Paranoia about health

What It is and How to Beat It |

Ken Goodman, LCSW

Member Since 2009

Ken Goodman, LCSW, treats anxiety and OCD in Los Angeles. He is the author of The Anxiety Solution Series: Your Guide to Overcoming Panic, Worry, Compulsions and Fear, A Step-by-Step Self-help Audio Program, Break Free from Anxiety, a coloring, self-help book for anxiety sufferers, and the Emetophobia Manual, for those who suffer with the fear of vomit. Ken Goodman is an ADAA board member and Clinical Fellow. Visit Ken's website.

Ken and ADAA

"Prior to joining ADAA I wrote and produced several self-help audio programs including The Anxiety Solution Series, a 12-hour audio course, Stress Free, a compilation of six guided meditations, and The Personal Growth Series, a collection of seven hypnosis sessions. Since becoming a member of ADAA and being elected to their Board of Directors, I have completed two books: Break Free from Anxiety and The Emetophobia Manual. Although my practice in Los Angeles was focused on treating anxiety disorders, prior to joining ADAA, I did not know other therapists who shared the same specialty. Attending my first ADAA conference in 2013 changed that. The presentations filled the gaps in my knowledge and I met and become friends with other experts in the field. The articles I have written and the webinars and videos I have produced for the ADAA website on health anxiety, the fear of driving, and emetophobia, have helped thousands of people around the world and they have generated close to one hundred patients in my private practice. ADAA is an organization that uniquely benefits anxiety sufferers, therapist, and researchers."

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June 22, 2020

Health Anxiety: What It is and How to Beat It

The illness you fear might not be the illness you have. I recently conducted an online support group for people with all sorts of health fears, from cancer and heart disease to ALS and MS. Each shared their worries about moles on the skin, irregular heart palpitations, and numbness and tingling. Although their specific fears varied, they all had one thing in common; none of them had ever been diagnosed with a series illness and they all related to the following scenario:

Dina felt great after getting a clean bill of health from her physician but as she tried to fall asleep, she dwelled on one statement he made, Tumors can grow at any time. Come back in six months if you’re concerned. Questions raced through her mind as she tossed and turned, Why did he tell me that? If there was nothing wrong, why would he say come back in six months? What if he missed something? Why do I keep getting headaches and dizziness? Dina felt so anxious she got out of bed and searched the web for answers. As she reread the same articles about symptoms of brain cancer, she began to feel lightheaded. Why do I keep feeling this way? Do I really have brain cancer? Is this really happening?

The good news was, Dina did not have brain cancer or a brain tumor. Dina had health anxiety. There are two types of health anxieties: Somatic Symptom Disorder and Illness Anxiety Disorder, formally known as hypochondriasis. Many people with health anxiety are often unable to function or enjoy life due to their fears and preoccupations. They obsess over bodily functions (breathing, heartbeat), physical oddities (skin blemishes), and physical discomfort (headaches, stomach aches, lightheadedness).They might worry about a specific organ (brain, heart) or a disease they heard about on the news or at work (MS, diabetes). They are preoccupied with the belief that they have, or are in danger of contracting, a serious illness. Many will purse doctors and tests repeatedly for reassurance, but are reluctant to seek mental health treatment since they believe their condition is medically based.

Why does health anxiety persist despite reassurance from doctors?

Although some refuse to be examined by their physician due to their fear of discovering the worst, seeking reassurance from doctors, insisting on repeated medical tests, and visits to urgent care, are more common in health anxiety. Being reassured by the doctor that there is no serious medical illness brings relief -- temporarily. The vicious cycle quickly resumes as new thoughts and physical sensation surface, followed by googling and self-diagnosis, misinterpretations of news in the media, anxiety, and more visits to doctors to resolve the uncertainty. The cycle ignites with each new alarming thought or symptom.

The False Alarm

Car alarms are set off when a criminal breaks in but imagine how problematic it would be if the siren blared each time a pedestrian walked by. The car alarm would be misinterpreting innocent people as dangerous criminals.

With health anxiety there is the misinterpretation of discomfort and normal bodily sensations as dangerous. The body is very noisy. Healthy human bodies produce all sorts of physical symptoms that might be uncomfortable, unexpected, and unwanted, but not dangerous.

Normal sensations in the body that can produce fear and worry include changes in visual acuity, heart rate, blood pressure, saliva levels, depth of breathing, balance, and muscle tone, just to name a few. These are normal and harmless bodily changes, but when a person believes they are symptoms of a terrible disease, it causes anxiety.The sensations are real, but the beliefs are false.

