Much ado about nothing often leads to something

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Mind and Body

Much ado about nothing often leads to something
Health anxiety is a very real – and treatable – condition

By JOY VICTORY
The Journal News

Ignoring the smog warnings, Chuck Miller decided to take a morning jog while on a business trip in Los Angeles almost 10 years ago. Before long, he was sweating profusely and his heart was racing. Miller (not his real name) made it back to the hotel lobby, but after that, his memory blurs. In the next few hours, he somehow left the hotel, passed out on a sidewalk and woke to find paramedics standing over him, insisting he needed to go to the hospital.

He refused their care, and rather than find out what was wrong, he flew home. But although he wanted nothing more than to put the scary brush with death behind him, he instead became obsessed with it. Any little reminder of the event would cause a panic attack.

“Heat, stress, anxiety would bring it on. I would think it’s a heart attack,” says Miller, who lives in Eastchester. “I had practiced martial arts all my life. I knew I was in pretty good shape. Still, if I had to catch the 8 o’clock train, at 9 a.m. I would still be sitting on the platform. I would think, ‘I’ll probably have a heart attack somewhere between here and 125th street.’ “

This went on for months, until his wife gave a second glance to a mailing from White Plains Hospital Center about a new program that treated something called health anxiety. Miller read it and saw himself.

“I talked to them and they said, ‘Boy, you’re the classic person with health anxiety,’ ” he says.

Dr. Frederic Neuman of the Anxiety and Phobia Center at White Plains Hospital Center, who essentially coined the term, defines it as “an exaggerated fear of illness, this fear being an outgrowth of a set of mistaken ideas about the nature of physical illness, including its diagnosis and treatment.”

It’s similar to the better-known clinical diagnoses of hypochondria and somatization disorder (frequent unfounded complaints of physical symptoms). But, Neuman says, health anxiety takes into account the frequent worrying and fear of death that the other two diagnoses leave out.

Although there are no statistics on people suffering from health anxiety, it is well-known that all forms of anxiety have spiked in recent years. Therapists like Christine Ratto Ziegler of Nyack report seeing more patients who are extremely worried about their health.

Some speculate that increased medical reports may be to blame. For example, despite its low risk to New Yorkers, SARS (severe acute respiratory syndrome) was covered substantially by local media outlets. Others say the attacks of Sept. 11, 2001, triggered all sorts of anxiety-based ailments in otherwise normal people.

At any rate, health anxiety is a poorly understood and rarely researched disease, in spite of its prevalence: Anywhere from 1 to 3 percent of people receiving outpatient medical care in the United States suffer from health anxiety or hypochondria, according to limited studies on the disease.

It’s not helpful that health anxiety, for the most part, has not been taken seriously by medical professionals or by society in general. Neuman points out that the stereotype of a hypochondriac, like a Woody Allen character, is intended to make people laugh, even though sufferers often risk losing their jobs and alienating their families and friends.

Neuman says it’s quite normal for people to worry excessively about their own health when a loved one has died, or, for example, after a famous person such as John Ritter dies without warning. It’s the prolonged, obsessive worrying that sets health anxiety apart.

Many health worriers can trace their problems back to childhood, says Ratto Ziegler, who directs the Hudson Valley Center for Cognitive Therapy in Nyack. For example, if a parent worries incessantly about a child’s health, the child may grow up worried about small illnesses like colds, or harmless but unexplained changes in the body.

“They grow up in this environment of ‘Watch out!’ ” says Ratto Ziegler. “That’s how they learn — life is dangerous until proven safe.”

Neuman details a childhood similar to this in his book “Worried Sick: The Exaggerated Fear of Physical Illness.” Neuman was not allowed to walk too closely to the street, to swim in anything bigger than a bathtub, to roller-skate or ride a bike, or even to eat a hot dog at a baseball game.

Not surprisingly, the excessive worrying by his parents led him to overanalyze illnesses or bodily functions. For instance, he would check, and double check, marks on his skin, looking for anything abnormal.

Neuman eventually got over his anxiety by researching the illnesses he thought he had, a technique he also recommends to patients. But his struggles with health anxiety helped him pick a career: He became a psychiatrist who specializes in treating phobias and anxieties.

“Sooner or later,” Neuman writes, “health worriers come to understand that, however they manage to appear to others, they do worry more than they should.”

That’s the case for another of Neuman’s patients, Lisa Abelson of Merrick, Long Island. She was tired of fearing everything around her.

