We are all dying. One of the cruel realities of being human is our capacity for introspection and our awareness that each and every one of us will be gone one day. Although health misfortunes and accidents may occur, many of us hope and imagine the end of our lives will occur somewhere in the very distant future as elderly people warm in our beds. The future holds a lot of unknowns, and the ‘how,’ ‘what,’ and ‘when’ of disease and death is no exception.
This uncertainty is present for everyone, but no group feels the weight of these question marks as intensely as those suffering with illness anxiety disorder and obsessive-compulsive disorder (OCD). Have you feared having a variety of diseases and ailments just because you saw it on the news, your friend mentioned it or your brain had a thought about it? You may be experiencing illness anxiety disorder, obsessive-compulsive disorder (OCD), or both.
Illness anxiety disorder is an OC spectrum disorder, meaning it is characterized by obsessions and compulsions. It replaces the former and more pejorative diagnosis, hypochondriasis, in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V). When an individual is experiencing excessive fear of having an undiagnosed disease or the fear of getting a disease in the future, illness anxiety disorder will be diagnosed. For an OCD diagnosis, an individual would also have to be experiencing obsessions and compulsions unrelated to health and / or fears that one can spread or catch a disease such as HIV, resulting in washing, avoidance or other rituals.
In the movie, “Up in the Air,” George Clooney was on an airplane on a business trip. To his dismay, the flight attendant serving him a soda asked, “Would you like the can sir (cancer)?” When you have heath anxiety, there is a constant bombardment of reminders that you may be unaware of a fatal disease growing in your body. A sufferer reading a diabetes pamphlet to pass the time at the pharmacy may discover her first name was used as the example dialysis patient. Watching a movie about a terminal disease or hearing about your co-worker’s neighbor’s brain cancer diagnosis may send you into panicked research and analysis of your own health.
Our bodies are always changing. Millions of your cells will die within the next second and will be replaced with new cells. We all periodically experience sensation, discoloration, aches, pains, fatigue, itching, numbness, swelling and other weird bodily stuff. Most of what we experience in our bodies isn’t attributed to something serious that needs our attention paid to it. In addition, focused attention often creates sensation. We’ve all had the experience of a friend telling us about his itchy rash or bed bug problem and we find ourselves scratching by the end of the story. Most of us are able to allow our bodily systems to run without micromanaging them. We can trust that our body knows how to do its thing and paying attention to it will not prolong our lives or prevent the inevitable.
So how do you know when something is serious and needs to be given medical attention? Treating illness anxiety disorder and OCD doesn’t mean neglecting your health. I instruct my clients to ask their medical doctor the recommendations for various health check-ups. Depending on your age this may mean having an annual physical, mammogram, or colonoscopy. In addition, ask your doctor what home checks are to be performed and do not exceed that recommendation. For example, it is often recommended that a self-breast exam should be performed once per month, where a woman with health anxiety may find herself compelled to check during her daily shower just to be certain.
You may be having intrusive thoughts shouting, “If you check again you will find it early enough and then you won’t die! If you don’t check you are an irresponsible person who will leave your children to fend for themselves on this earth alone!” These are the common manipulations of illness anxiety disorder and OCD. There is no need to do extra checks to be sure. The only thing you are making sure of with excessive checking is that your health anxiety will get worse and you will believe your health is more vulnerable than it actually is. Avoidance is another compulsive response to health anxiety and some sufferers may avoid medical care for fear of discovering a health problem.
Treatment for Health Anxiety
The treatment for OCD and illness anxiety disorder is a type of Cognitive-Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP). Just hearing the words breast exam, lump, cancer, and testicular exam may cause an increase in your anxiety level. Your brain in programmed genetically and has also learned to respond to these types of scary health words with fear, anxiety and doubt. It’s not even real disease that gets your brain triggered; it’s thoughts about disease, written words about disease, and disease imagery. This isn’t real disease.
In ERP, we have clients do exposures to scary health thoughts that normally bring up anxiety spikes. Exposure work can be helpful so that when you hear these buzz words or the bad health stories of others in your everyday life, the brain will be less reactive to them. Along with the exposure, we encourage the client to avoid doing any compulsions (rituals) that sends messages to the brain that the thought, image or idea was important.
Example of ERP:
Exposure – A cancer-fearing client writes the words lung cancer, breast cancer, brain cancer, metastatic, melanoma, stage 4, inoperable, untreatable
Response Prevention – Client resists urges to check skin for mole changes, avoids Internet disease searches (a.k.a. cyberchondria), avoids asking family, friends or doctors for reassurance, avoids mental rituals (e.g. self-reassurance, mental scan of body for signs of illness)
With the use of ERP, intentionally bringing up anxiety-producing thoughts repeatedly without doing the neutralizing rituals, the brains response to obsessions is reconfigured. Eventually, the person with health fears will be more confident in his or her ability experience intrusive health thoughts without responding with rituals that feed the problem. Over time, one will habituate to health thoughts and they often decrease in intensity, frequency and severity. Health concerns will no longer feel so urgent or the main focus of existence.
Throughout the process of ERP, it is also helpful to learn adjunct Cognitive-Behavioral Therapies which helps the sufferer to experience the difficult thoughts and feelings that arise when he or she is no longer performing certainty-seeking rituals.
A mindfulness-based therapy called “Acceptance and Commitment Therapy” teaches a person to observe and accept the thoughts and feelings that are occurring in the moment without making efforts to control it. Having willingness to have uncomfortable thoughts about health and being open to experiencing anxiety and uncertainty will create a more agreeable relationship with the current moment. This lack of struggle with thoughts and feelings will also help the sufferer to stay with discomfort and therefore prevent rituals that feed and maintain health obsessions.
Traditional cognitive therapy is useful to point out the way illness anxiety disorder and OCD will distort thoughts in regards to health. For example, three common cognitive distortions in health anxiety are ‘all or nothing thinking,’ ‘catastrophizing,’ and ‘thought-action fusion.’
Distorted thought – “I have a pain in my leg. What if it is a blood clot that goes to my brain and kills me?”
Alternative thought – “This is all or nothing thinking. There are more than two options here besides ‘no leg pain’ = ‘long life’ and ‘leg pain’ = ‘death.’ The gray area, and most likely scenario, is that I pulled a muscle today riding my bike. If I’m not catastrophizing I am considering other more likely outcomes than the storyline my health anxiety feeds me. In addition, just because I have a thought about a blood clot, doesn’t mean there is a blood clot. This would be thought-action fusion.”
Nobody is 100% certain about what is happening in their bodies at every moment. Even the doctor you get your reassurance from doesn’t know what is happening in his or her own body all the time! When you walk out of the office after the clear mammogram, a cancer cell can sprout up. Stop listening to the OCD message that you can know for certain that we are disease-free because nobody has that level of certainty. But uncertainty doesn’t mean your health fear is true. Reminding yourself to experience uncertainty is one of your best tools in quieting down your health anxiety.
But also remember, your health is not as vulnerable as your OCD leads you to believe. We are pretty resilient creatures. Even though you feel like you are about to fall off the edge of a cliff most of the time, doesn’t mean you are. This is the faulty brain messaging that makes you feel that you need to know for sure that leads to compulsions. Take the risks that everyone who inhabits a body must take. Label the unwanted health thoughts OCD and refuse to seek certainty. It will feel very dangerous at first, but through time your health will stop feeling so critical. Return your focus from saving your life to actually living it.