Why do people misinterpret sensations in their body and overestimate danger?

Sometimes misinterpretation is due to assumptions about an illness. For example, “My cousin died of cancer. It’s only a matter of time until I get it.” Or, viruses sped easily. People in Africa are dying of Ebola. It could easily spread to the U.S. People with health anxiety might hold rigid definitions of good health, perhaps believing that any discomfort whatsoever means bad health.

Anxiety is a protective mechanism and scanning the body for an illness seems like the right thing to do to protect ourselves. However, when we are preoccupied with something, we tend to notice it. Last month when I was looking to purchase a new car, I suddenly began to notice every car on the road; the make, model, and the color. Previously, I didn’t pay attention. Looking for symptoms makes you notice subtle sensations you might otherwise ignore. When you become preoccupied with bodily sensations, those sensations become amplified and last longer.

This is when it gets tricky.

Each scan of the body produces uncertainty and doubt, giving the imagination opportunity to create stories. As you imagine the worst, your body’s alarm system sounds off in the form of symptoms of anxiety (racing heart, tightness in the chest, difficulty breathing, jitters, tingling, lightheadedness, nausea, stomach discomfort, sweating, headaches, etc.) giving your imagination additional fuel to create great works of fiction.The symptoms are real. The thoughts are false.

The Most Effective Treatment is Cognitive-Behavioral Therapy

Since it is possible to suffer with anxiety and a serious medical condition, medical problems must be ruled out with a thorough physical exam. Once this is accomplished, Cognitive Behavioral Therapy (CBT) is the most effective treatment for any form of anxiety including health related anxiety.

CBT is a therapy model that focuses on our cognition, the way we think, and our behaviors, the way we act. The main concept behind CBT is that our thoughts about a situation (the fear of ALS) effect how we feel (afraid and anxious) and how we behave (holding out our hands to see if they are trembling). We tend to assign meaning to specific situations (tingling means we have MS). It’s not the actual situation causing our anxiety, but the meaning – accurate or not. And, when you have anxiety, you give your thoughts a lot of meaning, and thus, a lot of power.

CBT aims to help you overcome fears by correcting irrational thoughts and changing problematic behaviors. By acquiring a certain mindset, you can learn to approach anxious situations differently and learn to tolerate discomfort and uncertainty. Illness anxiety can be overcome with the help of a skilled anxiety specialist and CBT. You can find a therapist in your state on the ADAA website. And for additional information on Illness Anxiety watch my free ADAA webinar.

Additional Resources:

How to Tell If Your Health Concerns Are Normal—Or a Sign of Something More, ADAA member Michelle Patriquin, PhD, ABPP, TIME magazine, September 20, 2022
Health Anxiety Is Way More Than Being A Hypochondriac — And It’s Way More Common Than You Think
This Is Why Being Anxious Makes Some People Puke - Article, Tonic.vice.com, December 6, 2018

Ken Goodman, LCSW

Member Since 2009

Ken and ADAA

ADAA Blog Content and Blog Comments Policy

Health anxiety - NHS

Health anxiety is when you spend so much time worrying you're ill, or about getting ill, that it starts to take over your life. It's related to obsessive compulsive disorder (OCD).

Check if you have health anxiety

You may have health anxiety if you:

constantly worry about your health

frequently check your body for signs of illness, such as lumps, tingling or pain
are always asking people for reassurance that you're not ill
worry that a doctor or medical tests may have missed something
obsessively look at health information on the internet or in the media
avoid anything to do with serious illness, such as medical TV programmes
act as if you were ill (for example, avoiding physical activities)

Anxiety itself can cause symptoms like headaches or a racing heartbeat, and you may mistake these for signs of illness.

Self-help for health anxiety

Keep a diary

note how often you check your body, ask people for reassurance, or look at health information
try to gradually reduce how often you do these things over a week

Challenge your thoughts

draw a table with 2 columns
write your health worries in the 1st column, then more balanced thoughts in the 2nd. For example, in the 1st column you may write, "I'm worried about these headaches" and in the 2nd, "Headaches can often be a sign of stress"

Keep busy with other things

when you get the urge to check your body, for example, distract yourself by going for a walk or calling a friend

Get back to normal activities

try to gradually start doing things you've been avoiding because of your health worries, such as sports or socialising

Try to relax

try this simple breathing exercise or visit the Mind website for some relaxation exercises

Non-urgent advice: See a GP if:

your worries about your health are preventing you leading a normal life
self-help is not working

If a GP diagnoses you with health anxiety, they may refer you for a talking therapy, such as cognitive behavioural therapy (CBT), or offer you a medicine for anxiety.

