Sunday, January 23, 2011

Hypochondria and Health Anxiety OCD

Monsieur Charles Darwin (dessin de Sis)

About 15 years ago, I was in graduate school, and I had a sharp pain in my neck, ever so brief, and it didn't even register. Then it happened again when I was feeling more stressed, after having read about a bone marrow donor drive, and immediately assuming I needed to participate, in spite of all my anxieties about needles and surgery. This time, the pain in my neck panicked me. Was I having a stroke? What was wrong? Since the internet was still primitive, I did what I used to do, which was go to the library and look for books in the medical reference section. This time I stumbled across Susan Baur's Hypochondria: Woeful Imaginings. It was like seeing myself in the mirror, through the author's accounts of people in history who suffered from fears about their health.

It wasn't enough to make my OCD vanish, but it did give me a window of understanding about my anxieties about my body, and that other people had similar fears, even though the only other person I knew of with this kind of fear was my mother. Another book I found was about Charles Darwin and his health anxieties. He wrote often about his symptoms and fears. I was fascinated, since he is a larger than life figure in history, and yet so afraid. Recently, I read about another book, The Hypochondriacs: Nine Tormented Lives by Brian Dillon, which includes Charles Darwin, Glenn Gould, Michael Jackson and Andy Warhol.

Although the subtitles of these books are full of doom, I remember how much I suffered with my health fears before I had any ERP treatment. The difference now is that I did get Exposure and Response Prevention Therapy, and it is possible to get better, to move beyond torment and woe. Hypochondria, according to the DSM, includes a component of being convinced you have a disease, in spite of medical tests to the contrary. There are definitely similarities with health anxiety OCD, and some even argue they are really the same thing, but the part that differs for me is that I am never absolutely convinced I have a particular disease, but more that I want complete assurance that I don't have it, and my websearching and checking of my body are compulsions to reduce my anxiety. My obsessiveness also extends to getting stuck on whether I really have hypochondria instead of OCD(!), but I've learned that pursuing the fine distinctions makes me much worse. Paul Salkoviskis has done a lot of work with health anxiety, and he emphasizes that seeking reassurance for symptoms tends to make them worse.

Fear of being labeled as a time wasting hypochondriac in my doctor's office has complicated healthcare for me over the years, and caused a lot of angst. I understand doctors have a lot of pressures and time constraints, but health anxiety causes intense suffering, and can be treated, and the more general practice doctors realize this, the more possibility of alleviating the suffering.

Related Resource:
Jonathan Grayson's Freedom From OCD has a section on hypochondria/health anxiety
Script for Fighting Health Anxiety OCD
Skin Cancer Anxiety: Fear, Vigilance and All or Nothing Thinking

31 comments:

  1. Thanks for writing about this topic -- obsessions about health can often be mistaken for hypochondriasis or simple overworrying, I think. Often exposure to the health-related obsessive thought can be helpful.

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  2. Thanks for posting. I had this obsession for so many years. It started when I was a kid. I thought I was the only one suffering. I know it was a component in my choosing medicine as a career. Knowing a lot about different illnesses did help me know more about what was "worth worrying about". But, I also learned about many horrible possibilities that I hadn't known about before my medical education. I finally got relief when I started taking medication for my OCD. I also believe that a lot of my emotional symptoms played out in physical sensations. I was also hypersensitive to my body and changes in my body. I worried about those sensations and thought they were likely something serious. Now, I am not so sensitive. I also tune out a lot of that "noise". Sometimes when I am worried I resort to "its either nothing or something." If it is nothing it will go away. If it is something it will "declare itself". And I just try to enjoy the time I have and relax into not knowing and accept the uncertainty of it all. BTW: my cousin started her chemo for breast cancer and I still haven't gotten my mammo. So, while it is not the best practice, in some way, it feels like an ocd victory. Ironic.

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    1. What med did you take for ocd?

