You feel a sudden pain in your stomach and immediately think the worst: ‘Is this it? Am I dying?’ Then you turn to Google and your worst fears are confirmed… Many of us experienced this at least once. In more extreme cases, it might be indicative of health anxiety. Why are some people preoccupied with their physical health despite the lack of symptoms? And how might the ongoing pandemic affect people with health anxiety? Let’s find out!

This article will cover:

·       What is health anxiety?

·       How can it be treated?

·       Health anxiety and Covid-19

What is health anxiety?

Health anxiety (previously hypochondriasis) is often used as an umbrella term for two different conditions defined in DSM-5, namely illness anxiety disorder and somatic symptom disorder [3]. It is relatively common, affecting 4-5% of the population [5]. What these two diagnoses have in common is an excessive preoccupation with one’s health and high levels of anxiety surrounding one’s health. It becomes problematic because when we are preoccupied with our health, and potential symptoms of a disease, we tend to notice even the most subtle bodily sensations that we would not normally notice.

People with illness anxiety disorder (IAD) have none or only very mild symptoms (often a normal physiological sensation), yet they are excessively preoccupied with having or acquiring a serious disease [1]. If a person is diagnosed with a medical condition, the anxiety must be clearly disproportionate to the severity of the condition. They may either display excessive health-related behaviours (e.g., frequent doctor visits or excessive monitoring of one’s body for signs of illness) or maladaptive avoidance of doctor’s appointments due to fear of confirmation that they are ill. However, reassurance from medical professionals or negative test results generally do not alleviate the anxiety, in fact it might even reinforce it [5].

On the other hand, people with somatic symptom disorder actually experience physical symptoms (most commonly pain) that are distressing or cause significant disruption of daily functioning [1]. The person might also have disproportionate thoughts about the seriousness of those symptoms. As with IAD, these patients frequently seek medical attention which, however, does not help alleviate their anxiety.

DSM-5 Illness anxiety disorder [1]

A.    Preoccupation with having or acquiring a serious illness.

B.    Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.

C.    There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.

D.    The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).

E.    Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.

F.     The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.

DSM-5 Somatic symptom disorder [1]

A.    One or more somatic symptoms that are distressing or result in significant disruption of daily life.

B.    Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:

1.     Disproportionate and persistent thoughts about the seriousness of one’s symptoms.

2.     Persistently high level of anxiety about health or symptoms.

3.     Excessive time and energy devoted to these symptoms or health concerns.

C.    Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Development and risk factors

The specific causes are unclear. Sometimes, health anxiety might stem from major stressful life events or a major but benign threat to one’s health [3, 7]. Other risk factors might include history of childhood (sexual) abuse, having a close family member with a serious illness or parents who were preoccupied with health [3].

Health anxiety is often comorbid with other forms of anxiety or depression [3]. It may also be linked to negative affectivity [3].

How can it be treated?

The most common and effective treatment is cognitive-behavioural therapy (CBT) [3]. The goal of CBT is to challenge and change irrational thoughts and behaviours, so that the person can approach certain situations differently. It is important to underline that health anxiety, the symptoms/sensations themselves (if present) are not the cause of anxiety, it is the meaning that the person assigns to them (belief that they are indicative of a serious illness). The goal of CBT is to make the person realise that their worries about having a serious illness are excessive and irrational and that mild bodily sensations are normal and do not necessarily indicate that something is wrong. This should gradually teach the person to better tolerate uncertainty regarding physical sensations.

Health anxiety and Covid-19 pandemic

Some researchers have already started to investigate how the ongoing pandemic affects people with health anxiety. While health-related fear is normal during a pandemic, for people with anxiety, it might become even more problematic [4] and the widespread exposure to Covid-19 related news does not help.

People with health anxiety might misinterpret benign bodily sensations as a sign of being infected, which can in turn exacerbate their anxiety and influence their behaviour [2]. They can consider hospitals as a source of contagion and thus avoid them entirely. However, they can also seek reassurance that they are healthy, often by visiting several hospitals and doctors which puts a burden on the medical staff that is already dealing with a large number of Covid-19 patients. On the contrary, people with no or low levels of health anxiety might ignore the recommended guidelines (quarantine, social distancing) and might be less likely to get vaccinated.

Researcher Haig-Ferguson and colleagues [4] investigated health anxiety in children and young people in the context of the Covid-19 pandemic. They argue that children are vulnerable to developing health-related worries if their parents are particularly worried about the virus (modelling of anxious behaviour) or if they have a close friend or family member who fell seriously ill or died as a result of the virus. They also argue that children are less cognitively competent to process the abstract threat of the virus which might result in over-generalisation of the threat and exaggeration of their worries. In the figure below, they further explain the link between health anxiety and Covid-19 in children.

Source: Haig-Ferguson, A., Cooper, K., Cartwright, E., Loades, M. E., & Daniels, J. (2021). Practitioner review: health anxiety in children and young people in the context of the COVID-19 pandemic. Behavioural and cognitive psychotherapy, 49(2), 129-143. https://doi.org/10.1017/S1352465820000636

Moreover, Jungmann and Witthöft [6] investigated the link between HA, cyberchondria (anxiety about one’s health that is exacerbated by internet search for symptoms), coping strategies and Covid-19. They found a particularly strong virus anxiety among people with already elevated levels of trait health anxiety and cyberchondria. This suggests that health anxiety and cyberchondria might be risk factors for virus anxiety related to Covid-19. On the contrary, the sense of being informed about the virus and adaptive emotional regulation might serve as protective factors.

Extra resources:

1. Health Anxiety Podcast Show: https://open.spotify.com/show/79GbkgP2sxA8FJ97Qk1GKZ?si=-7jFIsVUS3WHePU6lgnt-w&dl_branch=1

2. YouTube video – Two Tips for Health Anxiety: https://www.youtube.com/watch?v=rhy2R1BLdxY

References

1. American Psychiatric Association. (2013). Diagnostic criteria and codes. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.

2. Asmundson, G. J., & Taylor, S. (2020). How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. Journal of anxiety disorders, 71, 102211. https://dx-doi-org.eur.idm.oclc.org/10.1016%2Fj.janxdis.2020.102211

3. Goodman, K. (June 2020). Health anxiety: What is it and how to beat it. Retrieved on July 31, 2021 from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/health-anxiety-what-it-and-how-beat-it

4. Haig-Ferguson, A., Cooper, K., Cartwright, E., Loades, M. E., & Daniels, J. (2021). Practitioner review: health anxiety in children and young people in the context of the COVID-19 pandemic. Behavioural and cognitive psychotherapy, 49(2), 129-143. https://doi.org/10.1017/S1352465820000636

5. Harvard Health Publishing. (April 2020). Always worried about your health? You may be dealing with health anxiety disorder. Retrieved on July 31, 2021 from https://www.health.harvard.edu/mind-and-mood/always-worried-about-your-health-you-may-be-dealing-with-health-anxiety-disorder

6. Jungmann, S. M., & Witthöft, M. (2020). Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety?. Journal of anxiety disorders, 73, 102239. https://doi.org/10.1016/j.janxdis.2020.102239

7. Mayo Clinic. (April 2021). Illness anxiety disorder. Retrieved on July 31, 2021 from https://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/symptoms-causes/syc-20373782