How To Deal With Health Anxiety and Hypochondria



how to deal with health anxiety and hypochondria I'm gonna talk about what it looks like and what you can do about it I'm dr. Tracy marks a psychiatrist and I published weekly videos on mental health education and self-improvement if you don't want to miss a video click Subscribe and the notification this topic is based on a viewer question from Little Red Riding Kyle and he says you should do a video on hypochondria health anxiety I'm only 15 and mine is ruining my life I can't sleep because I'm afraid my heart will stop because of some undiagnosed heart problem even though I've had many tests and the doctor has repeatedly told me that my heart is fine thanks Little Red Riding Kyle for this question with hypochondriasis you misinterpret body symptoms and assume that you have a serious disease even after you've been told that you don't you may believe that the doctor missed something you may even believe that the anxiety that you have will turn into something more serious like dying in your sleep or having a heart attack in 2013 the newest edition of the Diagnostic and Statistical Manual changed the name from hypochondriasis to somatic symptom disorder somatic means body so it's a disorder of being over focused on body symptoms and too focused on having an illness people who have this problem know that they have it because they are in a lot of distress for the purpose of this video I'm going to use the older term hypochondria with hypochondria you become so hyper aware of your body sensations that you spend time in your head analyzing symptoms and figuring out what illness it belongs to you can become so anxious that your body starts making up symptoms that match a disease process that you're worried about for example if you're worried that you have brain cancer you can start having balance problems and dizziness and maybe even headaches then when that wave of anxiety passes those brain cancer symptoms just disappear like magic until you start some other body symptom what's the difference between general anxiety with physical symptoms and hypochondria because anxiety can be very physical for example let's say you need to give a talk and you become anxious about it your heart starts racing your palms get sweaty you may even feel faint the person without hypochondria recognizes that they feel anxious and they can put the symptoms in the context even if you have more odd symptoms like getting a lump in your throat with general anxiety the first time you get that lump you might get scared and wonder if there's something seriously wrong you go see your doctor he examines you and tells you that your throat is fine it's probably anxiety you feel reassured and the next time it happens you remember oh this is what happens when I get anxious and then you work on calming down that's generalized anxiety in contrast the person with hypochondria isn't reassured by that doctor's visit they may think that this is a new symptom that's come up since the last doctor's appointment so it must be something else and not anxiety or the doctor missed something or there's some hidden undiscovered problem that medical science just hasn't been able to detect until your problem advances to the point where you're close to death and then they'll figure it out in the meantime you need to do your research and figure out what this physical problem is that's gonna kill you or permanently maim you unless you figure it out does this sound familiar what makes one person be reassured and the other not it's a conditioning response and that's one of the keys to the treatment so let me explain you've probably heard the story of Pavlov's dog Pavlov was a Russian scientists who studied learning theory in classical conditioning Pavlov showed that you could trigger a certain physiological response with a neutral stimulus if you pair it with a potent stimulus so he showed his dog meat which made the dog salivate Beni showed the dog meat and Abell and the dog would still salivate because of the meat by continuously pairing the meat in the bell he was eventually able to run the Bell around for me and the dog would salivate because the dolls associated the Bell with the meat in a similar way with health anxiety you come to associate the feeling of anxiety with a physical sensation and you eventually learn to fear the physical symptoms and just see them all as dangerous let's look a little closer at this let's say you have anxiety it can be free-floating anxiety about nothing in particular or it could be something that's completely unrelated to your body maybe you lost your job or you have a big deadline coming up then in response to the anxiety you also have a body sensation and let's say it's acid reflux because you experienced this while you're in an anxious state and you have a tendency to imagine the worst-case scenarios you conditioned yourself to think of the burning in your chest as a sign that you have a heart problem so you google chest burning for the hundredth time and then you find someone on reddit who says that their uncle complained of chest burning just before he went to bed then he died in his sleep so what's happening right now you're gathering more evidence and proof that what you're experiencing really is more than just anxiety and seeing that post reinforces your concerns about your chest burning and that they're there something legitimate and shouldn't just be blown off as anxiety your next response is to test your theory that your heart is on the verge of failing by paying really close attention to every body sensation that has to do with your heart so you do another round of research on what it looks like if your heart were in failure and you get a couple of clues further reinforcing all this investigation behavior and what happens you now start having some of those symptoms that you read about during your second round of research it started with chest burning but now you've got shortness of breath and you're you find yourself having a hard time breathing when you're just sitting trying to relax and this is just more reinforcement for you that what you really believe is true and at this point you may go back to the doctor who told you two months ago that your heart was fine but this time you have more