SWISS MEDICAL EXPERTISE: ZURICH, MALLORCA, LONDON, NEW YORK

11 Minutes

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Health anxiety refers to excessive worry about health to the extent that is inappropriate to the actual status of health. As a continuous spectrum, this type of anxiety ranges from mild forms of worry to strong health-related fears and misguided beliefs. Medically known as hypochondriasis, timely managing health anxiety is critical as unresolved cases may complicate into significant distress, excessive utilisation of healthcare resources, and functional impairment.

This article aims to provide an overview of health anxiety and its clinical profile and discuss how to stop health anxiety symptoms and its debilitating effects on life.

  • Health anxiety is known to affect 4-5% of the world population; however, experts often regard it as underreported, with actual prevalence ranging up to 12% or even more in the UK.
  •  Health anxiety has its roots in the ancient notions of hypochondriasis, a condition primitively thought to be a physical ailment characterised by medically unexplained digestive issues.
  • Approximately 39.8 percent of health anxiety or hypochondria cases in the UK are associated with poor recovery rates.
  • Patients diagnosed with health anxiety have a higher rate of psychiatric comorbidity, namely, generalised anxiety disorder, major depression, panic disorder, and somatisation disorder.
  • Health anxiety affects men and women equally and with early adulthood as the most common age of onset.

In order to understand how to break the cycle of health anxiety, it is critical to comprehend the psychiatric issue more deeply. Also known as hypochondria or hypochondriasis, health anxiety refers to perceived bodily changes or sensations falsely interpreted as indicators of a serious disease. Irrespective of the term used, the central questions to ponder include whether or not this excessive worry is related to actual risk and how it impacts their lives. It is not uncommon for such patients to undergo more examinations and testing and consume more health service resources than those without extreme health anxiety.

Health anxiety typically begins in adults, though children can also acquire it. The disease is usually chronic and follows a fluctuating course with any of the following two presentations:

  • Care-seeking behaviour: Such behaviours are characterised by seeking frequent medical care, consulting multiple specialists, and requesting medical tests even without reason.
  • Care-avoidant behaviour: Such behaviours include avoiding medical care and doctors based on trust issues and out of fear of transmission of infection by repeated visits to the hospital.

As with other types of psychiatric illnesses, healthy anxiety demands a rich, creative treatment plan based on the biopsychosocial model. The health anxiety support team typically includes primary care physicians, mental health professionals, and multiple subspecialists that cater to individual needs and provides many tips for health anxiety. 

Health anxiety can occur in various maladaptive presentations, characterised by different types of health-related checking behaviours and other associated dysfunctional beliefs. These presentations are severely debilitating on a personal level and often associated with societal costs.

According to the DSM-5 criteria, the following pointers need to be fulfilled in order to diagnose health anxiety:

  • A preoccupation with having a serious illness
  • Absence of somatic symptoms or a very mild picture of physical symptoms.
  • A very high anxiety level related to health
  • Getting easily alarmed about personal health status
  • Excessive health-related behaviours or maladaptive avoidance
  • At least 6 months of preoccupied behaviour
  • No other plausible cause of the underlying mental issue

Research has consistently indicated the significance of parental attitudes in developing health anxiety. Additionally, culturally influenced attitudes and previous encounters with the physical disease also contribute to the causative aetiology of the disease. Nevertheless, patients with health anxiety have elicited only a few clinical and demographic differences compared to the general population. Some findings indicate a role of low income, low educational level, and a history of childhood abuse or illness in triggering health anxiety in later stages of life.

Research suggests that misinterpretation of the bodily symptoms by amplifying the somatic sensations is quite common in patients with debilitating health anxiety. Such patients also exhibit significantly lower thresholds for physical discomfort. For example, what is normally perceived as abdominal pressure may be experienced as pain by them. So when an injury is sustained, it is accompanied by extreme anxiety over health which is usually perceived as confirmation of a medical issue. The problem might be due to a tendency in such patients to exaggerate their symptoms during assessments.

As per the social learning theories, health anxiety is regarded as a request for admission made by a person facing insolvable problems. This role allows them to avoid their obligations, responsibilities, and challenges. On the other hand, the psychodynamic theories believe that for such people, hostility and aggressiveness towards others transfer into physical complaints through displacement and repression. These physical symptoms are thought to undo the guilt they feel and serve as a punishment for their bad behaviours.