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  3. Kinder Brain--I too was in a position in the medical field, involving doing literature searches, and it was interesting how if something wasn't related to an ocd "hotspot" I was ok, but if it was related to my obsessing, I got very anxious. Similar to you, I finally had to tell myself if it was really an emergency, I'd wait for it to happen. Last year I had an ocd crisis of researching about screening mammograms, and finally realized I can't really know for certain what will happen in the future. That pretty much sucked, but it was also a relief to not have to "figure it out."

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  4. Can anyone tell me where to get help- the best help- in Philadelphia? I suffer everyday and think about dying/having cancer/leaving my family etc- all day!! I have the best life and want to enjoy it! I can't take another day of this

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  5. Welcome Deneen!

    Jonathan Grayson, whose book really helped me, has an anxiety center in Philly: http://www.ocdphiladelphia.com/

    There's also a GOAL support group for OCD:
    http://ocdphiladelphia.org/pages/aboutgoal.html

    Dr. Edna Foa, who pioneered a lot of Exposure Therapy is at U/Penn: http://www.med.upenn.edu/ctsa/
    and they are also sponsoring a research study with free treatment:

    http://www.ocdproject.org/about.php

    Hope this helps!

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  6. Thank you so much! I came to this site then could not find it again and so glad I cam eback to search again. Thank you for answering me. I can't take this anymore! I want to be happy again and love/live my life. I have this huge fear of leaving my family. I am so afraid and obsess over it every minute of the day. I push each day to work and be happy and put on my mask - try and be strong but it is getting harder. I have a mammogram due this month as well as a gynecology exam and I am so scared. I am so afraid of bad news. I feel like every twinge or pain in y body means something. Ugh- this has to go away. It just sucks so bad because I have such an amazing life and the greatest people in it. I am on 1550 mg of zoloft and obviously it is not working. been on this for years and really need to find an alternate treatment. With all of this said- I am so grateful to have found this site and for you to give me such great information. I wish you the best and thank you again for taking ti me for me. xo

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  7. Correction to above- I am on 150 mg of zoloft :-)

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  8. Hello! I found your blog after obsessively googling about lymphoma for the past week (every day). I've had hypochondria since I was a child and have learned how to live it with it, to an extent. Sometimes though it completely blows up out of control, like now. This is the second time this year. Earlier this summer it was more centered on food contamination and dying from a food-born illness. I had to talk myself into eating.

    Larger life changes always make my hypochondria flare. This year I turned 40, got a new job, am trying to buy my first house, and considering having a 2nd child. Pretty stressful! Last time it was this bad was right after my son was born and I convinced myself that his raised birthmark was actually an aggressive tumor and that he would be dead within the year or less.

    I started looking for support groups this weekend after my husband and I argued about my recent obsessive internet searching. I don't want to pass this anxiety on to my son or affect my relationship with my husband anymore. Most importantly, I'd like to actually enjoy life instead of pretending to enjoy it. So, thank you so much for this site! It's so good to be able to talk to others about this.

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  9. Wow- I am so grateful for all of these. I have been dealing with it for months now. I was doinggreat for a few years and it flared. It seemed to have started after I was in an accident and had to have my knee reconstructed. I did not feel too much stress but maybe it was for me. Right now I am so scared about cancer. I think I am going to go to the doctors and have my yearly tests and get bad news and it will ruin my daughter';s big Sweet 16 party. It is amazing how i can go down to the detail on how I will feel and what it will affect right now.
    It is good to be able to share this. My family is good but far from being able to really get it- I can't blame them- they don't feel this.
    Thanks to all of you who post.

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  10. Welcome Anon and Deneen! It is really hard to deal with this kind of anxiety alone. I am glad you are here. Check out the other ocd bloggers in my blogroll--you will feel much less alone. And if you can go to a support group or find an ERP therapist, that can really make a difference. And Deneen--I know how it is to have the "whatever I'm worried about will ruin a special occasion fear"--my therapist reminds me that I will deal with it when or if it happens--it might suck, but it's the OCD wanting assurance nothing will be ruined, in advance.

