Illness and Health Anxiety, Hypochondria and Hypochondriasis
On one hand, it is normal to have health anxiety and concerns about one’s health from time to time.
On the other hand, sometimes those concerns can become so severe that it causes problems.
Illness anxiety disorder, also known as hypochondria or hypochondriasis, is an excessive concern about having or developing a serious, undiagnosed general medical disease.
Health illness anxiety can start in children, but usually starts in early adulthood.
It is felt that up to 5-10% of the population may have health anxiety disorder.
Hypochondriasis: Ever since ancient times, people have worried excessively about their health. Hence the term hypochondriasis. Hypochondria comes from the Greek hypo (“under’) + khondros (“cartilage”), i.e. “under the cartilage (of the ribs).” It comes from the ancient belief that the organs (liver, gall bladder, spleen) ‘under the ribs’ are responsible for anxiety and fears.
Illness anxiety disorder: Although most people still use the term hypochondriasis (professionals included), you may hear the more up-to-date term ‘illness anxiety disorder’ which is the modern term from the DSM-5, the ‘official’ manual of mental health conditions.
Other terms: Health anxiety is often also used to refer to the same thing.
A person may be more likely to have illness anxiety worries if:
- They have a tendency to worry
- There are other family members who have anxiety and worries about their health.
Illness anxiety worries can be triggered when a person have stresses such as:
- School, work, relationship stress, including losses of loved ones.
- Having a medical condition, including having life-threatening allergies (such as to seafood, nuts).
- Everyday symptoms (e.g. sneezing, coughing, feeling our heart skip a beat, a headache; seeing a nut in a person with allergies).
- Less common symptoms such as finding a breast lump; noticing a swollen lymph node, etc.
- Hearing about health-related stories in the mass media (e.g. internet, TV, social media, etc.)
With illness anxiety, the person may do things such as:
- Regularly check themselves for any sign of illness, e.g. checking their temperature constantly; doing self-examinations of their body.
- Talk excessively about their health worries and complaints.
- Self-medicate or overuse supplements or over-the-counter medications.
- Use medical supplies such as bandages excessively.
- Seek out medical care (or ask loved ones to take them to see the doctor). They may have seen multiple healthcare providers who confirm there is no illness; they may have had diagnostic tests that confirm there is nothing wrong. They may excessively visit the emergency department.
- Asking constantly for reassurance, leading family and friends to become overwhelmed and frustrated.
- Excessively research health concerns, such as going online and visiting Dr. Internet.
- Avoiding people and activities due to fears of becoming ill.
Staying in the “just right”, calm zone
Start with healthy lifestyle strategies in order to take care of your brain:
- Get at least 8-hrs sleep a night, with a regular bedtime and wake up time.
- Get outside every day because nature is calming and soothing.
What key things help you stay well?
If you search, at least search healthier sites
If you are going to search the internet, at least try to use a more trustworthy, reliable websites as opposed to websites that will make you more worried.
The University Health Network in Toronto has a guide to help ensure a website is reliable
Examples of reputable health information websites
- University Health Network (UHN) Health Information (Canadian)
- Health Canada (Canadian)
- National Institutes of Health (American)
- National Health Service (NHS) (United Kingdom)
What are my top triggers and stresses?
What are possible ways to cope with each trigger or stress?
Once you become triggered, what are helpful ways to distract and calm yourself, giving your body time to get back into a "just right", green zone?
- Sensory strategies
- Smells: Scented candles; aromatherapy.
- Touch: Taking a shower, or bath.
- Auditory: Listening to music.
- Movement: Going for a walk; cleaning or tidying.
- Multisensory: Watching an ASMR video; playing a video game; playing some music, e.g. piano, drums.
- Playing with the dog or cat.
- Offering to help out a friend or family member.
- Calling a friend
|What things help you the best when you are overwhelmed? |
Is your loved one in the middle of a worry, and feeling stressed out and upset and turning to you for support?
- Instead of trying to give your perspective or tell them what to do, or using a logical argument, start with listening and validation, acceptance of their feelings.
