It’s the summer of 2014. There were a lot of exciting things on the calendar, the primary one being heading out of town to see one of my favorite musicians.
While surfing the net on the train, I saw a few different videos for the Ice Bucket Challenge. Curious, I went to Google to read about it. Why were so many people — famous or otherwise —throwing ice-cold water over their heads?
Google’s response? It was a challenge aimed at making people aware of ALS, also known as Lou Gehrig’s disease. The Ice Bucket Challenge was everywhere in 2014. Rightfully so. Even 5 years on, ALS is a disease we don’t know much about.
As I was reading, a muscle in my leg started twitching and wouldn’t stop.
For whatever reason, however irrational it seemed, I knew I had ALS.
It was as if a switch had flipped in my mind, one that turned a regular train journey into one seizing my body with anxiety over a disease I’d never heard of — one that introduced me to WebMD and the terrible side effects of Googling one’s health.
Needless to say, I didn’t have ALS. However, the 5 months that I experienced health anxiety were some of the toughest in my life.
Paging Dr. Google
My most-visited websites that summer were WebMD and Reddit communities centered around whatever disease I thought I had at the time.
I was also no stranger to sensationalist tabloids, telling us we were about to see a wave of Ebola hit the United Kingdom, or sharing the tragic stories of doctors ignoring seemingly-benign symptoms that ended up being terminal cancer.
Everyone seemed to be dying of these things, as well. Celebrities and people I didn’t know all hitting the front page of every media outlet in the stratosphere.
WebMD was the worst. It’s so easy to ask Google: “What are these weird red lumps on my skin?” It’s even easier to type in “twitching abdomen” (as an aside, don’t do this lest you lose an entire night’s sleep focusing on the aortic aneurysm you 99.9 percent do not have).
Once you start searching, you’ll be given a whole host of diseases that one symptom can be. And trust me, with health anxiety, you’ll go through them all.
In theory, Google is a great tool, especially for those in countries with incredibly flawed and expensive healthcare systems. I mean, if you don’t advocate for yourself, how are you going to know whether you should see a doctor or not?
But for those with health anxiety, this isn’t helpful at all. In fact, it can make things much, much worse.
Health anxiety 101
How do you know if you have health anxiety? Although different for everyone, some of the common signs include:
- worrying about your health so much it affects your day-to-day life
- checking your body for lumps and bumps
- paying attention to odd sensations such as tingling and numbness
- constantly seeking reassurance from those around you
- refusing to believe medical professionals
- obsessively seeking tests such as blood tests and scans
Is it hypochondria? Well, sort of.
According to a 2009 article, hypochondriasis and health anxiety are technically the same. It’s just more recognized as being the anxiety disorderit is, rather than one resistant to psychotherapy.
In other words, us hypochondriacs used to be seen as irrational and beyond help, which doesn’t do a lot for morale.
Unsurprisingly, in “On Narcissism,” Freud made a link between hypochondria and narcissism. That says it all, really — hypochondria has always been considered something it’s not. Therefore, it’s no surprise that those of us who might be experiencing these somatic symptoms could more easily see ourselves suffering from a rare form of cancer, than having it all be in the mind.
When you have health anxiety, you’re forced to walk hand-in-hand with your deepest fears — after all, they all reside within your body which you can’t exactly step away from. You obsessively monitor, looking for signs: Signs that appear when you wake, bathe, sleep, eat, and walk.
When every muscle twitch points to ALS or something your doctors must have missed, you begin to feel completely out of control.
For me, I lost so much weight I now use it as a punchline: Anxiety is the best diet I’ve ever done. Not funny, but then neither is being in a state of psychosis.
So yes, hypochondria and health anxiety are the same. But hypochondria isn’t a bad thing — and that’s exactly why it’s important to understand it in the context of an anxiety disorder.
The obsessive-compulsive cycle of health anxiety
In the midst of my health anxiety, I was reading “It’s Not All in Your Head.”