Other ways to access CBT

You can refer yourself directly to an NHS talking therapies service without a referral from a GP.

If you can afford it, you can choose to pay for your therapy privately. The cost of private therapy sessions varies, but it's usually £40 to £100 per session.

The British Association for Behavioural & Cognitive Psychotherapies (BABCP) has a register of all accredited therapists in the UK and The British Psychological Society has a directory of chartered psychologists, some of whom specialise in CBT.

More help for mental health

read more about getting help for anxiety, fear and panic
the mental health charity Mind offers more information on anxiety and panic attacks

Video: Psychological therapies for stress, anxiety and depression

Animated video explaining self-referral to psychological therapies services for stress, anxiety or depression.

Media last reviewed: 14 March 2022
Media review due: 14 March 2025

Page last reviewed: 14 October 2020
Next review due: 14 October 2023

Food paranoia. When the passion for healthy lifestyle ceases to be beneficial

The Invisible Enemy

In 1997, an American doctor, Stephen Bratman, first described a new ED - orthorexia. The doctor was a member and one of the founders of the ecovillage commune, where all residents ate organic food. The diet of the settlers became more and more "healthy", or rather, stricter and more limited, which eventually affected their well-being. Dr. Bratman described the symptoms of the new eating disorder from his own experience in the book “Addicted to healthy products: how to overcome the obsession with proper nutrition” and gave the name to his illness: “ortho” in Greek means correct, “rexia” means food. nine0003

Unlike bulimia and anorexia, orthorexia has not yet been included in the official international classifications of diseases of the ICD (International Statistical Classification of Diseases and Related Health Problems, authored by the World Health Organization) and DSM (Diagnostic and Statistical Manual of Mental Disorders, published American Psychiatric Association). Not all specialists are aware of the existence of such a diagnosis. However, orthorexia has been actively studied for the last 25 years. Who are orthorexics and how do they differ from bulimics and anorexics? nine0003

A lot of people, looking closely, will find an orthorex in their environment. Such a person knows all the latest news about healthy eating, carefully monitors healthy lifestyle blogs in social networks. He knows where to buy chia seeds or organic quinoa near his home or work, bakes gluten-free bread, and properly soaks lettuce leaves to remove pesticides. You can talk with him for hours about proper nutrition, the benefits and harms of certain products, but having lunch together is problematic - a healthy food fan is afraid to eat outside the home, because he cannot control the composition of the dishes. nine0003

fleepik.com

Such people do not strive for an ideal figure and weight. The benefit or prevention of harm from this or that food is at the forefront, and what size of clothing they have is not important to them. As diagnostic criteria, experts point out a preoccupation with healthy eating, obsessive reading of dietary texts, and a meager diet limited by strict rules. Orthorex self-esteem is based solely on nutrition. If he eats “cleanly”, bought everything useful, cooked it right and ate it - he is well done and smart. If a “harmful” product is in the menu, an attack of anxiety and self-loathing is inevitable. The only way to save yourself is to pay even more attention to the choice of products. As a result, a significant amount of time is spent planning meals, finding safe food and preparing it properly. nine0003

Because the diagnosis is not included in the classifications, it is not possible to accurately determine the extent of orthorexia. However, according to various studies compiled by the American National Eating Disorders Association (NEDA), from 21 to 57.6% of the population demonstrates orthorexic behavior, in women it can be observed twice as often as in men.

Food is like poison

Orthorexians call whole food groups "harmful". There are antibiotics and hormones in meat, mercury in fish, pesticides in vegetables, gluten in cereals, lactose in milk, sugar is poison, salt is even more poison. Both lactose and gluten are absolutely safe for the health of most people and are limited only on the recommendation of a doctor in the presence of intolerance due to rather rare diseases. But often people who are preoccupied with nutrition make their own diagnoses without consulting doctors. They are confident that by excluding certain products, they will be able to refuse medical services for many years. In reality, with such a selective approach, the meager diet of Orthorex is by no means healthy. And it is nutritional deficiencies, and not excessive consumption of "harmful" foods that damage the body. It is no coincidence that the official recommendations of nutrition institutes in different countries suggest not to exclude, but, on the contrary, to add more vegetables and fruits, nuts and seeds, cereals and grains, dairy products, various types of meat, fish and seafood to the diet. nine0003

