‘I think I’m going to die’
Alanah Sarginson says it started off as a slight ache in her arm, which caused her to panic. Then, she felt a pain in her chest that made her think she was struggling to breathe. Within five minutes, Sarginson texted her friends.
Her worries had taken over. “I’m in ‘I might die tomorrow’ mode,” she recalled.
The 20-year-old full-time student and part-time illustrator struggles with health anxiety. And though sometimes she comes to the realization that “this is probably mostly in my head,” it doesn’t matter.
“If I think I’m going to die, I don’t really care how embarrassing I am because obviously it’s like the most ultimate threat,” she explained. “So I’m going to take it seriously even if it’s just my mind playing tricks on me.”
Though Sarginson has dealt with health anxiety in the past, she says the coronavirus pandemic made it worse.
“It’s made me a lot more scared. It’s taken it up a notch,” she said. “Everyone’s going about their lives and I’m in my room Googling symptoms, panicking, checking my temperature.”
This hyper-focus on health concerns is something that people with health anxiety can struggle with daily, said Melissa Dowd, a therapist at PlushCare, a virtual mental health and primary care company. Many may be more familiar with the former term hypochondria (or more technically hypochondriasis), which was replaced in the Diagnostic and Statistical Manual of Mental Disorders in 2013 by two updated concepts: somatic symptom disorder and illness anxiety disorder.
Dowd defined health anxiety as “worries and obsessions related to a perceived threat to one’s health.”
“Often someone who is suffering from health anxiety, they’ll be hypersensitive to any changes or sensations that they experience in their body and then when they have those changes and sensations, they’ll misinterpret them as dangerous.”
Ken Goodman, LCSW, board member for the Anxiety and Depression Association of America and creator of “The Anxiety Solution Series” audio program, explained that health anxiety can also be an extreme reaction to external triggers, such as news reports or social media posts about illnesses like cancer.
“The person who has health anxiety would then take…. that social media post, and exaggerate it to the worst possible scenario, and believe that this might be happening to them,” Goodman explained.
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Sarginson, who lives in London, has noticed a correlation between how much COVID-focused news she’s been consuming and “how much I’m freaking out and thinking I’m going to die.”
And while many can relate to Googling symptoms, Goodman explains signs point to a diagnosable disorder when it “interferes with your life” and “becomes an obsession.”
This includes regular and intense worrying as well as things like compulsively checking your body for symptoms, researching for hours a day or constantly seeking reassurance from relatives or doctors. Someone with health anxiety may also become avoidant of the doctor for fear of what they might find out.
‘Overwhelming,’ ‘relentless and exhausting.’
For Amy Hupe, a 32-year-old from Hertfordshire, England, health anxiety is “relentless and exhausting.”
“It just goes really quickly to, ‘I’m going to die.’” she explained. “It just goes there always straight away… But then, I’ll kind of be able to walk back from that a bit… I start to kind of rationalize it a bit.”
The rationalizing can be challenging though, she said, explaining, “My brain almost gets into this thought cycle where what I struggle with is knowing when it’s appropriate to take action or not.”
She continued, “I can see it’s irrational but there’s this really persistent thought in my head, which is always like, what if this is the one time I don’t get help?”
Hupe says it can turn into a vicious cycle, with a physical sensation triggering anxiety and then the stress of that turning into more physical symptoms.
That feeling you can’t name? It’s called emotional exhaustion.
“We like to draw these lines between mental health and physical health, but it’s not separable like that,” she said. “If you’re having a really bad time mentally, you’re going to be feeling lots of things physically. It’s not all in my mind; it’s not some psychosomatic thing.”
Sarginson recalled having abdominal pains that she worried were bowel cancer. After she had tests done at the doctors, however, she was told it was likely irritable bowel syndrome due to anxiety.
“It’s stuff like that, where, even though it is real, it’s this weird kind of synergy between the anxiety and the health effects from the anxiety,” she said. “It’s so hard to untangle… the anxiety manifests so physically.”
Jane Mick, a retired customer service sales rep living in Arizona, describes her health anxiety as “overwhelming.”
“It overtakes your life. It’s really debilitating. I feel like I’m not even the same person,” Mick, 70, said. “It’s almost like madness, sometimes I really think I’m going insane. I worry about things that there’s no point in worrying about.”
Stigma surrounding health anxiety
Despite the confusion it can bring, Mick explains the feelings are very real.
“I’ll be honest, when I was younger and I heard people say they suffered from anxiety, I thought they were nuts and I thought they were making it up for attention,” Mick said. “I really didn’t believe it was real. I had none when I was younger, and then when it happened to me, I realized those people were telling the truth.”
Hupe adds that while the worries can be irrational, they plague “sensible, logical people.”
“I don’t think I’m somebody that people would look at as an irrational person who doesn’t have logic or agency over their behavior and thoughts and things,” Hupe said, but “logic just goes out the window when you’re dealing with something like this.”
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Sarginson says she’s “embarrassed and ashamed” to go into detail about her anxiety for fear she sounds “ridiculous,” making the experience even more isolating.
Health anxiety during the coronavirus pandemic
For some, the coronavirus pandemic has created a new problem or made one that already existed feel insurmountable.
“As soon as it was in the news about COVID being a thing, for some reason, I found myself really panicking and being over-aware with every single symptom, and since then, that constant self-checking has just gotten worse and worse,” Sarginson said. “It started off with me being worried about having COVID, but it’s kind of ended up with me being worried about having a heart attack, a blood clot or some kind of cancer.”
Dowd said PlushCare has seen an 300% increase in behavioral health visits.
“We’re absolutely seeing an increase in depression and anxiety related to the pandemic and certainly around health anxiety,” she said. “Even people who don’t typically run anxious are experiencing heightened anxiety right now”
Goodman notes, however, worries about COVID-19 don’t affect everyone with health anxiety.
For Mick, the pandemic’s impact isn’t COVID-related but time-related.
“I think (the pandemic has) made it worse in the sense that now I have more time to think about stuff,” she said.
How to cope with health anxiety
Know you’re not alone
“I don’t think anyone should have to manage this or suffer alone,” Dowd says. “There’s so much support out there, so I really encourage people not to have any shame or judgment around it if you are experiencing anxiety or depression – it’s just so important to reach out for support.”
Control what you can
“It’s really important to focus on the things we do have control over, for example, following the CDC guidelines, maintaining a healthy lifestyle and proper diet and exercise – which is not only a positive effect for physical health but it’s also so important for your mental health,” Dowd suggested.
Curb your Googling
Dowd also suggests avoiding self-diagnosis through the internet.
Turn to healthy distractions
Instead, try “healthy re-direction,” including meditation, breathing exercises and mindfulness activities. This can also include “positive and productive activities” such as cooking, playing videos games, doing a workout or working on a puzzle.
Go at your own pace
Everyone is different and so are their comfort levels, so it’s OK to take things slow, Dowd says. “Definitely setting small, achievable goals to try to overcome the feelings of anxiety is important,” she said.
Seek professional help
If someone has gone to doctors repeatedly, doctors have not found a medical diagnosis and they’re continuing to worry, Goodman says, “it is probably illness anxiety and they need to seek the assistance of a therapist who treats anxiety exclusively.”
