Catastrophizing is when someone assumes that the worst will happen. Often, it involves believing that you’re in a worse situation than you really are or exaggerating the difficulties you face.

For example, someone might worry that they’ll fail an exam. From there, they might assume that failing an exam means they’re a bad student and bound to never pass, get a degree, or find a job. They might conclude that this means they’ll never be financially stable.

Many successful people have failed exams, and failing an exam isn’t proof that you won’t be able to find a job. A person who is catastrophizing might not be able to acknowledge that.

It’s easy to dismiss catastrophizing as over-exaggeration, but it’s often not intentional or that simple. People who do it often don’t realize they’re doing it. They may feel they have no control over their worries, and it can even impact their health. Fortunately, effective treatments exist.

It’s unclear what exactly causes catastrophizing. It could be a coping mechanism learned from family or other important people in a person’s life. It could be a result of an experience, or could be related to brain chemistry.

Research involving people who catastrophize and who also have chronic pain suggest they may have alterations in the hypothalamus and pituitary responses, as well as increased activity in the parts of the brain that register emotions associated with pain.

People who have other conditions such as depression and anxiety, and people who are often fatigued may also be more likely to catastrophize.

Chronic pain

The combination of chronic pain and catastrophizing happens often and is widely studied.

Because someone with chronic pain is used to constantly being in pain, they might conclude that they’ll never get better and will always feel discomfort. This fear may lead them to behave certain ways, such as avoiding physical activity, which rather than protecting them, can ultimately make their symptoms worse.

A 2011 review on pain, depression, and catastrophizing looked at participants with rheumatic diseases. It found that patients who catastrophize reported an increase in the severity of their pain. Another 2011 review had a similar conclusion, suggesting that addressing catastrophizing is important when treating chronic pain.

However, this does not mean that chronic pain should not be taken seriously. Catastrophizing isn’t the same as exaggerating about pain. A 2009 study on chronic pain and catastrophizing found that catastrophizing is more than just psychological — it affects the physiology of the brain. As such, it should be taken very seriously.

Anxiety disorders and depressive disorders

Catastrophizing is associated with depression as well as anxiety disorders such as generalized anxiety disorder (GAD), PTSD, and OCD.

A 2015 study looked at 2,802 teenagers and found that those who tended to catastrophize were more likely to have anxiety disorders.

A 2012 study found that catastrophizing was linked to both anxious and depressive disorders in children, particularly among children in the third grade or younger. Controlling for anxiety, it showed that there was a strong relationship between depression and catastrophizing. The authors concluded that this was because assuming that the worst will always happen leads to feelings of hopelessness. Constantly feeling hopeless can lead to depression.

Fatigue

A 2012 review of studies showed that there’s a link between fatigue and catastrophizing. The review concluded that catastrophizing could be a predictor of how tired people feel. In other words, it can make fatigue worse. That said, the review looked at a small number of people, and more research is needed.

Therapy

Since catastrophizing is closely associated with mental illnesses, it’s no surprise that therapy can effectively treat catastrophizing. Cognitive-behavioral therapy, or CBT, is one of the most common forms of talk therapy. A 2017 study found that CBT was effective at addressing catastrophizing in fibromyalgia patients, and that it helped them better manage their pain.

CBT tries to address your thinking and behavioral patterns. In the case of catastrophizing, your therapist might help you recognize irrational thoughts and replace them with rational ones.

For example, you might be used to thinking, “I handed this report in late. I’m a total failure, and I’m going to lose my job. I’ll be financially destitute.” Through CBT, you’ll recognize that this is an irrational thought. Your therapist might help you replace that thought with, “I handed this report in late. If I apologize for it my boss will understand. She won’t fire me for this single mistake. I’ll be okay.”

Mindfulness

If you often find yourself catastrophizing, mindfulness may be helpful. It might help you recognize which thoughts are irrational and can help you control your thoughts.

A number of studies have suggested that mindfulness can treat or reduce catastrophizing. A 2017 study on people with fibromyalgia found that mindfulness can help.

Medication

If your catastrophizing is linked to another condition, such as depression, your doctor might prescribe medication for that underlying condition. That said, there’s no medicine that specifically treats catastrophizing.

Catastrophizing is a symptom of many mental illnesses, and it can affect your quality of life. While it might feel overwhelming, there are many ways to treat catastrophizing. If you think you have a tendency to catastrophize, talk to a psychologist or therapist.