Health anxiety continues to rise
In the aftermath of a global pandemic, an increase in medically-related anxiety is to be expected. But hypochondria, now known by the less stigmatizing term of “health anxiety,” has been increasing over the past three decades.
Hypochondria was first recognized by the Ancient Greeks, when the disorder was thought to originate in a part of the body below the rib cage. Identified as a mental health condition in the early 20th century, the diagnosis of hypochondriasis was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The term was replaced in 2013 in the DSM-5 with two diagnoses: illness anxiety disorder and somatic symptom disorder.
“The difference between the two is in the extent of somatic symptoms that are being reported,” said Sarah Feigon, Ph.D., a licensed clinical psychologist with Cambridge Psychology Group who specializes in anxiety disorders and OCD.
“In illness anxiety disorder, the person is worried about illness, but they have no or mild somatic symptoms. With somatic symptom disorder, they also are worried that they have an illness, but they have moderate to severe symptoms.”
According to studies, rates of health anxiety are both underreported and increasing. Health anxiety has been diagnosed in close to 5% of people, although experts believe actual rates are 12% or higher.
Studies have shown an increase from 8.67% to 15.22% in college students over the past 30 years as well as a 25% increase in health anxiety during the peak years of the pandemic.
The advent of home-based internet, an increase in health news reporting, and the removal of restrictions against pharmaceutical advertising all dovetail with the rise in diagnoses, Feigon pointed out.
A new term, cyberchondria, has been coined to identify those who spend countless hours searching the internet for health information to confirm their own fears.
“People have become much more informed consumers of healthcare and if you have a predisposition to illness anxiety disorder, and you’re seeing so much more about illnesses, that would then contribute,” she said.
Unlike generalized anxiety, which is more prevalent in women, health anxiety affects both sexes equally. There is some heritability noted from twin studies but, in general, experts blame environmental factors, said Feigon.
“Certainly, traumatic experiences with a parent or caregiver being ill or dying, or personal illness or modeling by parents who are anxious about a child’s health may all contribute,” she said.
With a rise in rates, and the belief that many cases go undiagnosed, there is concern that many who suffer are under treated, which can lead to increased medical costs, an overburdened health care system and societal impacts of work absenteeism or unemployability.
“But the main risk really is the suffering,” said Feigon. “The person is very distressed in an ongoing fashion. It’s a quality-of-life issue.”
For therapists, Feigon stressed the importance of treating the maladaptive behaviors along with the fears. Things like internet searches, constantly checking their bodies, or checking vitals signs with a fitness tracker, pulse oximeter or blood pressure cuff should be addressed.
“You might see one part of the picture, the illness worries, but there likely are subtle, or not so subtle, behaviors that need to be addressed in order for a person to get better,” she said.
Treatment for health anxiety includes CBT, education, cognitive restructuring, stress management, and exposure therapy to learn to tolerate uncomfortable thoughts or symptoms rather than continually checking on them.
“There’s an analogy that has been used that anxiety is like an undigested meal you keep burping up,” said Feigon, “and in order to digest it, you have to process it and face it head on.”
“It’s important to help a person live with the uncertainty.”