Hi, I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Health anxiety is a term that combines two disorders
from the DSM-5.
Somatic symptom disorder and illness anxiety disorder.
Previous versions of the DSM called it hypochondriasis.
And from this term came
the pejorative label, hypochondriac.
People with health anxiety obsess over bodily functions,
like breathing or their heartbeat or physical imperfections
like skin blemishes or physical complaints like headaches
and stomach aches and lightheadedness.
When you have health anxiety,
you catastrophize even minor things.
For example, you may take feeling queasy
after two meals in a row to mean
that you're exhibiting early signs of stomach cancer.
Another way this can look is by overreacting
to any body sensations.
You can fixate on sensations and then analyze them
so that you can assign the sensation to an illness.
You don't appreciate that if you have heart palpitations,
which is feeling your heartbeat in your chest,
that sensation can be because you're anxious.
Instead, in your mind,
it must be because of a physical illness
and a serious one at that.
Then you go get a medical workup
and when that shows no clear signs
or physical reason for your symptoms,
you start to believe that the doctors missed something,
leading you to seek second and third opinions.
People with health anxiety often see multiple doctors
and get many unnecessary medical tests
feeling that the medical establishment
isn't taking their concerns seriously.
With health anxiety, you develop false beliefs
about your symptoms and the medical system at large.
Here are six examples of misconceptions
people with health anxiety have.
Number one, my physical anxiety symptoms
will escalate to something that kills me in my sleep.
So, even if you come to terms with the idea
that your dizziness and chest tightness is anxiety
and not heart disease,
you still believe anxiety symptoms can get so bad
that they do permanent damage or kill you.
Number two, normal medical test results
means that my illness is undetectable.
You are not reassured by normal tests.
It just means that the doctors can't see it or find it
because the tests aren't sensitive enough.
Number three, even if my exam is normal today,
the disease could still materialize tomorrow.
This is an extension of the idea
that negative test results means that someone is missing it
or that your illness
is just festering in your body undetected.
Number four, doctors can't know what's wrong
without running all available tests.
If you go see a doctor and they don't run tests,
you don't trust them
or think that aren't taking you seriously
because the only way to diagnose an illness
is to do some kind of test, which is not true by the way.
Some disorders have obvious physical signs
associated with them that can be seen
by doing a physical exam.
Some people refer to these signs as clinical stigmata.
Number five, I continuously check for new symptoms
so I will know when the illness is getting worse.
This is called body surveillance.
You see yourself as the only one you can trust
to keep up with the progression of the illness
that you believe you have.
So you need to stay alert to catch a new sign
or pick up on the worsening of the current symptom.
When your symptoms seem like they are worsening,
you won't hesitate to go back to the doctor
and hopefully get more tests.
Number six, the more I learn about the illness,
the better I will be at helping the doctors find the cause.
This is the misconception
that keeps you researching and Googling your symptoms.
You know doctors are busy
and because you believe they may be missing something,
you see it as vital to learn as much as you can
to help your doctors figure it out.
How do you develop these misconceptions?
People with health anxiety have a conditioned response
to their physical symptoms.
You come to associate feeling anxious
with physical sensations and conclude
that all physical sensations are dangerous
and represent hidden signs of catastrophic disease.
Researching your illness, seeking reassurance,
and body surveillance
all reinforce the conditioned response.
What can you do about this?
Usually people with health anxiety
don't seek mental health treatment
because they don't believe their problems are mental.
You only see a therapist or psychiatrist
as a late stage intervention
after your doctor treating the physical symptoms
has reached a dead end.
One effective therapy intervention
is interoceptive exposure.
Interoception is a term
that means awareness of your internal body state.
When you have physical symptoms with your anxiety,
you can become hyper-aware of every body sensation
that you associate with feeling anxious.
This association is the conditioning response.
The physical sensations trigger more anxiety
and when you experience these sensations,
you become conditioned to associate them
with a fearful state and your anxiety can spiral.
Interoceptive exposure is a type of exposure exercise
where you intentionally provoke a physical sensation
and tolerate the distress the sensation causes.
With this activity, you disprove your false beliefs
about the catastrophic consequences that you expected
by tolerating the distress.
You also desensitize yourself to the extreme reactions
to the body sensations.
For example, dizziness is a bothersome experience,
but if you desensitize yourself to it through exposure,
you learn to see it as a nuisance
and not assume it's a precursor to something more dangerous.
To practice interoceptive exposure,
you identify the body sensations you find most problematic.
Here are some questions to help you identify the sensations.
What physical sensations make you believe
you have a severe condition?
What physical sensations signal
that you're getting ready to have an attack of panic?
What sensations are you afraid to experience
because you fear they will lead
to a more considerable negative consequence?
Once you have your list of sensations,
group them by body system or types of sensations.
For example, if we use the symptom of dizziness,
you would attach it to the head body system.
Palpitations would be paired with the heart system.
Then you choose an activity
that triggers the sensation that you fear.
If you're trying to provoke dizziness,
you could spin in a swivel chair for one minute
or spin while standing for 30 seconds.
After you perform the activity, notice how you feel.
Write down what you noticed in your body
and write down what thoughts went through your mind
during the activity.
If you keep doing this,
you can get to where you are less fearful
of experiencing dizziness and break the conditioned response
of believing dizziness is a sign of serious illness.
This is a simple example of interoceptive exposure.
There are many exercises you can do
to intentionally trigger the symptoms or body sensations
that make you anxious
and make you think that you have a serious illness.
The exercises are not dangerous for people
who do not have serious medical conditions,
but if you have a health condition
that may be aggravated by these kinds of activities,
check with your doctor about your ability to engage in them.
I have a section of my book, "Why Am I So Anxious?"
that goes into more detail on interoceptive exposure
and an appendix that gives you a list of exercises
to trigger sensations for different body symptoms.
It's available for pre-order at GetYourPreorder.com.
If you pre-order it before August 16th,
you get a bonus guide with additional information,
including charts and tables.
If you're watching this video after August 16th,
you can order the book from Amazon as a hard cover,
ebook or audio book.
Check out this video right here for more on health anxiety.
Thanks for watching, see you next time.