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  11. Thanks again. Hello Anonymous. My heart feels what you do. I read about you worrying about the birthmark and it's funny how I can think" no way should you have worried about that- of course it was only a birthmark" yet I think every feeling in my abdomen is cancer. And you would probably tell me " come on Deneen- its just gas" lol.
    Well, I took the leap and went to my annual gynoc appt on Friday. Wednesday just ended and no call ( yet). But I went and I feel better yet still worried I will get a dreaded call. Next it's a mammogram but ad I said I scared I will get bad news and it will affect the enjoyment of my daughters big sweet 16 party in January.
    I know- I am so sick of living with my painful mind. I want to find a therapist but concerned about cost. I just got Grayson's book and did inquire about the free study participation- but no replies.
    I pray we all will find an end soon and can come here and say we are cured :-)

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  12. Please help. I'm in Albuquerque and née a good therapist/ support group. I've had OCD for a long time, but just Started having severe health anxiety. Very recently, and I'm not 100% convinced that it's no physical... I.e. Brain tumor, etc. I'm really stuck, and have been for 3 months. It's scary and I feel very alone. Thank you for any advice/ help.

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    1. Are you still in ABQ? I'm starting support group, and wanted to get you information.

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    2. Yes, but I can't login to my account on here. Not sure how to contact you.

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  13. Deneen--I hope that you are hanging in there! I'm glad you got Grayson's book. It sounds like you have some similar anxieties as mine in that the feared consequence is the ruination of a future event that you want to enjoy--since I started treatment, I am much better able to deal with this kind of fear.

    amberjake--I would recommend Jonathan Grayson's Freedom from OCD, and also the International OCD Foundation at http://www.ocfoundation.org/--I found one therapist listed on their site in Albuquerque:
    Susan P. Kaspi , PhD
    9426 Indian School Road NE, Suite 1
    Albuquerque, New Mexico 87111
    (505) 345-6100
    spkaspi@behaviortherapy.com
    www.behaviortherapy.com

    and someone in Corrales who cowrote OCD for Dummies:
    Laura J. Smith , PhD
    Clinical Psychologist
    4313 Corrales Road
    Corrales, New Mexico 87048
    (505) 440-3595
    laurasmith@psychology4people.com
    www.psychology4people.com

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    1. I'm starting an OCD Support Group in Albuquerque in October 2015, please message me for details. Sheilahbo@mac.com.

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  14. Amazing to come to this blog and read about others who have hypochondriacal symptoms. I was diagnosed with OCD (manifested as hypochondria) almost 20 years ago. So few people understand the pain and the anguish we put ourselves through in trying to cope with these fears. I have had mixed results with CBT because ultimately, we do all die and no ERP is going to help me 'get past' that. So, for me, some of this is maybe an existential crisis of sorts. Coping with mortality. Yet still there is help to be had and both CBT and/or medication can make life more manageable. Thanks so much for this blog expwoman, bless you!

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    1. Beth--I've struggled with the existential crisis stuff as well--no ERP won't eliminate death, but in ERP therapy I did realize that my obsessing about death was actually a ritual, a way to damp down the anxiety briefly, and then it would pop back up even stronger. OCD is promising that I can have certainty about the nature of death if I analyze it enough, but that's an illusion, and one that erodes what life I do have.

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  15. Wow, I'm so glad I found this page. I've been suffering from health anxiety for about 15 years and now that I have 2 little ones my obsessing is really focused on them. Can totally relate to this post... My compulsion to search the Internet is to find things that will say "they don't have that " thus reducing my anxiety. Ugh. It's difficult for sure. I feel like I'm wasting this incredible life I have worrying. Thinking about going on meds after I wean my little boy. Anyone have any success with meds ??? Thx for the site!!! Jax

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  16. Hi Jax
    I noticed no one chimed in on medication. Here's a link to a series of articles I wrote about deciding to take medication. http://exposingocd.blogspot.com/p/medication-for-ocd.html
    Medication combined with exposure therapy helped immensely.
    E.