The symptoms of health anxiety can drastically reduce the quality of life and even impact family members and friends. If you are seeking health anxiety help it is crucial to get so before the symptoms get out of control. The care plan usually involves working with a mental health professional to identify the problem and building coping mechanisms to address the underlying symptoms.

Before focusing on how to beat health anxiety symptoms, it is routine practice for counsellors and therapists to rule out the possibility of a serious health issue. If there are any concurring mental health issues like depression, OCD, cancer, or diabetes, managing them is also included in the part of the treatment plan.

The basic principles that form the basis of health anxiety cure are outlined below:

  • Establishment of a solid therapeutic association between the doctors and patients
  • Educating the patients regarding the clinical manifestations of health anxiety
  • Offering continuous reassurance throughout the length of the treatment plan
  • Avoidance of all low-yield, highly risky and invasive procedures
  • Optimisation of the patient’s ability to cope with their symptoms instead of attempting to eliminate them
  • Collaborating with all treatment providers to avoid duplication of investigations and medical tests

Just like with other somatoform issues, hospitalisation in a psychiatric ward is rarely needed. Due to a risk of anxiety, concurrent mood, and development of other personality disorders, a psychiatric admission might be needed, particularly if the patient presents with suicidal ideation based on a secondary psychiatric issue or develops severe anxiety.

In addition to the above-mentioned, the following therapies may also work how to calm health anxiety.

Psychoeducation

Psychoeducation refers to educating oneself about health anxiety, its development pattern, causes, and other factors. It can potentially help people recognise the triggers behind their issues and learn to differentiate between normal and abnormal somatic symptoms. Psychoeducation can successfully provide people with a better sense of control of their mental as well as physical health, leading to better health and wellbeing. It also includes providing education to the families or carers of the patients in addition to offering them support.

As a part of psychoeducation, the following pieces of information are ensured to be communicated to the patients:

  • Anxiety does not indicate a character defect or weakness
  • Having uncomfortable physical symptoms does not always mean that you have a serious disease
  • It is perfectly normal to experience uncomfortable physical symptoms like tiredness, nausea, or pain
  • Health anxiety is treatable and can be controlled to improve the quality of life

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy is a part of psychotherapy routinely offered to patients with health anxiety. It constitutes a health model that focuses on cognition, behaviours, thinking patterns, and how the mind and body respond to these patterns. The primary concept that forms the basis of CBT is that the thoughts we perceive about a situation can affect how we feel about them and behave in reference to them.

We as humans routinely assign meanings to certain situations; for example, tingling in arms and legs always means that we have multiple sclerosis, and these false meanings are what trigger extreme anxiety. This anxiety, in turn, makes you believe that your initial thoughts (of having multiple sclerosis) are right and grant them the power to take charge of you.

Cognitive behavioural therapy helps by empowering you to overcome your fears in such situations. It aims to correct all the false and irrational thoughts you have associated with certain situations. It helps you acquire a specific mindset that, in turn, supports you to get through anxious situations differently. CBT also helps develop tolerance towards uncertain and uncomfortable situations without panicking. It is commonly offered in almost all mental healthcare facilities and includes multiple sessions with approved therapists that continue unless the goals are reached.

Medication for Health Anxiety

If your health anxiety is responding well to psychotherapy alone, it is usually continued until the established treatment goals are achieved. However, some people fail to respond adequately to psychotherapy and need an adjuvant to control their symptoms. If you are that person and wondering how to get rid of health anxiety, prescribing medications is the next best step for you.

Common medications used to manage health anxiety symptoms include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitor, and Beta-adrenergic receptor-blocking agents. If you have a mood disorder in addition to health anxiety, medications may also be prescribed to control them.

It is important to remember that the routinely prescribed medications for health anxiety may come with serious side effects and risks. Hence, it is essential to review the treatment options with your doctors and discuss all queries before commencing them.

Health anxiety is a unique long-term psychiatric issue that varies in severity and can present itself in different forms over time. In many people, it worsens with stress or age; however, seeking timely treatment and sticking to it can possibly help reduce the symptoms and improve the overall quality of life. Learning how to break the cycle of health anxiety can be time-consuming, but it’s definitely doable and can bring much-needed happiness.

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