symptoms than you had before like the shortness of breath and so you even think you might even see a little bit of swelling in your legs the doctor checks you says your heart is fine she may even tell you it's probably anxiety and you might feel a little bit better especially because you're at the doctor's office and your ear symptoms kind of go away a little bit but you're not really satisfied because the doctor said that there's nothing wrong but she didn't even do a body scan and how can she know that something isn't wrong with your heart if she didn't do a heart scan so you go home even more anxious now you can't trust the medical system and you're all on your own just you and the internet and then what happens you live through the night without dying like that Reddit guys uncle your symptoms seem to get a little bit better and you eventually believe that you're okay for now but that's just now until it reaches a crisis level again but you'll keep your eye on it so then you do your third type of reinforcing conditioned behavior and that's the constant checking or body surveillance you keep checking for signs of your heart problem and you're gonna be acutely aware of everything you feel so that you will know when something is wrong again and the only thing that can really distract you from this is having some other body problem that makes you think you have another condition and this is the life of a person with hypochondria it's exhausting and it's just extremely distressing for the person affected in exasperating for the people around them who are trying to reassure them how can you get help for this medication for anxiety can help somewhat by calming the anxiety but it doesn't really address the the thought and behavior cycle the medications that we would use would be serotonin enhancing antidepressants like prozac what tends to be more helpful is cognitive behavior therapy or CBT with BTW you address your distorted automatic thoughts that you have about your body sensations because your fears are triggered by body sensations and an example of a distorted thought in hypochondria is that good health means you don't have much going on with your body you don't really feel much at all people with hypochondria don't believe that a healthy person can stand up and feel dizzy if that happens it must mean that you have an illness that needs to be addressed before it turns into something more serious CBT also addresses the behaviors that you engage in like the research and the body surveillance and the frequent doctor appointments to get reassurance so what would CBT look like first you want to get a medical workup and chances are you've had plenty but if you haven't you first want to make sure that you don't have a physical illness that needs treatment just because you worry about your health doesn't mean that you don't have a real health problem the issue is you assume that any health problem that you have is catastrophic or permanent so get medical clearance so that then you can feel free to focus on the problem as an anxiety problem and not as a medical problem second you want to see a therapist who is trained in and uses CBT in their practice you don't want to sit around talking about your relationship with your mother that's useful for some problems but it's not going to get you very far here a CBT therapist will most likely be a doctorate level psychologist or a master's level therapist it's probably not going to be a psychiatrist some psychiatrists do CBT but many more non psychiatrists do CBT once you're in therapy here are some components of the therapy one is education on the illness or illnesses that you're concerned about now the facts here will come from your medical doctor but your therapist can help reinforce this information for you so when you go to the doctor have questions about your illness concerns written down most doctors offices are busy and if you're anxious you can easily forget to ask the questions that you have or feel like your questions are too crazy to ask but the doctor you're seeing is the one who needs to address these questions not the internet someone in the comments said that she saw multiple doctors and they ruled this out and ruled that out but she still had pain so she asked me in the comments why was she still having pain well I can't tell her why she's still having pain no one on the Internet can tell her with any accuracy why she's having pain the person who can tell her that is the person who examined her ran the tests for her and that would be the person who would say you don't have cancer because people with cancer have this this and this and you don't have that you don't have a brain tumor because people with brain tumors have this this and this you don't have that so that is why you don't have a brain tumor so don't save your questions for research later think of whatever questions that you might have no matter how extreme they sound and then ask your doctor about them then take notes on the answers so you can use those answers later in therapy another component of CBT is thought restructuring and this is going to be very individual depending on what your thoughts are chances are your therapist will give you homework assignments for you to write down what your automatic thoughts are regarding your body sensations and this goes back to things like heartburn means a failing heart or dizziness means you may have a seizure disorder stomach problems mean you have cancer the therapists will then help you break down these thoughts into steps to see how you connect the sensation to your conclusion then you will challenge those conclusions with other possibilities and this is where you can use the medical information that you wrote down from your doctor so let's go back to the concern about dying of a heart attack in your sleep in general there's different types of heart disease this might be something like your doctor might say there's structural problems like valve defects or defects of the heart muscle that caused it not to pump properly these problems can occur at any age but they're generally seen on heart imaging like an echocardiogram you might say well my doctor didn't do an echocardiogram if you have valve problems or a muscular problem where your your heart won't pump properly you're gonna