Health anxiety is, simply, a condition in which certain individuals (“health worriers”)

worry too much about their health. They include patients who cross a number of
theoretical and diagnostic categories, including generalized anxiety
disorder, obsessive-compulsive disorder, and depression; but also, especially,
somatization disorder—a condition in which anxious people present with physical
symptoms, such as stomach ache, headache and palpitations—and
hypochondriasis—a condition marked by the individual’s inclination to respond to
physical symptoms by imagining the worst possible illness. The worst possible
illnesses are those that might lurk silently but nevertheless, have the potential to kill.
They include cancers of various sorts, particularly brain and pancreatic cancers,
heart disease, degenerative neurological conditions, such as multiple sclerosis, brain
aneurysms, and A.I.D.S. Health anxiety is a common condition that leads to
considerable distress and over-utilization of medical services, including laboratory
tests and procedures that are likely in the long run to worsen this psychological
condition.

Doctors are well-aware of these unhappy persons. They see them every day. Some
doctors are likely to be dismissive of their complaints, since their symptoms plainly
do not reflect a medical disorder. They speak of such patients derisively as “crocks.”
Most doctors, however, are sympathetic. They respond endlessly to the same
questions in a vain attempt to reassure their patients. Then they typically do two
things that are well-meaning, but likely to aggravate their distress:

1. They tell their patients to avoid looking at the drug insets they receive with
medications that have been prescribed for them, since reading about potential
side-effects makes them more afraid. And, indeed, that is what happens. For
similar reasons they tell them to stay off the internet and stop reading about the
illnesses they are afraid they may have. These practices are antithetical to the
proper treatment of health anxiety because they discourage the patients from
confronting their fears. All irrational fears will be ameliorated in the end by
confronting them. And that is the essence of treatment. Patients get upset
when they learn a little about things they fear. When they learn more, they lose
that fear. Since patients know very well that they get more upset—initially—
when they read about their feared illness, it is hard to get them to so, and
harder still when their physicians make them hesitate more. (Naturally,
physicians have the obligation to correct any misconceptions and half-truths
their patients pick up from the internet or from any other place.)
2. Physicians agree to do special tests and procedures in order, once and for all,
to prove to their patients that they do not have one or another disease. This is a
bad practice. Health worriers can no more be reassured by tests or further
examinations than a patient with OCD who checks the front door over and over
again to see if is locked is reassured by checking it just one more time. In fact,
checking makes the underlying fear worse. It reminds the patient of the
possibility of the feared condition really being present. Besides, laboratory tests
and procedures are inherently ambiguous. The health worrier is likely to seize
on some result just barely out of the normal range and worry still more. One
ambiguous laboratory result is likely to lead to further tests and further
concerns.
Physician need to acknowledge to their patients that these worries reflect an
emotional problem which requires particular treatments of an emotional sort.

The therapy program for health anxiety instituted at the White Plains Anxiety
and PhobiaCenter revolves about six principles. The patients are instructed:

1.

A. Learn the truth about yourself—the particular physical symptoms you

characteristically develop, over and over again, in the face of stress. For example,
fatigue, back pain, panic attacks, palpitations, etc. These accustomed complaints are
not likely to reflect some new physical disorder.

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B. You need to learn about the illnesses you fear. Knowing a little is scary. Knowing
a lot is reassuring.

2. Confront your fears. Thinking the unthinkable diminishes fear. (This is an allusion
to the “Nightmare Fantasy” in which patients are asked to imagine, in detail, the
worst case scenario of their fears. It is possible to desensitize to a fear of illness and
death by fantasizing.)

3. Avoid checking and the search for empty reassurance. (Patients are not allowed
to ask the same question twice.)

4. Think of the odds against being desperately ill rather than the stakes. (“Wouldn’t it
be awful if I died suddenly from a ruptured aneurysm?” “Yes, but what are the
chances of that happening?”)

5. Do not seek absolute certainty or safety.

6. Live in a healthy way. (Including principles of eating properly and exercising.)

These summarize to certain “dos” and “don’ts”

Things to do

1. Research diseases.
2. Construct and dwell on the Nightmare
3. (at the prescribed time)
4. Exercise.
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Things to avoid doing

 1. Do not examine yourself.
2. Do not ask M.D. s for reassurance
3. Do not ask your doctor to do tests or prescribe drugs he does not think to do
on his own initiative.
These principles and practices are elaborated on in detail in “Worried Sick?” which is
a description of this program.(c) Fredric Neuman Follow Dr. Neuman's blog
atfredricneumanmd.com/blog