- Your loved one: “I’ve got a headache again. What if its a brain tumuor?”
- You (Gratitude): “Thanks for letting me know.”
- You (empathy): “Wow, those are big worries.”
- You (offer support, but not solutions): “Can I give you a hug?” “Can I sit with you?” “How can I support you?”
Is your loved one calmer?
- This is the time when you might have a more rational, logical conversation about their fears, and problem-solve ways to support them. Talking with them when they are calm is much more productive rather than talking with them when they are in the midst of worry.
- You: “I love you and worry about you. It must be stressful, all these worries you have.”
- “How can I help (with the worries)?”
- “Anything you don’t want me to do?”
- “Anything you do want me to do?”
Give them a medical explanation to help them feel safer.
- This one might be easier if you are supporting a child rather than a peer, nonetheless, you might still try it.
- Is your loved one calm enough? If os, then hopefully they are able to access their “rational brain” and so you can try talking with them rationally.
- When a person with health anxiety sees a friend coughing, their lack of medical knowledge may lead them to become anxious and fear the worst and instantly think that their friend has COVID and is going to die.
- It may be helpful to provide them with enough medical knowledge so that they can reassure themselves. E.g. that their friend is coughing because they have asthma or allergies; their friend has received all the recommended vaccinations, etc.
Do encourage and support them in having outside activities and interests.
- Offer your time to help keep your loved one busy. The more time they spend on healthy activities, the less time there is for worries.
- For example:
- Schedule regular times to go for a walk together, play a board game together, do household chores together, etc.
Do mindfulness activities.
- Ask if they might want to do some yoga or relaxation with you. For many people however, yoga or relaxation is not something they are interested in.
- If that’s not for them, consider “informal” mindfulness. This is where you do any activity that takes minimal mental effort, and where you do it without external distractions (e.g. no radio, no watching videos or other multi-tasking), for example:
- Going for a peaceful walk together and simply being in "awe" of nature, without talking; doing a puzzle together quietly; mindful cleaning, mindful sweeping, mindful folding the laundry together, etc.
Don’t expect that you can reason your way out of their health anxiety.
- When people are overwhelmed by anxiety, they go into “emotional brain” and are unable to access their “logical brain”.
Don’t stay involved if things are getting escalated.
- Your loved one might be quite opinionated, and you’ve probably seen that you can’t just “win the argument”.
- Sometimes no matter what you do, your loved one is getting more and more upset.
- So if things are escalating, perhaps better to just say, “I love you. I need to use the washroom -- we’ll catch up later.”
Don’t trigger them
- Hearing or seeing about other’s health worries tends to be triggering, so perhaps best not to talk about health issues in front of them.
Is your loved one having significant anxiety that 1) persists, is 2) pervasive at home, school and other contexts, and 3) causes problems?
If so, consider seeing a health care provider such as your primary care provider.
Health professionals such as psychologists, social workers, and psychotherapists can provide various interventions to help such as:
- Cognitive behavioural therapy (CBT), which helps people to:
- Identify triggers for their anxiety, e.g. having a headache.
- Identify worry thoughts that contribute to anxiety, e.g. “Oh no, I have a headache, I must have a brain tumour.”
- Come up with more helpful thoughts, e.g. “Every other time I’ve ever had a headache, its never been a tumour.”
- Come up with more helpful behaviours, e.g. “Instead of staying in bed all day, here are the things I can do to help with my headache… And IF things don’t get better, I can always see my doctor.”
- Exposure therapy
- Exposure therapy refers to gradually exposing one to situations that trigger health anxiety, while ensuring that one has the skills to face their anxiety.
Have various (non-medication) strategies been tried without success?
- If so, then medications may be helpful, such as specific serotonin reuptake inhibitors (SSRIs).
Free workbook on Health Anxiety by the Centre for Clinical Interventions, funded by the Australian Government. Uses a cognitive behavioural therapy (CBT) approach.
When you are in a good space, write down a plan for how to prevent, cope and deal with the health anxiety.
Date of Last Revision: Jul 22, 2022