On Health Anxiety
Early Signs of Health Anxiety in Childhood
Beginning in my early childhood, I’d often have these little bodily fixations that were oddly specific and nearly always on my mind. A bump on my hand that needed to be pushed down, the need to pull imaginary hairs off of my tongue, or the compulsion to rip little patches of hair out of my head. I didn’t have the words to describe these things and my environment wasn’t conducive to explaining them to me. In my late teens, I vividly remember the fear that if I didn’t stop these repetitive visible displays I would become ostracized by my peers. This was enough for me to ignore them for a time. The urge was still there, mind you. I distracted myself with video games, playing the drums, anything that captured my attention long enough for the compulsions to pass. But the body will always find a way to get its message across.
Panic Attacks & Physical Sensations
At the age of 19, I had begun to dissociate at seemingly random times throughout the day. An odd sensation would begin in my lower abdomen, a sort of stitching pinching tingle, and I would observe it cautiously. My anxiety would rise the longer I engaged with the feeling and I feverishly engaged with my habitual tools of distraction in the hopes that it would pass. It came to a head one night in October 2017 when I had my first panic attack. I remember being gripped by an overwhelming state of terror and fear. Something had gone horribly wrong with my body, something I’d like overlooked for too long.
Isolation and Searching for answers with health anxiety
For the next four years or so I became stiffened and afraid to do things that might compromise my body’s integrity. My mind fixated on the faintest of sensations rising in my gut, my throat, my chest… It only took a few moments of poking and examining myself to succumb to yet another panic attack. I began to feel sore in the places I’d continually examined and this only further contributed to the notion that my body was a time bomb ticking its way toward disintegration. It was utterly exhausting, but it bled into the interpersonal realm as well.
I’ve written up until now about how this impacted my mental health on an individual level but that doesn’t tell the full story and it isn’t the whole story when it comes to health anxiety. You see, after months of doctors visits and emergency room trips in the hopes of gaining clarity on what was so wrong with me, I had to face the realization that, physically at least, I wasn’t in such a dire state as I’d come to believe.
This might sound relieving but it was actually something that eroded my confidence in my ability to perceive the world, my body, and my thoughts. I began hoping doctors and nurses would find something physically out of sorts and finally be able to affirm the hundreds of hours I’d spent in a cold sweat, shaking, gripped by fear. No diagnosis ever came. This gave way to a new sort of distress: isolation.
I felt like I couldn’t keep bothering those around me with apparently incurable symptoms. They never seemed to understand how much of my time was spent fending off these repetitive thoughts. I stopped letting my friends and family join my internal experiences, stopped sharing my feelings and emotions. I didn’t see a point if it would only frustrate them and myself. And so my world shrank, my capacity to handle uncertainty and complexity dwindled.
A Message to Others With Health Anxiety
The larger point of writing this in a public space is to combat the sense of isolation that I know others are experiencing. I want you to know I see how hard you’re trying and I believe you when you say you are so deeply uncomfortable and exhausted. I want to be there for you and I believe the Relational therapeutic approach offers a particularly useful means of approaching health anxiety.
What is Health Anxiety?
Definition & Common Behaviors
Hypochondria, or for our purposes, health anxiety, is seen as the presence of persistent obsessive thoughts about the state of one’s own health, physical or mental. People managing these intrusive thoughts and sensations often believe they have an undiagnosed illness. They worry that what they are experiencing are minor symptoms of a major health problem and they feel compelled to do frequent scans of their physical and psychological state in order to ‘get ahead’ of anything potentially serious.
The Vicious Cycle of Self-Diagnosis
This leads to Googling symptoms and inevitably being confronted with innumerable potential illnesses. Some may respond to these search results by making yet another doctor's appointment just ‘to be safe’. Others, myself for example, may become so convinced that something terrifying is right around the corner that they head straight to the emergency room or urgent care. I spent many days in waiting rooms of hospitals, afraid and alone, hoping the medical professionals I spoke with would finally be able to locate the source of these symptoms; give me a clear diagnosis. After all, it would be demoralizing to think that these all-consuming and debilitating thoughts weren’t indicative of something real.
Of course, they were always pointing to something beneath the surface, just not the catastrophic worst-case-scenario illness I had spent four hours researching. But in order to explain the roots of health anxiety, I will dedicate a little section to how memories, trauma, and prolonged states of anxiety can manifest in our physical bodies as real sensations.
Where Do These Sensations Come From?
The Connection Between Trauma and the Body
I do want to make one thing clear: despite the fact that those of us with health anxiety do not actually have the illnesses we’re so afraid of, it does not mean the pain and discomfort we feel isn’t real. The body is not merely a vehicle for our mind to move around with, but is connected with the brain and often working alongside it to regulate or store memories. I won’t dive into the theories as to how trauma or intense anxiety can wreak havoc on the body, but I will attach two sources that go into the specifics a bit deeper.
Physical Symptoms as Emotional Messages
The way I like to see it, these sensations that occur over and over again can be understood as messages. Things that have long been shelved and will need to be engaged with eventually, either through therapeutic work or coping strategies that are often less productive. Let’s discuss a few of the steps we can take to gain clarity on this form of anxiety.
How Relational Therapy Can Help You Manage Health Anxiety
At the outset, it needs to be said that our starting point will always be getting checked out by a doctor before we assume the issues are anxiety, depression, or trauma-based. This is a normal part of beginning any therapeutic relationship, but if you’re in a position like I was then you’ve likely been to the doctor many times already.
The Relational approach that we work with can be particularly useful in health anxiety work for many reasons, but one factor stands out to me: Embodiment.
Embodiment in Relational Therapy
Listening to the Body’s Messages
There is so much written about the relational approach on our website and I will provide links that I encourage you to check out. But in broad terms, this approach puts forward that the relationship between therapist and client is the most important tool for change in the therapeutic relationship. Embodiment is the recognition of the physical ways our body reacts throughout our therapeutic work. Learning to listen to our bodies and embrace the initial uncertainty of how we feel can provide valuable insights for things to share or paths of thought to follow. The therapy room becomes a space to explore these feelings safely and see curious responses modeled in real time.
Making Room for Discomfort in Therapy
Relational therapists will be attuned to the physical manifestations of negative feelings, encouraging clients to ask what these sensations might mean or simply sit with them and acknowledge the discomfort they bring. A tension in the throat, a heaviness in the eyes, cramping in the stomach, or rapid heartbeat are all ways health anxiety can show up in our lives. Therapy provides a safe place to sit with these feelings, notice the patterns behind their occurrence, and process the immense discomfort with someone who cares deeply about your well being.
We will often ‘check in’ with clients and each other; asking with complete sincerity: “How are you, really?”. I mentioned earlier the isolation that comes from believing no one will understand how you feel or that none of what you’re feeling is real. Nothing combats this isolation more thoroughly than the persistent reminder that your internal experiences are valid and deserving of attention.
Health anxiety can be terrifying to live with, but you don’t need to shrink your world and go it alone. I would love the opportunity to support you.
Further Reading on Trauma and Healing
Liam DeGeorgio, AMFT, is a neurodivergent associate marriage & family therapist who strives to challenge society’s expectations and perceptions of ‘normal’. He lives with ADHD, OCD, and PTSD and enjoys working with clients wanting to challenge toxic masculinity, embrace feminism & anti-racism, and adults with childhood trauma. He loves playing the drums, reading books, his partner, and their four cats.
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