The process hypochondriacs go through - expert

Adrenaline rush, heart pumping, sweating, and light-headedness follow, confirming the gravity of the terminal self-diagnosis... Photo / 123RF

We all worry about our health from time to time, at least to some degree, but some people worry excessively about catastrophic consequences of seemingly benign symptoms. They're known as hypochondriacs.

This is the sort of process hypochondriacs go through: what's that? A benign lump or malignant bump on your face, breast or rump? Adrenaline rush, heart pumping, sweating, and light-headedness follow, confirming the gravity of the terminal self-diagnosis.

Thoughts racing and images of a foreshortened future, orphaned children, and opportunities missed. Overwhelming distress. Must plan the epitaph - see, I told you I was sick!

Our future and physical health are inherently uncertain. But people with hypochondriasis (or, since the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, somatic symptom disorder) immediately resolve any uncertainty about novel physical sensations and symptoms on the side of catastrophe.

Seeking symptoms

The body is constantly in a state of flux. The heart pumps, blood flows, muscles twitch, lungs inflate, and bowels contract. Strange symptoms come and go. And most pass without conscious awareness as we focus on daily tasks.

But try this. Hold your hand upwards, so that your palm and fingertips face the sky. Focus all your attention on the tips of your fingers and wait ...and wait ...until you notice some sensations. Tingling, temperature changes, or just an awareness of the sensations on your skin.

Here's an even simpler task. As you read this, shift your attention on to the sensations of the ground or chair pushing up against your body. Chances are you were unaware of all these sensations just moments ago.

Attention, you see, is the microscope of the mind. It can filter in or out any of your internal or external experiences.

Now imagine becoming hypervigilant to all the physical changes naturally occurring in your body. Try it. Just focus on all the sensations in your body for a minute. Amazing, isn't it? Itchy toes, tense jaw, mild headache, numbness, and so on. All the normal workings of a healthy body.

People with somatic symptom disorder are experts at searching for and noticing normal bodily changes. They're also experts at interpreting these in potentially catastrophic ways - fatigue is leukemia; a lump on the arm is cancer.

The number one enemy of someone with the disorder is Dr Google ("cyberchondria"). Indeed, the only thing more catastrophically creative than a hypochondriac's mind is Google's 2.42 million webpages on the causes of cancer. Every possible symptom can be linked to every possible diagnosis, by at least one disreputable source or another.

The hypochondriac is searching not for information, but for confirmation of their imminent demise. If they're unlucky, they might come across contradictory information or additional ailments they hadn't yet considered.

Their intense worry and anxiety feel intolerable and must be neutralised. Seeking out a sympathetic doctor or other source of reassurance, or avoiding the health section of the newspaper all provide temporary relief until the next physical symptom is perceived.

Moving forward from health anxiety

So what are some things that keep hypochondriacs worrying?

Belief: worrying will help me catch something early.

No, it won't. Worrying will just keep you miserable until you're old enough to find out how you will shuffle off this mortal coil (unless, of course, your demise is a blissfully brief surprise). Worry itself will not get you any closer to predicting, preventing, or planning for your death.

Belief: I can get certainty about my health.

Nope, can't get that either. No amount of checking, doctor visits, Googling, reassurance-seeking will guarantee with 100% certainty that you're well. I can, however, guarantee that the unrelenting pursuit of certainty will make you miserable.

So, how can you manage health anxiety?

First, develop some healthy guidelines for monitoring your health and stick to them.

Based on your past experience, how long do benign symptoms typically last? One day, two days, one week? Decide how long you will wait before seeking any form of certainty or reassurance (from the internet, friends, family, or medical practitioners) the next time you notice a symptom, especially ones you've worried about in the past.

Once this time expires (no pun intended), make a decision about whether you need to get the symptom checked or whether you can wait another little while before doing so. Follow guidelines from reputable sources about the recommended frequency of body checking.

And, be willing to sit with uncertainty about your health. None of us ever have certainty about our health. I could have a brain tumour as I write these words. I am willing to accept this possibility and shift my attention onto the next paragraph.

Think about it this way: if I offered you a $2 million insurance policy for your house, even if I promised to build you a gold-plated replacement if it were destroyed, you would likely consider it far too expensive.

So, how much are you willing to pay to prevent any possibility of illness? Are you willing to give up your capacity to work, time you would otherwise spend with friends and family, and ultimately your happiness? This is a very high price to pay.

Spend energy on things you truly value, rather than wasting it on a false insurance policy. Learn to accept uncertainty about your health. Revel in not knowing when or how the end will come. Focus instead on the time between now and then.

Ultimately, what you have to decide is which epitaph you would prefer when your inevitable end arrives: "lived decades in misery and fear of death", or "didn't see that coming but my life was far richer for it."

For more information about how to manage health anxiety, see the Helping Health Anxiety modules here.

The Conversation

Peter McEvoy is Associate Professor of Clinical Psychology at Curtin University. He does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

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