have many more physical signs other than chest birding in fact indigestion isn't a sign of valve defects people with valve defects or a stiff heart have some serious physical activity intolerance and they don't need to beg their doctor to look at their heart so if you have a structural problem chances are it would have been picked up early in childhood or early adulthood another type of heart problem is blood vessel disease your arteries get clogged with plaque and the heart muscle doesn't get enough oxygen because it's clogged up you can't get enough blood and then you have a heart attack it would be very unusual for a fifteen-year-old like Little Red Riding Kyle to have this kind of heart disease it takes years for your blood vessels to clog up there are some genetic diseases though that cause accelerated plaque formation but if you had that there'd be other signs and symptoms other than chest burning and these will be signs that would trigger a doctor to investigate so this is the kind of education that you would want to get from your doctor about your situation to know why what you feel isn't a certain disease so ask why don't I have heart disease why don't I have a brain tumor and write down those answers to challenge your distorted and catastrophic conclusions that you have the last component that I'm going to talk about addresses the reinforcing behaviors that you engage in such as the internet research the body checking the doctor shopping for reassurance a CBT intervention is exposure response prevention it's used for obsessive-compulsive disorder to stop the compulsive behavior but it can also be used with health anxiety the idea is to use exercises that your therapist gives you to expose yourself to the anxious thoughts then not allow you to research or check your symptoms sometimes your therapist may use relaxation techniques or other activities to distract you from engaging in the behaviors what if you can't afford to see a therapist are you just doomed there are self-help books out there on CBT for anxiety and worry the difference is is that its general help it is not customized for your issues that's where the therapist comes in but here's a watered-down self-help version of the CBT you would still start with getting medical clearance though that's very important don't try and diagnose yourself from internet research before you see your doctor make a list of your conclusions that you draw on your own about each of your physical symptoms take this list of the doctor and get him or her to explain why your conclusions are incorrect you have to use some judgement though if you have a two-page list you need to prioritize the questions because chances are many of them are repetitive but that's okay you still want to keep the list anyway you want to put your thoughts down on paper that's always good next write the doctors responses on a card or in a notebook then the next time you have a physical symptom pull out the card and read it if you think yeah but he didn't know at that time that I also have pain in the shoulder maybe this is something new resist the urge to look it up use self-talk to change the monologue in your head about that here's an example of a self-talk script I'll have this in the description and you can just copy it if it applies to you I'm gonna say it is if I'm you so going back to the new shoulder blade pain instead of focusing on how the doctor missed something you can just say something like this to yourself I've been checked out by my doctor my new body symptom does not mean I really have a medical illness I have anxiety and this is what I tend to think anxiety makes me believe I have something I don't I'm not more of a medical expert than the people who have seen and examined lots of sick people I know what sick people look like I can only say what I look like so I don't have a point of comparison to know what the illness I'm concerned about really looks like the Internet does not give me a complete picture of what it really looks like to have a failing heart or you can just fill in the blank with whatever it is you're concerned about this self talk is part of the process to mentally distract you from investigating your problem after you complete this self-talk do something physical to distract yourself go for a walk or listen to music do some yoga exercises get a punching bag and beat it until you're tired in my family growing up my parents do their own landscaping so there was always a need to move dirt or leaves from one part of the yard to the next so they're old-school solution to boredom or upset was to tell us to go outside throw some dirt or dig a hole now is uninformed as this sounds there is some merit to this if you've never dug holes or thrown dirt it's pretty grueling work and if you've got chest burning or a twitching eye muscle that you're worried is cancer if you go throw some dirt the physical exertion and pain in your arm muscles will distract you from the twitching eye muscle because remember random body sensations that are not clearly connected to anything are triggers for the anxiety lifting something heavy that makes your arm muscles sore makes sense and that doesn't usually trigger the anxiety what if after all that you come back in the house you get showered up and then you start back worrying again then you will have to just brute force make yourself not do research whatever that takes put the phone away restrict yourself from using the computer and create these restrictions ahead of time know how you're going to keep yourself from engaging and the behaviors and stick to it then to address your thoughts but you've got to replace them with more self-talk and if you can't remember what to say then write it down and read it one of the things about the CBT approaches that takes effort this is not going to passively go away that's why taking a pill isn't really going to get rid of this it may help your anxiety especially if it's so bad that you become too unglued to do therapy but hey if you've got the energy to go to ten different doctors looking for answers you can take some of that time to do these exercises to reprogram how you think and how you react to your body I hope this helps you please share this video and let me know in the comments what you think see you next time

