclusion that they are symptoms of a particular illness. A pain in one’s groin area may be misinterpreted as prostate cancer.
Following this misappraisal, the person pays even greater attention to these physical sensations, which then results in the vicious cycle of reassurance checking and avoidance, leading to heightened anxiety.
MAINTENANCE FACTORS
Selective Attention to Threat: Those with health anxiety choose to error on the side of caution, due to their tendency to overestimate the occurrence of threat. This style of thinking leads to increased attention to the perceived threat (bodily changes), resulting in a greater sensitivity to these physical sensations; solidifying the belief that a serious medical condition exists.
Confirmation Bias: Guess what happens when your looking for danger? You’ll find it. Health anxious individuals consistently look for evidence to confirm the presence of illness, due to their “error on the side of caution” belief. Thus, if one’s doctor orders additional tests, “just to be sure”, this is interpreted as evidence that an illness must surely be present.
Reassurance-Seeking: Frequently checking one’s body, and consulting with physicians regarding the possibility of having a serious illness, increases the likelihood of obtaining a false positive result; strengthening the belief that a real physical threat exists. For example, when contradictory information is obtained from different sources, anxiety intensifies, triggering additional reassurance checking. Since short-term relief from anxiety and uncertainty occurs as a result, this behavior is reinforced, and becomes one’s default manner of responding when believing the threat of illness is imminent. This strategy also prevents experiences that would have corrected misinterpretations of harmless physical sensations. Health anxious individuals believe their habitual way of behaving is necessary for managing their anxiety, and avoiding a life-threatening illness. Unfortunately, this perceived solution, has now become the problem.
Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit anxietytreatmentinclinevillage.com to learn more.
