During a pandemic, it's normal to be vigilant about your health. But what's the difference between a healthy level of caution and anxious preoccupation? Mental health experts weigh in.

By Julia Malacoff
August 18, 2020
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Does every sniffle, throat tickle, or headache twinge make you nervous, or send you straight to "Dr. Google" to check your symptoms? Particularly in the coronavirus (COVID-19) era, it's understandable—maybe even smart—to be concerned about your health and any new symptoms you're experiencing.

But for people dealing with health anxiety, sheer worrying about getting sick can become such a major preoccupation that it starts to interfere with daily life. But how can you tell the difference between helpful health vigilance and straight-up anxiety about your health? Answers, ahead.

What is health anxiety?

As it turns out, "health anxiety" isn't a formal diagnosis. It's more of a casual term used by both therapists and the general public to refer to anxiety about your health. "Health anxiety is most widely used today to describe someone who has intrusive negative thoughts about their physical health," says Alison Seponara, M.S., L.P.C., a licensed psychotherapist who specializes in anxiety.

The official diagnosis that most closely fits with health anxiety is called illness anxiety disorder, which is characterized by fear and worry about uncomfortable physical sensations, and being preoccupied with having or getting a serious disease, explains Seponara. "The individual may also worry that minor symptoms or body sensations mean that they have a serious illness," she says.

For instance, you might worry that every headache is a brain tumor. Or perhaps more relevant to today's times, you might worry that every sore throat or stomachache is a possible sign of COVID-19. In severe cases of health anxiety, having exaggerated anxiety about real physical symptoms is known as somatic symptom disorder. (Related: How My Lifelong Anxiety Has Actually Helped Me Deal with the Coronavirus Panic)

What's worse is that all this anxiety can cause physical symptoms. "Common symptoms of anxiety include a racing heart, tightness in the chest, stomach distress, headaches, and jitters, just to name a few," says Ken Goodman, L.C.S.W., creator of The Anxiety Solution Series and board member for the Anxiety and Depression Association of America (ADAA). "These symptoms are easily misinterpreted as symptoms of dangerous medical illnesses like heart disease, stomach cancer, brain cancer, and ALS." (See: How Your Emotions Are Messing with Your Gut)

BTW, you might be thinking that all of this sounds similar to hypochondriasis—or hypochondria. Experts say this is an outdated diagnosis, not only because hypochondria is heavily associated with a negative stigma, but also because it never quite validated the real symptoms that people with health anxiety experience, nor did it provide guidance on how to address those symptoms. Instead, hypochondria often leaned on the premise that people with health anxiety have "unexplained" symptoms, implying that the symptoms aren't real or can't be treated. As a result, hypochondria is no longer in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, which is what psychologists and therapists use to make diagnoses.

health anxiety

How common is health anxiety?

It's estimated that illness anxiety disorder affects between 1.3 percent to 10 percent of the general population, with men and women affected equally, says Seponara.

But anxiety about your health can also be a symptom of generalized anxiety disorder, notes Lynn F. Bufka, Ph.D., senior director of practice transformation and quality at the American Psychological Association. And data shows that, amid the COVID-19 pandemic, anxiety overall is on the rise—like, really on the rise.

Data collected by The Centers for Disease Control and Prevention (CDC) in 2019 showed that approximately 8 percent of the U.S. population reported symptoms of anxiety disorders. As for 2020? Data collected from April to July 2020 indicates those numbers have jumped to more than 30 (!) percent. (Related: How the Coronavirus Pandemic Can Exacerbate Symptoms of Obsessive-Compulsive Disorder)

Bufka says it makes sense that people are having more anxiety right now, particularly about their health. "Right now with coronavirus, we've got a lot of inconsistent information," she says. "So you're trying to figure out, what information do I believe? Can I trust what government officials are saying or not? That's a lot for one person, and it sets the stage for stress and anxiety." Add to that an illness that's highly transmissible with vague symptoms that can also be caused by a cold, allergies, or even stress, and it's easy to see why people are going to be very focused on what their bodies are experiencing, explains Bufka.

Reopening efforts are also complicating things. "There are many more clients reaching out to me for therapy since we started opening up stores and restaurants again," says Seponara. "There are individuals I see who can't seem to get rid of the constant intrusive thinking about getting this virus, who believe that if they do get it, they will die. That is where the true internal fear comes from these days."

How do you know if you have health anxiety?

It can be tricky to figure out the difference between advocating for your health and health anxiety.

According to Seponara, some signs of health anxiety that need to be addressed include:

  • Using "Dr. Google" (and only "Dr. Google") as a reference when you don't feel well (FYI: New research suggests "Dr. Google" is almost always wrong!)
  • Excessive preoccupation with having or getting a serious disease
  • Repeatedly checking your body for signs of illness or disease (for instance, checking for lumps or body changes not just regularly, but compulsively, perhaps multiple times a day)
  • Avoiding people, places, or activities for fear of health risks (which, BTW, does make some sense in a pandemic—more on that below)
  • Worrying excessively that minor symptoms or body sensations mean you have a serious illness
  • Worrying excessively that you have a specific medical condition sheerly because it runs in your family (that said, genetic testing can still be a valid precaution to take)
  • Frequently making medical appointments for reassurance or avoiding medical care for fear of being diagnosed with a serious illness

Of course, some of these behaviors—such as avoiding people, places, and activities that may pose health risks—are totally reasonable during a pandemic. But there are key differences between normal, healthy caution about your well-being and having an anxiety disorder. Here's what to watch out for.