I’d already spent the summer trying to live my life while breaking down in hostels, on public transport, and in doctors’ surgeries. While I was still reluctant to believe this could be, well, all in my head, I did a flip through the book and discovered a chapter on the vicious cycle:
- SENSATIONS: Any physical symptoms you’re experiencing such as muscle spasms, shortness of breath, lumps you hadn’t previously noticed, and headaches. What could they be?
- PERCEPTION: The sensation you’re experiencing being somehow different to others. For example, the headache or muscle spasm lasting too long to be “normal.”
- UNCERTAINTY: Asking yourself why with no resolution. Why do you have a headache when you’ve just woken up? Why has your eye been twitching for days?
- AROUSAL: Coming to the conclusion that the symptom must, therefore, be the result of a serious illness. For example: If my headache has lasted for a couple of hours and I’ve avoided my phone screen and it’s still there, I must have an aneurysm.
- CHECKING: At this point, you’re so aware of the symptom you need to keep checking if it’s there. You’re hyper-focused. For a headache, this could mean putting pressure on your temples or rubbing your eyes too hard. This then exacerbates the symptoms you were worried about in the first place and you’re back to square one.
Now that I’m on the outside of the cycle, I can see it clearly. In the midst of the crisis, however, it was much different.
Having an already anxious mind flooded with intrusive thoughts, experiencing this obsessive cycle was emotionally draining and affected a lot of the relationships in my life. There’s only so much that people who love you can deal with if they can’t exactly help.
There was also the added aspect of feeling guilty because of the toll it takes on others, which can lead to despairing and worsening self-esteem. Health anxiety is funny like that: You’re both extremely self-involved while also being tremendously self-loathing.
I always used to say: I don’t want to die, but I wish I did.
The science behind the cycle
Almost every type of anxiety is a vicious cycle. Once it gets its hooks into you, it’s hard to step out without putting in some serious work.
When my doctor told me about psychosomatic symptoms, I ended up trying to reroute my brain. After blocking Dr. Google from my morning repertoire, I searched for explanations as to how anxiety could result in tangible, physical symptoms.
Turns out, there’s a lot of information out there when you’re not heading directly to Dr. Google.
Adrenaline and the fight-or-flight response
While searching the internet for some way of explaining how I could “manifest” my own symptoms, I found an online game. This game, aimed at medical students, was a browser-based pixel platformer explaining the role of adrenaline in the body — how it kicks off our fight-or-flight response, and once it’s running, it’s hard to stop.
This was amazing for me. Seeing how adrenaline worked from a medical perspective explained like I’m a 5-year-old gamer was everything I never knew I needed. The abbreviated version to the adrenaline rush is as follows:
Scientifically, the way to put a stop to this is to find a release for that adrenaline. For me, it was video games. For others, exercise. Either way, when you find a way to release the excess hormones, your worry naturally decreases.
You’re not imagining it
One of the biggest steps for me meant accepting the symptoms I had were of my own making.
These symptoms are known in the medical world as “psychosomatic” or “somatic” symptoms. It’s a misnomer none of us actually have explained to us. Psychosomatic might mean “in your head,” but “in your head” isn’t the same as saying “not real.”
Lead scientist Peter Strick spoke of psychosomatic symptoms, saying “The word ‘psychosomatic’ is loaded and implies that something is all in your head. I think now we can say, ‘It is in your head, literally!’ We showed that there is real neural circuitry that connects cortical areas involved in movement, cognition, and feeling with the control of organ function. So what have been called ‘psychosomatic disorders’ are not imaginary.”
Boy, could I have used that reassurance 5 years ago.
Can you feel that lump?
I’m guilty of visiting websites for those who actually have been diagnosed with diseases. Cancer and MS forums see a lot of people turning up to ask whether their symptoms could be X disease.
I personally didn’t get to the point where I asked, but there were enough threads to read through with the precise questions I’d wanted to ask: How did you know…?
This seeking of reassurance that you’re not sick or not dying is actually compulsive behavior, not unlike what you’d see in other forms of obsessive-compulsive disorder (OCD) — which means rather than alleviating the anxiety you feel, it actually fuels the obsession.
After all, our brains are literally equipped to form and adapt to new habits. For some people, that’s great. For people like us, it’s detrimental, making our stickiest compulsions all the more persistent as time goes on.
