What Causes Health Anxiety (Hypochondria)
Feeling anxious over your health is completely normal (even expected) from time to time.
A rational response to a health concern or new, uncomfortable body sensation could be:
Feel initial - but manageable - anxiety.
Monitor the symptom, and mention it to a doctor at the next appointment if it persists. If it worsens, make an appointment to see a doctor sooner.
Meanwhile, life goes on.
See your doctor, obtain a remedy or reassurance, and the initial anxiety quickly disappears.
With health anxiety, you react irrationally:
You feel extreme anxiety over your symptom, perceiving it as imminently dangerous, not just uncomfortable.
You Google your symptom, find evidence pointing to a serious illness, and immediately fear the worst.
You visit the doctor or emergency room as soon as possible (even if it means abandoning other commitments). Life comes to a halt.
You discuss your health concerns often with family and friends, and check frequently to see if your symptom(s) are still present.
When tests come back negative and your doctor reassures you that you're healthy, your anxiety escalates even further - convinced they’ve missed something.
Sound familiar? 😬
People challenged by health anxiety get swept away by a story created in their subconscious mind, beginning a wild-goose chase for an illusive diagnosis to explain their symptom.
It’s your mind’s way of attempting to keep you safe - by getting one step ahead of the (hypothetical) disease, restoring a sense of control over your future.
In other words, health anxiety isn't about the presence or absence of illness, but your psychological reaction to the initial discomfort.
You might be thinking... "What caused my health anxiety? What's wrong with me?"
You weren't born with health anxiety... nor did you consciously choose to develop it.
Somewhere along the way, your subconscious mind learned to mis-interpret health-related thoughts and physical sensations, and respond irrationally.
Causes vs. risk factors
With any illness and disorder, there are causes, and risk factors. These can be easy to confuse.
Causes are factors that are always present with an illness or disorder... that is, the presence of one or more causes leads to almost certain development of the illness or disorder.
Risk factors are factors for which there’s a statistical association with an illness or disorder. That is, the presence of one or more risk factors significantly raises the probability of development of the illness or disorder, but doesn’t guarantee it.
For example: The common cold.
The common cold is caused by a viral infection, most commonly a rhinovirus, transmitted through the air, or through contact with a person or surface infected with the virus, followed by introduction to the nose, mouth or eyes.
Risk factors for the common cold include:
Age (children and seniors are most at risk).
Weakened immune system.
Poor hand-washing habits.
Time of year.
Exposure (especially in an enclosed or densely-populated environment, such as an airplane, child-care facility, school or workplace).
Make sense? Cool... Now let's look at the causes and risk factors of health anxiety (hypochondria or illness anxiety disorder).
Health anxiety (hypochondria) causes
Depending who you ask, you process between 12,000 and 65,000 thoughts per day. The most credible estimate I was able to find is 15,000, made by Dr. Dennis Gersten, MD and American Board of Psychiatry and Neurology diplomate.
Regardless whose estimate is most accurate, consensus is you process a lot of thoughts - many of them automatically, in your subconscious mind. It stands to reason that some of them are negative (some estimates even suggest that up to 70% of your mental chatter is negative).
This is true for everyone. What’s different is how you interpret, and respond to automatic negative thoughts (ANTs).
ANTs you accept to be true, without challenging them, become anxious thoughts.
Negative automatic thoughts usually fall into one of these common thinking traps:
“I'm anxious about today's doctor visit. My test results are back and I just know it’s going to be bad news.“
“I'll believe I'm healthy when all my symptoms are gone.”
“My doctor and family must think my symptoms are all in my head.”
“Physical symptoms are only caused by physical illnesses.”
“I’m sick, I just know it.”
“My heart is pounding - what if I’m having a heart attack?”
"I was feeling so much better lately, until this happened - now I'm starting all over again."
“I met someone in a chat room who had the same symptom - I must have the same thing they do.”
“I’m tired and I have a headache - what if it’s a brain tumour?”
“I should try not to worry.”
Your thoughts are interpreted according to your beliefs - about yourself, and about the world.
Beliefs are a product of profoundly emotional moments in your past.
