Who among us can legitimately say they haven't stayed up way too late diagnosing themselves with an illness there's virtually no chance they actually have only to wake up the next morning surprised to be alive? (Don't worry, we'll let you keep the rest of your browser history to yourself.) What we call "hypochondria" actually has many names: hypochondriasis, health anxiety, illness anxiety disorder, to name a few. And recent research shows that, with Google in our pockets, the condition is only becoming more common — and complex. So, beyond those 2 a.m. freak-outs, what does it really mean to have hypochondria?
"A person with hypochondriasis is someone who worries excessively about their health in general and having a [specific] terminal disease in particular," says Martin Diner, MD, PhD, who specializes in the treatment of health anxiety at White Plains Hospital in New York state. This also includes a hyperawareness of normal bodily functions, says DeAnsin G. Parker, PhD, assistant clinical professor of psychiatry at the Icahn School of Medicine at Mt. Sinai.
Of course, it's natural and normal to be conscious of your personal set of health risks (and, sure, a late-night Googling sesh every once in a while is part of that). But for those with health anxiety, the messages we get from the medical community are particularly significant and urgent. "[Patients] believe that, if they are vigilant about their bodies and pick up the first indication of a disease they’re afraid of, they’ll be able to save their lives," Dr. Diner says. "And medical culture reinforces that view to some extent." For instance, we're all told that keeping our blood pressure at a healthy level is a good thing to do, so we get it checked during our regular appointments. But someone with health anxiety might purchase their own blood pressure cuff and measure themselves several times a day.
As you'd probably imagine, many people's first stop for health anxiety is their doctor. But that doesn't always do much good. "Medical doctors generally do various tests thinking that a negative test result will reassure the patient that they don't have the condition [they're worried about]," Dr. Diner explains. In some cases, that reassurance does help — for a short time. "But if you have a tendency to worry, the worrying comes back," he says.
How is health anxiety treated if going to your doctor isn't any help? "This is a psychological disorder expressed in a medical setting," Dr. Diner says. So the first step is to shift the way patients are thinking about their disorder, from a medical issue to a psychological one. From there, he explains, the goal is to help patients distinguish between "sensations" and "symptoms" — and understand that all bodily sensations are not signs of an underlying medical issue.
Working mostly in group sessions, Dr. Diner says he talks patients through the real sensations of having a heart attack or aneurysm, for example, and clarifies what sorts of conditions count as true medical emergencies. "Most medical conditions...can be dealt with tomorrow, or next week, or next month even — and symptoms can go away on their own," he says. All of this is meant to help patients challenge their assumptions about their bodies and the misguided narratives they've built around those (totally normal) bodily functions.
For Dr. Parker, who works mostly in individual sessions, treatment starts with a full picture of what the patient experiences. That includes the physical sensations as well as when and how significantly they impact the patient's life. In some cases, she says, the symptoms act as a sort of coping mechanism for underlying anxieties and emotional challenges.
For instance, Dr. Parker says that one of her patients has intense anxiety around vomiting, especially in public. "But underneath the fear of vomiting is an enormous fear of socializing and relating to others," she says. As a result, the patient has a lot of discomfort and worry around germs at restaurants and in foods. "The physical symptoms...keep this person at home and away from others," Dr. Parker says. "So [the health-related anxiety] is serving a function — to help avoid a deeper fear." The goal here, then, is to help "people understand that a symptom does not stand by itself," she says. It's probably not surprising, then, that many people with health anxiety also have other related anxiety issues, such as social anxiety and obsessive-compulsive tendencies, Dr. Diner says.
So, if you feel like you get unnecessarily anxious about your health, it's probably worth checking in with a therapist, not your doctor. They can help you work through that anxiety and figure out what's really at the root of it — even if it's not what WebMD tells you.