Once your habit of visiting websites or asking friends if they can feel that lump on your neck is in motion, it’s difficult to put a stop to it — but like any other compulsion, it’s important to resist. It’s also something both those with health anxiety and OCD do, further strengthening their link.
That means your excessive search engine use? That’s a compulsion, too.
One of the best ways to stop consulting Dr. Google is to simply block the website. If you use Chrome, there’s even an extension for doing this.
Block WebMD, block health forums you probably shouldn’t be on, and you’ll thank yourself.
Stopping the cycle of reassurance
If your loved one is searching for reassurance on health issues, the best option might be along the lines of “you have to be cruel to be kind.”
Speaking from experience, being told you’re okay only makes you feel okay... until it doesn’t. On the other hand, what might help is listening and coming from a place of love, however frustrating it might be.
Here are a few ideas of what you can say or do with a loved one who’s experiencing a bout of health anxiety:
- Instead of feeding into or reinforcing their compulsive habits, try and reduce how much you do this. Depending on the person, stopping checking health queries for them completely might cause them to spiral, so cutting back might be the best choice. It’s good to keep in mind that needing to check lumps and bumps all the time only ever comes with a tiny bit of relief, so you’re actually helping.
- Instead ofsaying, “You don’t have cancer,” you can simply say that you’re not qualified to say what cancer is or is not. Listen to their concerns, but don’t confirm or deny them — simply express that you don’t know the answer and that you can understand why it would be scary to not know. That way, you’re not calling them irrational. On the contrary, you’re validating their worries without feeding them.
- Instead of saying, “Stop Googling that!” you can encourage them to take a “time out.” Validate that the stress and anxiety is very real, and that those emotions can worsen symptoms — so pausing and checking back in later if the symptoms persist can help delay compulsive behaviors.
- Instead of offering to drive them to their appointment, how about asking if they’d like to go somewhere for tea or lunch? Or to a movie? When I was at my worst, I somehow still managed to see Guardians of the Galaxy at the cinema. In fact, all of my symptoms seemingly stopped for the 2 hours the movie lasted. Distracting someone with anxiety can be hard, but it’s possible, and the more they do these things, the less they’ll be feeding into their own behaviors.
Does it ever get better?
In short, yes, it absolutely can get better.
Cognitive behavioral therapy (CBT) is the main way of combating health anxiety. As a matter-of-fact, it’s considered the gold standard of psychotherapy.
I like to say the first step to anything is realizing you actually have health anxiety. If you’ve searched for the term once, you’ve taken the biggest step there is. I also say the next time you see your doctor for reassurance, ask them to refer you for CBT.
One of the most helpful CBT booklets I used to combat my health anxiety was free worksheets shared on No More Panic by cognitive therapist Robin Hall, who also runs CBT4Panic. All you need to do is download and print them and you’ll be on your way to overcoming something I wouldn’t wish on my greatest enemy.
Of course, because we’re all wired so differently, CBT doesn’t have to be the be-all-end-all of overcoming health anxiety.
If you’ve tried it and it hasn’t worked for you, that doesn’t mean you’re beyond help. Other therapies such as exposure and response prevention (ERP) might just be the key that CBT wasn’t.
ERP is a commonly used form of therapy to combat obsessive-compulsive thoughts. While it and CBT share some aspects, exposure therapy is about facing your fears. Essentially, where CBT gets to the bottom of why you feel the way you do and how to fix it, ERP is asking the open-ended, “and, so what if x did happen?”
No matter which path you take, it’s important to know that you have options and that you don’t need to suffer in silence.
Remember: You’re not alone
Admitting you have health anxiety is hard, but there’s scientific proof that every single one of the symptoms you’re feeling — and all the behaviors — are real.
Anxiety is real. It’s an illness! It can make your body sick as well as your mind, and it’s time we start taking it as seriously as the illnesses that make us run to Google in the first place.
Em Burfitt is a music journalist whose work has been featured in The Line of Best Fit, DIVA Magazine, and She Shreds. As well as being a cofounder of queerpack.co, she's also incredibly passionate about making mental health conversations mainstream.