HEALTH ANXIETY

The term "Health Anxiety" is not considered to be a specific psychiatric disorder, described in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V). Indeed, Health Anxiety is not even listed under the category of Anxiety Disorders within the DSM-V. Up until May, 2014, the term Health Anxiety was best described as Hypochondriasis, which was classified as a somatoform disorder in the DSM-IV-TR. This diagnosis was characterized as someone who is preoccupied with fears of having a severe medical condition, based on their own misinterpretation of benign physical bodily changes (symptoms), despite the fact that medical tests consistently ruled out any specific true medical condition. Today, the DSM-V now refers to Health Anxiety as "Complex Somatic Symptom Disorder" (CSSD), which needs to be differentially diagnosed from disorders such as "Delusional Disorder (somatic type)", characterized as having bizarre delusions regarding bodily sensations more characteristic of schizophrenia (e.g., having an invisible third leg); "Disease Phobia", characterized as an intense fear of contracting a specific disease (e.g., HIV); and Panic Disorder related to specific sudden physical sensations.  In the case of Panic Disorder, the individual is concerned with imminent death, as opposed to a diagnosis of Complex Somatic Symptom Disorder, which is more concerned with a slow, ongoing medical condition which may eventually result in ones own death.

Individuals who evidence severe Health Anxiety endorse strongly held core beliefs concerning the issue of health, which is much more rigid and extreme than others interpretations of health-related issues. The most common cognitive error associated with Health Anxiety is the belief that bodily sensations (e.g., dizziness, pain, skin flushing, etc.) or sudden physical changes such as skin blemishes, a lump in one's throat, etc. are indicative of a serious medical condition, as opposed to simply the result of a non-threatening normal, transient bodily change. When experiencing these bodily sensations/changes, the individual will typically display two forms of maladaptive behaviors which only serve to exacerbate the problem. First, the person will engage in several forms of reassurance-seeking behaviors directed at lowering their anxiety levels. These behaviors may consist of repeatedly asking others (friends, various doctors) if they believe that their "symptoms" are indicative of a serious medical condition, or the individual may seek reassurance by spending an inordinate amount of time checking various internet medical web sites (cyberchondriasis) related to further researching the bodily changes in question. Another form of "checking" simply consists of "body self-checking", that is, frequent monitoring regarding a specific part of their own body (e.g., looking in the mirror at a facial blemish to check for additional growth, etc.).  In addition to these forms of reassurance checking, the individual with severe health anxiety will also engage in several forms of avoidance behaviors directed at decreasing the probability of triggering the very bodily sensations/changes which are causing their anxious arousal. An example would be the person who is fearful of the sudden onset of sweating and increased heart rate, who therefore avoids taking part in frequent exercise which he or she believes may result in cardiac arrest or stroke. Other avoidance behaviors may include intentionally not driving past hospitals, urgent care centers, etc. Thus, these various forms of reassurance-seeking and avoidance behaviors only serve to prevent the person from discovering that their physical sensations and/or bodily changes are, in fact, not medically threatening in nature, and instead only serve to strengthen their maladaptive beliefs, and the anxiety which results from these cognitive and behavioral response patterns.

In terms of the treatment for Health Anxiety, research consistently demonstrates that the most effective intervention is Cognitive-Behavior Therapy (CBT), with a strong emphasis on Exposure & Response Prevention (ERP). My therapeutic approach depends heavily on the use of Cognitive Therapy treatment strategies which first involve helping the patient to become more aware of, and subsequently change, perceptions and typical interpretations of their own physical sensations and/or bodily changes (e.g., "these headaches I keep having are no doubt indicative that I have a brain tumor"), as well as several other maladaptive health-related beliefs, which create high levels of emotional arousal. That is, I first help the patient to better understand their current thought patterns which they frequently use to predict specific health-related outcomes, as well as how these outcomes are often catastrophized. I then help my patients to explore other possible interpretations/predictions regarding these outcomes; interpretations that they may not be accustomed to thinking about. In other words, encouraging patients to widen their "perspective lens" by getting into the habit of saying..."wait a minute, rather than keep using the term 'symptoms', which implies a medical condition, I'm going to simply refer to the term 'body noise', which just indicates a normal physical change that most people experience on a day-to-day basis".

Once this goal has been accomplished, the Behavior Therapy component of each treatment program for Health Anxiety, which incorporates the use of Exposure and Response Prevention (ERP) strategies, while at all times working together with the patient, at his or her own pace, is implemented. As a result of these goals, it is common to assign weekly out-of-office planned exposure exercises to perform, in addition to various "behavioral experiments", which are designed to (a) expose the individual to the feared objects, situations, and physical sensations related to the source of their anxiety, (b) prevent safety behaviors and reassurance seeking, and (c) formally test maladaptive health-related beliefs. Common cognitive errors (i.e., the manner in which a person tends to consistently misinterpret a particular situation) often include: Jumping to Conclusions (e.g., "the doctors keep agreeing to test me, so there must be something wrong"); Emotional Reasoning (e.g., "since I'm feeling worried about my health, surely I must be very ill"); and Intolerance for Uncertainty (e.g., "if I am not completely sure that I am healthy, then I'll always remain anxious that I may have a serious medical condition"). The basic therapeutic goals are simply this:  If the patient does not want to do something, then they need to do it; if the patient wants to avoid something, they should face it; if the patient wants to do something to feel better (i.e., seek some form of reassurance), they should not. For more information on Health Anxiety (Complex Somatic Symptom Disorder), please visit the Anxiety & Depression Association of America and the National Institute of Mental Health web sites.