I've lost count of all the conditions I've thought I had over the past year and a half alone. There were COVID-19 worries, of course (at one point, I convinced myself a suspicious rash was COVID-related; it wasn't), but the pandemic wasn't the only thing that kept me up at night. I also had bouts of panic about potential blood clots, possible intestinal parasites, a particularly painful bump (that later turned out to be just an ingrown hair)—the list goes on.
Health Anxiety Explainer D, a licensed psychologist and executive director at Innovation360, an outpatient counseling center in Texas, tells Health.
That doesn't make the intrusive thoughts any easier, of course, but it does show you aren't suffering in a vacuum. Here, we dig into what health anxiety really is and what it stems from, how the COVID-19 pandemic has affected those who deal with the condition, and what to do if you've been feeling especially anxious about your health lately.
What is health anxiety?
Health anxiety refers to the preoccupation with having or developing a serious illness—whether that's COVID-19, cancer, HIV, or something else. While most people think of health anxiety as "being a hypochondriac," that diagnosis was actually removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) when it was published in 2013, according to the Mayo Clinic.
Instead, health anxiety now typically refers to two distinct mental health conditions: illness anxiety disorder and somatic symptom disorder. "People who are having real medical and/or physical symptoms and they're terrified about what they might mean—that's typically understood as somatic symptom disorder," Josh Spitalnick, PhD, a licensed psychologist and CEO of Anxiety Specialists of Atlanta, tells Health. "And then there are people who worry about just getting a disease—getting COVID, getting cancer, having a stroke—where there's no real physical or medical symptoms." That said, there isn't always a clear distinction between the two, and a person might experience both at different times of their life.
Health anxiety can also be a feature of obsessive compulsive disorder (OCD), panic disorder, or other mental health conditions. It can also be something you experience to a lesser extent without quite meeting the criteria for any of these conditions. Basically, health anxiety exists on a spectrum, and many people can relate to feeling it at least some of the time.
A key characteristic of health anxiety is the presence of rituals or safety behaviors that keep you focused on your worries and actually serve to reinforce your anxiety, explains Dr. Spitalnick. These rituals could be something you do—like excessively washing your hands, taking your temperature, or checking your body for anything out of the ordinary—or they could be psychological—like overanalyzing any physical symptoms and ruminating on all of the "what if" scenarios. Another common safety behavior is reassurance seeking through Googling symptoms or going to the doctor (or multiple doctors) frequently.
Of course, it can be really hard to know if your health concerns fall into the "excessive" category—particularly during a pandemic. "The worry that we have for health anxiety is productive at the beginning, but excessive worry—which only each person can individually measure—is not healthy," says Dr. Spitalnick.
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What causes health anxiety?
While there's no specific cause of health anxiety, there are plenty of factors that seem to up a person's risk. "One of the most common risk factors for health anxiety is just someone being extra sensitive to or aware of their body," says Dr. Spitalnick. Here's why: Bodies are noisy and they fluctuate in all sorts of ways that can sometimes be noticeable and uncomfortable without actually signaling a problem. But for those of us who are acutely attuned to our bodies, we often interpret these bumps and blips as flashing neon danger signs. And this can kick off a horrible cycle where the more we pay attention to these symptoms, the more noticeable they become, and the more anxiety it causes.
"What happens is the brain doesn't know to distinguish between real danger and imagined danger," Merav Gur, PhD, a licensed clinical psychologist in New York City, tells Health. "If you tell yourself, 'I think something is terribly wrong' and you ruminate over it, the brain can release those anxiety hormones and you will start to feel anxiety-related symptoms like the fight or flight response, which is really uncomfortable." Or it can lead to disturbances in your sleep, mood, or appetite—all of which can also lead to more physical symptoms for you to worry about.
Having a family history of health anxiety or a personal history of anxiety can also increase your risk, as can generally being someone who tends to catastrophize and always think of the worst case scenario, says Dr. Spitalnick.
Other risk factors include paying a lot of attention to scary health news and experiencing a traumatic health-related event (case in point: the current COVID-19 pandemic).
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How the pandemic is impacting health anxiety
In March 2020, I felt surprisingly calm and prepared for this level of panic. It was like a lifetime of health anxiety had made me uniquely qualified to navigate this new normal. Denise R., a recent heart transplant recipient from Northern California, felt the same way; monitoring her vitals and wearing a mask in certain situations was already something she had been doing since her transplant surgery in 2018. "[The year] 2020, to me, wasn't super anxiety-producing, because now everybody's wearing a mask everywhere, everybody's kind of joining me, everybody's elbow bumping instead of hugging," she tells Health. "Everybody was conscious about how to respect other people with illness issues."
But as the pandemic persisted and shifted, so did many people's concerns about their health, their bodies, and their ways of coping—mine included. The experts I interviewed for this piece shared anecdotes from their practices; though some patients experienced similar feelings to what I felt at the beginning of the pandemic (preparedness, a lull in symptoms during stay-at-home orders), others experienced mounting anxiety about getting sick or dying while home alone, which I eventually began to feel, too.
It's also something that's repeatedly crossed Rebecca F.'s mind. "I [thought], What if I die and no one finds me?" she tells Health. "So then I did a lot of Googling about: Can you die from asymptomatic COVID? What if you don't even know you're sick?" For Rebecca, those thoughts were something she had to actively talk herself out of. "It was giving me a lot of anxiety," she says.