Orthorexia is very dangerous. A person may experience physical health problems and dangerous weight loss, as with anorexia nervosa. The list of long-term effects of orthorexia on the NEDA website includes decreased attention and memory, decreased work efficiency, kidney disease, cardiovascular disease, menstrual irregularities, and fertility problems in women. Another unpleasant consequence is social isolation. Orthorex cannot eat in restaurants and guests, they carry food with them in boxes or eat exclusively at home, in a hurry to arrive at the table on time, leaving everything to do. Orthorexians inevitably experience stress, spending a huge amount of energy worrying about food, angry at loved ones if they do not support them, disgusted with themselves at moments of deviation from the rules in the diet, seek to punish themselves for not eating healthy enough. In the most severe cases, Orthorexians may even have suicidal thoughts and self-harm. nine0003

How to solve the problem

A person who has noticed the symptoms of orthorexia is recommended to reconsider their attitude to nutrition and debunk numerous myths about food. You can refer to the confirmed scientific information. For example, read the recommendations on the WHO website or the book by Elena Motova, an evidence-based nutritionist, “Food for Joy. Dietitian's notes”, psychologist Svetlana Bronnikova “Intuitive nutrition”. To begin with, do not completely eliminate, but limit the "harmful" foods that cause anxiety. In general, it makes sense to specifically eat "terrible" food in small portions several times a week. Start with the least disturbing foods and gradually increase the variety of your diet. Remind yourself that one occasional burger or bag of chips will not harm your health, and the anxiety about food from such meals will gradually go away. If you can’t change your diet on your own, you need the help of a specialist. Orthorexia is not a funny quirk, but rather a dangerous condition that requires timely treatment by a psychotherapist, nutritionist, or clinical psychologist trained in special protocols for helping such patients. nine0003

The Swiss alchemist and physician Paracelsus, who lived in the 16th century, is credited with the famous quote: “Everything is poison, and nothing is without poison; one dose makes the poison invisible. Orthorexia is the best illustration of this wisdom and allows you to see how too much concern for proper nutrition leads to poor mental and physical health.

Unhealthy paranoia: what causes excessive attention to one's health

Often, ordinary people tend to constantly worry about their health. When this excitement is groundless and develops into real paranoia, it becomes a syndrome, which in medicine is called health anxiety. nine0044

Fear of getting seriously ill can have a negative impact on daily life and general well-being. The Informant learned about this from a message from Acting Minister of Health Uliana Suprun on her Facebook page.

Paranoia lies in the fact that people are constantly doing additional tests or examinations, which are often prescribed to themselves, looking for hours on the Internet about the disease that they have invented for themselves. Even worse, when the fear of discovering the disease leads to the opposite consequences - a person generally begins to neglect visits to the doctor. Moreover, scientists note that excessive anxiety and stress itself increase the risks of real, no longer far-fetched diseases, such as cardiovascular diseases. nine0003
Yes, worrying about your health is quite normal and useful. But when thoughts about it become obsessive, it negatively affects a person’s daily life. Therefore, doctors advise to follow the rules that will help to cope with the problem:

Keep a diary

It is worth writing down what worries you about your health the most. This will help to analyze the situation and understand what problems are worthy of attention.

Internet is not always a good advisor

People who are overly concerned about their health tend to constantly go to various sites on the Internet and check for symptoms. To avoid this, try not to visit these resources on purpose, or, if necessary, block them.

Do not diagnose yourself

This is very dangerous, because in addition to excessive excitement, the risks of starting unjustified and potentially dangerous treatment increase. While there are many resources to check for symptoms and identify the disease, be sure to check with your doctor. nine0003

Try to get distracted by other things

Doctors advise trying to take your mind off worrisome thoughts about your illness by walking, exercising, reading, or hanging out with friends.

Consult your doctor

In some cases, the doctor may prescribe special treatment or refer you to a psychotherapist.

If you haven't chosen your family doctor yet, do so

A trusted specialist will monitor your health, recommend necessary examinations and relieve you of unnecessary worries. How to choose a family doctor in Kyiv - read the link.

Recall that earlier we told you how to correctly diagnose yourself using the Internet. Such an independent search for information about your health can be dangerous, but if you practice this, you should know how not to make a mistake.
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