Health anxiety can be all-consuming. Accepting uncertainty is an important step

In an era where a world of information is just a few clicks away, health anxiety has taken on a new dimension. Many of us have experienced moments of worry when seemingly innocuous symptoms trigger thoughts of dire health conditions. Could that persistent headache be a sign of a brain tumour rather than just a consequence of too many late nights? Is that peculiar skin lump a harbinger of melanoma? A quick Google search often exacerbates these worries, leaving us awash in a sea of potential ailments. Fortunately, for most, these fears dissipate once the headache subsides or a reassuring word from a trusted GP alleviates concerns.

In the wake of a devastating global pandemic, there is naturally a greater concern for the health of ourselves and those around us. But for those grappling with health anxiety, this concern is not so easily overcome by rationalising or reassurance. Their fears persist and intensify, and their worry about health is frequent, severe and resistant to the soothing words of medical professionals. Temporary relief is short-lived, as fears and doubts quickly resurface or latch on to a new symptom. Their ceaseless preoccupation with health obstructs their ability to relax and savour life, compelling them to seek perpetual and expensive medical consultations, procedures and tests.

This condition used to be called hypochondriasis and it was often met with derision and misconceptions that it stemmed from attention-seeking or malingering. As our understanding of the condition has deepened, we have become more aware of the profound distress experienced by those afflicted and the incapacitating anxiety underlying their health concerns. The latest version of the Diagnostic and Statistical Manual has also replaced hypochondriasis with two related disorders: illness anxiety disorder and somatic symptom disorder.

In illness anxiety disorder, individuals harbour an overwhelming fear of contracting a severe, potentially lifethreatening illness, even in the absence of any significant symptoms. For instance, in the wake of the pandemic a small percentage of the population are so afraid of getting Covid that they can’t function normally. They remain housebound, compulsively sanitise and order everything online. In contrast, those grappling with somatic symptom disorder do manifest subjectively experienced symptoms, such as back pain, breathlessness or heart palpitations, which support their belief that they have a grave illness. However, there is an excessive focus on these symptoms and a catastrophising of their meaning. Instead of attributing their real back pain to tension or their palpitations to panic, they are convinced of sinister ailments like tumours or impending heart attacks. This having been said, the first port of call is of course always to rule out a physical cause before assuming a psychological condition.

Ironically, in a cruel twist of fate, health anxiety fuels itself through the physiological symptoms of anxiety, attentional bias and the nocebo effect. When confronted with fear, the body’s natural response is to trigger the fightor-flight reaction, eliciting a wide array of somatic symptoms, such as elevated heart rate, shortness of breath, chest pain, sweating, nausea, diarrhoea and dizziness. These somatic responses reinforce the belief that something is seriously amiss, exacerbating anxiety and creating a feedback loop. Furthermore, once we fixate on a symptom, we develop an attentional bias,