According to Dr. Gur, the pandemic seems to have exacerbated symptoms, particularly in her patients with health anxiety, OCD, and panic disorder. "Generally people who have anxiety have an extreme need for control. So living in an ambiguous state—that gray area—feels very uncomfortable," she says. "When you don't know what's going to happen, when it's hard to predict, the world feels much more dangerous, and that triggers more anxiety symptoms."
Zeroing in on health anxiety a little more, it seems people are much more aware of—and then worried about—the physical sensations going on in their bodies. "The biggest change I've seen from COVID—whether someone has a history of health anxiety or no history—is this trend towards somatic symptom disorder," says Dr. Spitalnick. "We're all very much in tune to the sniffles, the sneezes, the rib cage sensations when we cough, a little feeling in our chest, that a few years ago someone would have said, 'Oh that's probably nothing' and move on."
The pandemic's impact on health anxiety specifically is something that researchers have been looking into. One study published in April 2021 in the International Journal of Cognitive Therapy looked at anxiety in response to past disease outbreaks and compared that to our current reality. The researchers concluded that the COVID-19 pandemic has many unique features that make it especially troubling for people prone to health anxiety. For starters, there's the highly transmissible and highly fatal virus. Then there's the guidance to closely monitor yourself for symptoms (some of which feel a lot like anxiety—like shortness of breath), to sanitize our hands and surfaces often, and to make sweeping changes to your daily life to keep you and those around you safe.
"For the last 18 months we've been told by the CDC—more so in the beginning—wash your hands, don't touch doorknobs, don't shake hands, potentially wear gloves or protective gear," says Dr. Spitalnick. "We're now literally being told by the health care professionals to do the things that many of us have encouraged people who battled health anxiety and OCD not to do." (Treatment for health anxiety and OCD often includes facing your fears around things like illness or contamination in a safe and controlled setting, but that can be increasingly difficult in a pandemic.)
There's also the isolation factor. Being as homebound as we have been—particularly for people who live alone—can strip us of our usual coping strategies and lead to rumination and catastrophic thoughts, says Dr. Gur.
Finally, there's the inescapable news coverage and limitless information (and misinformation) about the virus all over social media. A German study published in the Journal of Anxiety Disorders conducted a survey early on in the pandemic, in mid-March 2020, and found that pandemic anxiety was highest for people who exhibited both health anxiety and excessive Googling of health information. It seemed that seeking out more and more information online was only leading to more distress, which is certainly relatable.
And covering all of this is that dreaded uncertainty, which we know can exacerbate symptoms in people with anxiety. In all, a rise in health anxiety was nearly inevitable in our current situation: "I do think it is absolutely reasonable to expect that we see some increased rates of OCD, panic, and avoidance behavior," says Dr. Gilliland.
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How to manage your health anxiety
Maybe you've always dealt with anxiety and this pandemic has kicked things up a notch—particularly around your health. Or maybe this is brand new to you and you're suddenly Googling "is this a sign of COVID?" every time you notice anything slightly off about your body. Either way, you're not the only one struggling—and there are things you can do to make your life easier and quiet your brain.
First, if you're worried about specific symptoms, Dr. Spitalnick suggests seeking medical attention, ideally with a primary care doctor you trust so that you feel more confident with whatever results they give you. It's a frustrating reality that there are certainly times when medical professionals are dismissive of your concerns—which disproportionately happens to women and marginalized groups. So it might be worth doing some legwork upfront to find a doctor that you trust and feel comfortable seeing. Recommendations from friends and family and reviews on sites like Zocdoc can help. Also, though this may go without saying, the best route for avoiding COVID-19 or at least serious illness caused by the disease is to get vaccinated.
If you've gotten the all-clear from a medical professional and you're still spending a lot of time worrying about physical symptoms—or worrying about your health and safety in the absence of symptoms—then it might be time for mental health support.
Both Dr. Gur and Dr. Spitalnick suggest looking for a therapist who specializes in health anxiety and OCD, ideally with a focus on cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). Exposure therapy is one aspect of CBT that can be especially helpful for people with health anxiety, says Dr. Spitalnick, which focuses on facing our fears and uncertainties (in a safe, controlled setting) and learning ways to cope that don't involve those rituals or safety behaviors that we've come to rely on.
Other recommendations from the experts include limiting how much pandemic news you're consuming and finding safe ways to do more of what brings you joy. While it can be tempting to just wait things out and hope that your anxiety subsides as cases (hopefully, eventually) subside, it's worth finding support and coping strategies if you're struggling now.
"My guess is that it's not going to resolve even when things are safer," says Dr. Gur. "I think after going through a pandemic, my guess is that in general these issues are with us to stay to some extent. So it's helpful to learn to manage that and to manage the unknown."
As for my own health anxiety, I'm still working on accepting that certain uncertainty and keeping my safety behaviors to a minimum. Therapy, journaling, and setting boundaries around my news consumption all help, but it's hard work. For instance, I still have a few at-home COVID tests sitting in my bathroom, stacked up next to a thermometer. But every day that I consider opening that cabinet—craving the reassurance it might bring—and choose not to is a win in my book.
Casey Gueren is the author of It's Probably Nothing: The Stress-Less Guide to Dealing with Health Anxiety, Wellness Fads, and Overhyped Headlines.
The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.
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