The more traumatic the experience, the more deeply-rooted the associated anxious belief will be in your subconscious mind. Upon detecting similar sensations or situations, your subconscious mind will engage the fight-or-flight response to ensure it doesn't happen again.
Anxious beliefs make it challenging for you to tolerate uncertainty and discomfort.
Uncertainty is dangerous.
I’m only safe when I’m in control.
Worrying keeps me in control, and therefore safe.
Coupled with a poor understanding of body sensations, anxious beliefs can lead you to misinterpret all unfamiliar or unusual body sensations as indications of a serious, undiagnosed illness.
Confirmation bias takes over, compelling you to search for evidence to confirm that you have a serious illness so you can get one step ahead of it, and regain control over your future.
Anxious Safety Behaviours
Safety behaviours are those you engage in when you feel threatened, in an attempt to reduce your anxiety.
I call them anxious behaviours because these they do you more harm than good.
While anxious behaviours may (sometimes, but not always) provide some immediate relief, it's most often short-lived because anxious behaviours cognitively reinforce your automatic negative thoughts and anxious beliefs.
In other words, in time, anxious behaviours raise, not reduce, your anxiety level.
Worrying: Giving anxious thoughts undue attention over more important demands for your attention - including but not limited to career, education, family, friends and self-care.
Research: Most often, cyberchondria (Googling symptoms, or engaging in online discussion groups to discuss symptoms, remedies and possible diagnoses).
Checking: Physically examining your body to check whether your symptom is still present, or searching for new ones.
Seeking reassurance: Frequent and unnecessary doctor or emergency room visits, and frequently discussing health concerns with family and friends.
Suppressing sensations: Taking deep breaths or ceasing physical activity in an attempt to make the symptom/sensation go away. These are similar to escaping, below.
I was guilty of all of these (and many more - which I cover in another post).
Anxious thoughts, beliefs and behaviours quickly create a vicious cycle:
Initial discomfort or challenging situation.
Worry that you may have an undiagnosed, serious illness.
Your anxious behaviours reinforce your fears.
Rising anxiety results in physical symptoms of anxiety.
You become even more convinced that you have an undiagnosed, serious illness.
More anxious behaviours reinforce your fears.
This creates more anxiety and more physical symptoms.
Tests and medical opinions indicate that nothing is physically wrong, providing no relief and causing you to believe they missed something.
Isn't it time you finally say goodbye to anxious behaviours - so you can neutralizing a major cause of health anxiety, and get one step closer to lasting recovery?
Doesn't a chemical imbalance cause anxiety?
One theory is that a reduced availability of feel-good neurotransmitters (most notably, serotonin) in the brain causes mental health disorders, including anxiety and depression.
Therefore, it's no surprise that anxiety is conventionally treated with prescription medications that aim to fix the chemical imbalance.
There's just one problem with this theory: Anxiety can cause reduced serotonin levels, and anxiety-reduction strategies can elevate serotonin levels.
Total chicken vs. egg scenario, right?
In other words, unless you have a physical condition known to alter the balance of neurotransmitters in the brain, or are taking another medication that does, it’s hard to say which came first.
Truth is, there’s no way to know for sure because there's no medical test to detect such an imbalance.
One thing we do know for sure is that pharmaceutical companies make billions of dollars based on the chemical imbalance theory. 😉
Either way, for the best and lasting relief, you must address your anxious beliefs, thoughts and behaviours.
I’m no neuroscientist, but in my experience, the human brain already has the power to overcome health anxiety - whether or not a chemical imbalance exists, came first, or resulted from your anxious state.
Health anxiety risk factors
Prolonged stress, mainly caused by your career, finances and interpersonal relationships (romantic, social, business, or even your relationship with yourself) are major contributors to anxiety.
A serious childhood or adolescent illness where you feared for your health, and was the focus of attention from doctors and loved ones. This can lead you to believe that any health abnormality could be dangerous, and that you will receive the same level of attention you received from loved ones as you did previously.
llness of a loved one
Experiencing the serious illness of a loved one can create a link, especially in the mind of a child, between love, attention, and illness. This could form a subconscious, unhealthy belief that you must be sick in order to receive the love and attention you need.