“I was distracted and unhappy,” Abelson says. “If you looked at me, you couldn’t tell or understand that there was something wrong with me. But I think my mind was preoccupied a lot with things I didn’t want to be thinking about.”

Abelson’s obsession was with the threat of disease, particularly any ailment making headlines, such as skin cancer or Lyme disease.

“I was worried about everything,” she says. “Everything. A cough is lung cancer, a headache is a brain tumor.”

Both Neuman and Ratto Ziegler prescribe a combination of cognitive therapy, education, journal-keeping, exposure therapy and role-playing to help health worriers overcome their fears and get back to a normal life. Antidepressants are thought to be effective, too, but health worriers often have a fear of medication and won’t take pills.

Neuman first directed Abelson to use her “nightmare fantasy,” or her very worst health fears.

“You take your worst-case scenario and take it to the end,” Abelson says. For her, it was hearing the doctor say she had cancer. She ran the scene many times, finally realizing that it wasn’t cancer she feared so much as the loss of control that illness can bring.

“I really needed to learn the things that most people take for granted: How to live with ambiguity and doubt,” Abelson says. “People who don’t have health anxiety, and the doctor says ‘Everything looks pretty good,’ can take that for an answer.”

Chuck Miller, constantly fearful of dropping dead from a heart attack, heeded Neuman’s advice and took notes whenever he thought he had warning signs. Some days he might feel symptoms several times; other days he might notice anything at all.

On rough days, Neuman instructed Miller to hold the notes in his pocket until the end of the day, when he was finally permitted to read them and analyze them. He started to realize he could hold off his worry most of the day, and “after six months of writing the symptoms down, you start to realize nothing happens.”

Ratto Ziegler, who mainly uses cognitive therapy, says her patients often suffer from health anxiety for years before they seek treatment from a mental-health specialist, even though they may have been bugging their primary-care doctor for years.

“Their families don’t even want to hear it anymore,” she says. “Or they’re worried they’re going to scare their kids.”

That was a major concern of Miller’s. But with enough treatment, he was able to get his life back. Or, as he puts it, “You have got to face the fear and turn the what-ifs into so-whats.”

The Health Anxiety Scale

Here’s a sampling of questions from the Health Anxiety Scale, a test to determine whether a person is at risk for health anxiety. A person who answers yes to more than half the questions on the full-length quiz may be at risk.

  • Do you feel more likely than others to become sick, or do you feel more likely to get sicker than others?
  • Do you think a lot of about getting illnesses that run in your family?
  • When you do get physical symptoms, do you immediately contemplate the most serious illnesses as the cause?
  • Do you visit doctors more than you really need to in order to be reassured about your health?
  • Do you avoid doctors because you are frightened about what they might discover?
  • Do you constantly question your doctor’s opinion?
  • Are you afraid to take medications because of concerns about side effects?
  • Do you check parts of your body repeatedly, looking for an abnormality?
  • Do you often suffer palpitations?
  • Do you frequently ask other people whether you are looking a little better today or a little worse?

Source: Dr. Frederic Neuman, White Plains Hospital Center’s Anxiety and Phobia Treatment Center.

Signs of health anxiety

  • Persistent, obsessive thoughts about being sick.
  • A tendency to attribute symptoms to an obscure but profound, perhaps fatal, illness.
  • Compulsive acts of self-monitoring for the presence of symptoms.
  • A need for continual reassurance from doctors or family members.
  • An ambivalent relationship with doctors and drugs (seeing the doctor too often but refusing to take prescribed medications).

Source: Dr. Frederic Neuman, White Plains Hospital Center’s Anxiety and Phobia Treatment Center.

Health anxiety markers:

  • Persistent, obsessional thoughts about being sick.
  • A tendency to attribute symptoms to an obscure but profound, perhaps fatal, illness.
  • Compulsive acts of self-monitoring for the presence of symptoms.
  • A need for continual reassurance of health from doctors or family members.
  • An ambivalent relationship with doctors and drugs (seeing the doctor too often, but refusing to take prescribed medications).

Source: Dr. Frederic Neuman, White Plains Hospital Center’s Anxiety and Phobia Treatment Center.

For more information:

Westchester For a free evaluation or information on the Health Anxiety Program at White Plains Hospital Center, call 914-681-1038.

Rockland For information on treating health anxiety using cognitive therapy, contact the Hudson Valley Center for Cognitive Therapy in Nyack at 845-353-3399.

Reprinted with permission by The Rockland Journal News.