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  17. Brain Lock by Schwartz is a terrific resource. In the book, Schwartz lays out the four-step method, which over time and through repeated application can actually rewire the brain of those suffering from OCD (health related and other). Dr. Schwartz believes that medication can be used to help treat OCD, but that it should not be relied on as the sole treatment, rather as "water wings" to help one get to a point where they are well practiced with their application of the four steps.

    Personally, I don't allow myself to Google anything health related. If I need reassurance and want to turn to the web, I now know that obsessively searching up sites like this one are more helpful for me.

    The four step method must be practiced, over and over, but over time and with repeated practice, can reduce one's anxieties tremendously. And remember, with OCD, if you find the reassurance you're after for one symptom, another symptom will surface, creating an endless loop. So, focus on your actual health problem: your OCD.


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    1. The endless loop is a pattern I know well!

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  18. Very helpful, recently I've had some health concerns that have been difficult to diagnoses. I do find Grayson's book very useful in this regard. But more insight is great. Problem for me is I also have social anxiety. Dealing with doctor's is just as anxiety provoking as worrying about illness. My symptoms and test results seem just worrying enough to warrant monitoring the situation but I'm constantly worried the doctor will think I'm just being a hypochondriac.

    I actually looked through some books on hypocondria, but they all focused on worrying about something that has been ruled out. Which isn't the case for me. I'm working on establishing a format of when to call a doctor, which symptoms or tests should be followed up on and which need not. I'm finding this helps me to let it all go and enjoy things more, particularly when I am having low symptom period. I've got a ways to go, though. :)

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    1. Welcome MinM--Your comment really resonated. I wrote a post inspired by it
      Fear of Being a Bad Patient: Health Anxiety and Self Worth.

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  19. Perhaps we can all learn a bit from the Book of Job. Job said, "The thing I greatly feared has suddenly come upon me."

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  20. My son has medical hypochondria,hasn't been medically diagnosed,but, we both know he does.He will have different types of aches and pains,or a sore,he will say probably cancer,he has a recovery alcoholic friend with scherosis of the liver,then he started saying I will probably develop hepatitis.He needs medication and therapy,but,he says he really doesn't want to start medication,but,it hurts me so to see him suffer day by day.It rules him and I try to advise to him,that there is help,you just have to seek it.What types of bloodwork do the physicians do to tell what chemicals are low,or do they just start adminerstting medication on a trial base?Any help would be grateful,we live in Nashville,any good therapist

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  21. I suffer a lot worrying abt my heart especially as i suffer panic attacks so get pains in my back and chest. I have had an ecg and that was ok apart from my heart raci g which they say is anxiety.. I also have a pain and strange feelings around my shin amd bottom half of my leg. Have bin checked for DVT but still think there is something really wrong with me. I have just started citalopram 30mg ten days ago. Im going out of my mind worrying im going to die. Its ruining my life so much. I cry a lot as not sure how to handle how i feel. I stay in as worry abt being bad when im out. Not sure if this is ocd abt my health. Help plzzz

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  22. I suffer with anxiety & OCD, but this year manifested as health anxiety. Every sick feeling or runny nose I swear is meningitis or cancer or a tumor. It certainly has created a very negative feedback loop- and I am *in* therapy. I did great for 2 years but after I quit smoking I developed this new health anxiety that is 24/7. it is absolutely awful.

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  23. Welcome Anons and Kelly. The International OCD Foundation has information about therapists trained in Exposure Therapy as well as OCD Support groups and info on medication. I just started going to a mindfulness group, in order to learn more about staying with the sensations instead of racing ahead in my mind and creating even more bodily chaos. The book we are reading is Mindfulness by Mark Williams and Danny Penman.

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  24. Is anyone in Albuquerque? I'm starting an OCD Support Group and want to get the word out.

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