It's affecting your life.

"The tell-tale sign with any anxiety disorder, or any other mental health disorder, is whether what's happening is affecting other areas of your life," explains Seponara. So for example: Are you sleeping? Eating? Can you get work done? Are your relationships being affected? Are you experiencing frequent panic attacks? If other areas of your life are being affected, your worries may go beyond normal health vigilance.

You seriously struggle with uncertainty.

Ask yourself: How well do I do with uncertainty in general? Especially with anxiety around getting or having COVID-19, things can get a little tricky because even a COVID-19 test only gives you information about whether you have the virus in a particular moment in time. So ultimately, getting tested may not provide much reassurance. If that uncertainty feels like too much to handle, it might be a sign that anxiety is an issue, says Bufka. (Related: How to Cope with COVID-19 Stress When You Can't Stay Home)

Your symptoms crop up when you're stressed.

Because anxiety can cause physical symptoms, it can be hard to tell if you're sick or stressed. Bufka recommends looking for patterns. "Do your symptoms tend to go away if you get off the computer, stop paying attention to the news, or go do something fun? Then those may be more of a sign of stress than an illness."

What to Do If You Think You Might Have Health Anxiety

If you're recognizing yourself in the above signs of health anxiety, the good news is there are a ton of different options for getting help and feeling better.

Consider therapy.

Just like with other mental health issues, there is, unfortunately, some stigma around needing help for health anxiety. Similar to how people may carelessly say, "I'm such a neat freak, I'm so OCD!" people may also say things like, "Ugh, I'm totally a hypochondriac." (See: Why You Should Stop Saying You Have Anxiety If You Really Don't)

These types of statements might make it harder for people with health anxiety to seek treatment, says Seponara. "We have come so far in the past 20 years, but I can't tell you how many clients I see in my practice that still feel so much shame for having to 'need therapy,'" she explains. "The truth is, therapy is one of the most courageous acts you can make for yourself."

Therapy of any kind can help, but research shows cognitive behavioral therapy (CBT) is particularly effective for anxiety, adds Seponara. Plus, even if you are dealing with some real physical health issues that need to be addressed, mental health care is always a good idea regardless, notes Bufka. "When our mental health is good, our physical health is better as well." (Here's how to find the best therapist for you.)

If you don't already have one, find a primary care doctor you trust.

We often hear stories about people who've pushed back against doctors who dismissed them, who advocated for their health when they knew something was wrong. When it comes to health anxiety, it can be hard to figure out when to advocate for yourself, and when to feel reassured by a doctor saying everything's fine.

"We're in a better place to advocate for ourselves when we have an ongoing relationship with a primary care provider who knows us and is able to say what's typical for us, and what's not," says Bufka. "It's hard when you're seeing somebody for the first time." (Here are a few tips on how to get the most out of your doctor's visit.)

Incorporate mindful practices.

Whether it's yoga, meditation, Tai Chi, breathwork, or walking in nature, doing anything that helps you get into a calm, mindful state can help with anxiety in general, says Seponara. "A lot of research has also shown that living a more mindful life helps create a less hyperactive state in your mind and body," she adds.

Exercise.

There are so many mental health benefits to exercise. But particularly for those with health anxiety, exercise can help people understand how their bodies change throughout the day, says Bufka. That might make some of the physical symptoms of anxiety less unsettling.

"You might suddenly feel your heart racing and think something's wrong with you, having forgotten you just raced up the stairs to answer the phone or because the baby was crying," explains Bufka. "Exercise helps to get people more in tune with what their body does." (Related: Here's How Working Out Can Make You More Resilient to Stress)

And here are some suggestions specific to managing COVID-related health anxiety:

Limit social media and news time.

"The number one step to take is to schedule a time every day that you allow yourself to watch or read the news for 30 minutes max," suggests Seponara. She also recommends setting similar boundaries with social media, since there's a lot of news and COVID-related info on there, too. "Turn off electronics, notifications, and the TV. Believe me, you will get all the info you need in those 30 minutes." (Related: How Celebrity Social Media Affects Your Mental Health and Body Image)

Maintain a solid foundation of healthy habits.

Spending more time at home because of lockdowns has seriously messed with everyone's schedules. But Bufka says there's a core group of practices most people need for good mental health: good sleep, regular physical activity, adequate hydration, good nutrition, and social connection (even if it's virtual). Check-in with yourself and see how you're managing with these basic health needs. If necessary, prioritize any that you're currently missing. (And don't forget that quarantine can potentially impact your mental health for the better.)

Try to keep things in perspective.

It's normal to be afraid of getting COVID-19. But beyond taking reasonable measures to avoid getting it, worrying about what might happen if you do get it won't help. Truth is, being diagnosed with COVID-19 does not automatically mean a death sentence, notes Seponara. "That doesn't mean we shouldn't take proper precautions, but we cannot live our lives in fear."