Death of a loved one
When a loved one dies (especially if somewhat suddenly), the emotional trauma can create anxiety over your own personal health.
Witnessing or experiencing abuse of any kind, particularly as a child, can result in a greater sense of physical vulnerability, leading you to have an exaggerated concern for your physical health. Past abuse can also lead you to feel insecure about interpersonal relationships, leading to care-seeking behaviour.
Observing anxious health-related behaviours by family members and authority figures may lead you to believe that it's healthy to constantly question your health. Also, those who use fear to manipulate your behaviours may lead you to view the world as a dangerous place, raising your anxiety level to an unhealthy level. Lastly, genetics influence your physiology and sensitivity to pain.
Excessive media consumption (TV, Internet, etc)
Cyberchondria: Googling your symptoms and participation in online forums to discuss symptoms, diagnoses and remedies.
Social media: Causes you to (consciously and subconsciously) compare yourself to the ideal version of themselves others share.
Health-related dramas: Ever seen a TV character experience tightness in the chest caused by anxiety (not a heart attack)? Me neither. 😕
News: Headlines like 5 Easy-to-Miss Cancer Symptoms and French fries will kill you: Study says they double risk of death do leverage fear to attract our attention. I mean, c'mon, who doesn't enjoy the occasional plate of french fries?
Poor digestive health, food sensitivities and excessive intake of sugar, caffeine and processed foods may be contributing to your anxiety.
A sufficient, regular exercise routine can help reduce anxiety and keep your anxiety level in check.
Insomnia or some other sleep disorder is almost present with any anxiety disorder. Poor sleep contributes to anxiety, and anxiety contributes to poor sleep. Bad combination that'll get you stuck.
A low sense of worthiness, feeling inadequate and a constant concern over what others think about you are known to contribute to anxiety.
Substance misuse or abuse
Alcohol and drug abuse contributes to anxiety, and anxiety contributes to alcohol and drug use. Another bad combination that'll get you stuck.
Other mental health disorders
This includes, but isn't limited to:
Generalized Anxiety Disorder (GAD)
Obsessive Compulsive Disorder (OCD)
Some medications are known to raise your anxiety level. If you're concerned about a medication you're taking, talk to your doctor.
Recovery from health anxiety
Negative thoughts are normal - but they create anxiety, anger, self-pity, guilt and other emotions that don't serve you.
Unchallenged, automatic negative thoughts lead to self-destructive behaviour, robbing you of your focus on what's most important to you: Family, career, education, leisure, life!
Two Wolves is a Cherokee legend about the battle between your positive and negative thoughts.
An old Cherokee is teaching his grandson about life.
“A fight is going on inside me,” he said to the boy.
“It is a terrible fight and it is between two wolves. One is evil – he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.” He continued, “The other is good – he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. The same fight is going on inside you – and inside every other person, too.”
The grandson thought about it for a minute and then asked his grandfather, “Which wolf will win?”
The old Cherokee simply replied, “The one you feed.
Our thoughts can be our own worst enemy - but only if we let them.
With mindful awareness, self-compassion, and practice you can transform your negative thoughts to positive ones.
Beginning a holistic, action-oriented recovery plan (like the one I teach students in the 30-Day Anxiety Detox) that integrates cognitive behavioural therapy (CBT) to transform your thoughts, beliefs and behaviours is your best path to a healthy life, free of anxiety.
📗 If you don't have a journal, get one. Documenting what you learn, and your progress, is critical to your recovery. I recommend Day One (iPhone or iPad | Android) because it's easy to use and I can take it with me everywhere I go. If you prefer pen and paper, that's fine - any journal will do.
💡 Ask yourself: "Self, what risk factors are contributing to my anxiety the most? What specific, positive changes must I make to reduce or eliminate each of them?" Write them down in the form of goals.
✏️ Each day, write down what automatic negative thoughts and thinking traps are "feeding" your health anxiety. Patterns (certain situations, areas of your life, thinking traps) will begin to emerge, that you can later target to begin transforming your life.
🙏🏼 Share this post - it may help a loved one or friend finally begin a healthy, fearless life, free of anxiety.