- 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. Tracey Marks, a psychiatrist,
and I publish weekly videos
on mental health education
and self-improvement.
If you don't want to miss a video,
click subscribe
and the notification.
(bell dinging)
This topic is based on a viewer question
from Littleredridingkyle, 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 Littleredridingkyle
for this question.
With hypochondriasis, you
misinterpret body symptoms,
and assume 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 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 mean 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 gonna 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 are 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 having
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 can put the symptoms into context.
Even if you have more odd symptoms
like getting a lump in your throat.
With general anxiety, the
first time you get the lump,
you might get scared
and wonder if there is
seriously something wrong.
You go see your doctor, he examines you,
and tells you that your throat is fine,
and 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
(laser zapping)
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 scientist
who studied learning theory
and classical conditioning.
Pavlov showed that you could trigger
a certain physiological response
with a neutral stimulus
(bell dinging)
if you pair it with a potent stimulus.
So he showed his dog meat,
which made the dog salivate.
(dog panting)
Then he showed the dog meat
and rang a bell,
(bell dinging)
and the dog would still
salivate because of the meat.
By continuously pairing
the meat and the bell,
(bell dinging)
he was eventually able to ring the bell
(bell dinging)
without the meat
and the dog would salivate,
(dog panting)
because the dog 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 see them all as dangerous.
Let 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 experience this
while you're in an anxious state
and you also imagine the
worst case scenarios,
you condition yourself to
think of burning in your chest
a sign that you have a heart problem.
So you Google chest
burning for the 100th 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 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 of
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 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 to back to the doctor
who told you 2 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 and
says, your heart is fine.
She may even tell you,
it's probably anxiety.
And you might feel a little better,
especially because you're
at the doctors office
and your symptoms kinda
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 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 the Reddit guy's 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 crisis level again,
but you'll keep your eye on it.
So then you do the 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 you 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 the
person with hypochondria.
It's exhausting.
And it's extremely distressing
for the person affected,
and 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 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 CBT, you address your distorted,
automatic thoughts that you
have about your body sensations,
because your fears are
triggered by body sensations.
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 you have a illness,
that needs to be addressed
before it turns into
something even 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 the CBT look like?
First, you wanna get a medical work up,
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 wanna 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 that's not gonna
get you very far here.
A CBT therapist will most likely
be a doctorate level psychologists,
or a master's level therapist,
it's probably not gonna be a psychiatrist.
Some psychiatrists do CBT,
but many more non-psychiatrists do CBT.
Once you're in the 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 out this
and ruled that out,
but she still had pain.
So she asked me in the comments,
why was she was 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 gonna 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 the things like:
heart burn means a failing heart,
or dizziness means you may
have a seizure disorder,
stomach problems mean you have cancer.
The therapist 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, lets 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 are structural
problems like valve defects,
or defects of the heart muscle
that cause it not to pump properly.
These problems can occur at any age,
but they are 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 heart won't pump properly,
you're gonna have many more physical signs
other than chest burning.
In fact, indigestion isn't
a sign of a 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 plague,
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 15-year-old
like Littleredridingkyle to
have this kind of heart disease.
It takes years for your
blood vessels to clog up.
There are some genetic diseases, thought,
that cause accelerated plague formation,
but if you had that, there would
be other signs and symptoms
other than chest burning.
And these would 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 have 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 gonna 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 it's general help,
and it's 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 to diagnose yourself
from Internet research.
Before you see your doctor,
make a list of your conclusions,
you draw on your own, about
each of your physical symptoms.
Take this list to the doctor,
and get him or her to explain
why your conclusions are incorrect.
You have to use some judgment 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
wanna keep the list anyway;
you want to put your
thoughts down on paper,
that's always good.
Next, write the doctor's
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 is 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 as 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 have 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 am not more of a medical expert
"than the people who
have seen and examined
"lots of sick people.
"I don't 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 did their own landscaping,
so there was always a need
to move dirt or leaves
from one part of the yard to the next.
So their old-school
solution to boredom or upset
was tell us to go outside
and throw some dirt,
or dig a hole.
Now, as 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 have 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 the
you start back worrying again?
Then you will have to 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
in the behaviors and stick to it.
Then, to address your thoughts,
you've gotta 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 approach
is it takes effort.
This is not gonna passively go away.
That's why taking a pill isn't
really gonna get rid of this.
It may help you if 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 10 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.
(upbeat music)
♪ I am what I am today ♪
♪ 'Cause I did it my way ♪
♪ Nothing y'all can say ♪
♪ In this life or the next one ♪