27 comments

  1. I’ve watched this video everytime I’ve had an anexity attack and it’s like it cures it— IVE DONE EVERYTHING IN THIS VIDEO

  2. Is chest pain and chest burning and chest discomfort happen by health anxiety? I’ve had it for 4 days now, how long does it take to pass? I’ve had an ECG 4 weeks ago and it was fine but that was before the chest pain came on, please help?

  3. This is me to a t. Having rough time atm an new symptom popping up, I have pins an needles in legs an pain in shoulder. Googled for days now worried sick xx

  4. Wowwwww. This Dr. knows her stuff. Not even my doctors asked me anything pertaining to this subject. I've found the name of my issue. Even tho she said stop researching stuff, I'm super excited to have found her. Where is she located, I would love to have her help me.

  5. This couldn’t have explained my anxiety and fear of a heart attack any better, I’ve watched this video around 15 times now, this helps when I have a panic attack
    Thank you

  6. Omgggg you just explained me perfectly. If I get a symptom I always search it and then I assume I have cancer, or I'm having a stroke, or I'm having a heart attack and it's horrible. Also if I get small bumps, let's say in my mouth, then I go to the doctor and they say I'm fine I get relieved but then the next day I get another symptom and I freak out again. I want it to end, it's controlling my life and idk what to do.

  7. Such a hard battle to fight. I wake up each morning feeling like this. It's an endless cycle out of nowhere, and the only reason one stops is because another worry is in the works. I'm tired :(.

  8. I'm only halfway through the video but this is helping me so much. I do so much of this. Now I'm wondering if I really do have chronic fatigue or heart trouble or if it's just me being worried about my health. THANK YOU

  9. Thank u for keeping a valuable video
    Mam ! I have a major problem
    Pls make a reply if u r free
    From,
    …. A subscribed viewer

  10. so much truth is spoken in one video ! I kind of feagured this out on my own as well but this perfects everything I learned so far which is verry nice! The thing I mostly see as well is that other people cant grasp how heavy hypochondria can be. As soon as i say " i had panic attacks all the time" they are suddenly shocked.

  11. Cancer is my worst fear it scares me to much and I torture myself by saying I'm dying all the time

  12. So….ive been having tingling and pain in almost my whole body…and i go on google and the first thing that comes to mind is cancer! omg i have cancer! and then i check again again and again looking for answers….. in my mind im like i have ms! oh i have bone cancer omg what if i have a heart attack sometimes im afraid to go to sleep fearing that i wont wake up…and its like the more i worry and the harder i worry the worse my symptoms get and spread plz help me

  13. Iquit ativan cause im tired of being buzzed all of the time ,as with anti depressants, i feel ill never get to the root of this issue if im freeze on pills.

  14. 10 years ago i had a car accident and got hit by a firetruck. After that ive had crazy dizziness and my doctor only treated it as anxiety. Ive only had a xray at the time. I was discharged 3 hours later. The dizziness came after, and it subsided for a while and 2 years later i started to have pancreatitis, ive had 19 of idipathic cause, and since those events i always feel dizzy, my heart races, ive had low energy from time to time. Ive had a concussion of course but only knew that last year cause i didnt know anything about that. Ive always had migraines and neck pain since. My doctors always put everything down to anxiety, which caused more and more anxiety and always refused to do the tests i asked, turns out i have a hernia in my neck. So my point is that i am having a very hard time trusting them with my physical symptoms being only anxiety even when indont feel anxious sometimes. How do i know if i dont have a neurological disorder , or a post concussion syndrome or anything like that that cant be shown on tests. Of course i worry with my health, my body isnt working properly since and ive lost everything. And of course all medications ive tried didnt worked and made me more depressed, or caused neurological symptom,without helping the anxiety. I was taking ativan for 2 years, 0.5 a day. I quit 2 weeks ago, its my 13th day. The first three were really gross, after i felt less nervous than ever. But now its coming back. Is it thr withdrawal since or just the original anxiety, or another condition. Mainly heart symptoms of course, dizziness, and a constant feeling of weirdness. Anyway. I love you

  15. I feel smell and taste changes,numbness uneasiness,right shoulder pain sometime ifeel cigarette smell please help me what should i do

  16. So I have a question. I have anxiety, depression, ptsd, bipolar and ,bpd… in addition I was previously told I have somatic disorder but in my situation I also had / have a pituitary tumor, hypophysitis ( inflammation of the pituitary stalk) I have had cervical, thyroid and stomach cancer. Now with the hypophtitis I have some nerve damage in my right eye giving me double vision that won’t recover. So does the somatic disorder really fit my situation. I really don’t know who I am.

  17. i have this, and it really really really sucks, i worry about my health everyday and every time i feel any kind of discomfort i research it, and watching this video just made me realize that researching was a mistake

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