Cognitive-Behavioral Therapy for Anxiety and Related Disorders
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Fear of being ill (Hypochondriasis)

Fear of being ill (Hypochondriasis)

Most people have some fear of illness; health-related anxiety, in fact, motivates people to engage in behaviors — such as exercise, eating lower fat foods, and having regular visits with doctors and dentists — that prolong and improve people’s lives.

When this fear becomes part of an OCD obsession, however, the fevered pursuit of health can damage the lives of the person and his or her loved ones.

Example

Kate checks her body regularly for signs of ill-health. In the shower, she runs over her torso and breasts, especially, to discover any possible new lumps. Afterward, she looks at them in the mirror with her arms raised to ensure they are still perfectly symmetrical. This habit makes it difficult to get to work on time, because inevitably she cannot feel 100% certain that her breasts are the same as they were the day before.

During her waking hours, Kate is repeatedly distracted by physical sensations: she wonders whether a dull ache in her abdominal cavity might be ovarian cancer or a twinge in her chest indicates lung or breast cancer. Sometimes the anxiety about these symptoms can cause her to spend much of her day in a near-panic, and she researches symptoms on the Internet and puts in calls to her gynecologist to seek reassurance when she can no longer tolerate how she’s feeling. When she visits the doctor, Kate writes up a list of questions and things to talk about beforehand, knowing that her anxiety during the appointment usually makes it difficult to remember everything. As the doctor or nurse reviews the matter with her, Kate tries to write down what they say, verbatim, so that later on she can go over what they told her and reassure herself that everything is OK.

Even when her body feels comfortable, Kate feels anxious if she hears songs performed by celebrities who are known to have contracted cancer or if a coworker discusses the illness of a family member or a friend. She feels bad that she can’t be a “good friend,” but she finds that she simply cannot be supportive to people who are going through health problems because of her overwhelming anxiety. Kate withdraws from individuals who are dealing with health issues and has lost friendships and has problems with family members as a result.

Kate’s obsessions about health have spread to people whom are closest to her, as well. She sometimes feels an overwhelming need to ask her boyfriend repeatedly about physical discomfort that he might talk about in an off-handed way. When he brushes aside her concerns, Kate feels ignored and worries that he is hiding something from her. As a result, she asks more questions, and this sometimes results in a heated argument.

Kate also reports that her obsession about cancer keeps her from enjoying sex as much as she used to. She notes that she cannot bear to have certain parts of her body touched because then she has an intrusive thought about cancer. She has asked her boyfriend to avoid these parts of her body, and this has caused more tension between them.

Each person who obsesses about their health will manifest it in a slightly different way. A person with OCD may have a fair amount of insight into the irrationality of their fears, and, indeed, may have a history of handling serious health problems in an adaptive way. Others may have very little insight about the mismatch between the degree of fear they experience and the probabilities of adverse health outcomes; they may feel, as a result, that their rituals for preserving health are – quite literally – a matter of life and death. People also vary widely in the type of health problems they obsess about and the rituals and avoidance they use to cope with their fears. Some, for example, may over-use the medical system, asking for repeated scans and consult with an excessive number of specialists. Others may avoid medical services for years, unable to face even the possibility that an illness will be discovered.

Treatment

Exposure and Response Prevention (ERP) is the type of Cognitive-behavioral Therapy considered the front-line treatment for OCD, with or without medications. ERP targets the insidious cycle of intrusive obsessive thoughts/fears, associated distress/anxiety, and subsequent threat reducing behaviors (e.g. compulsive checking for signs of illness or disease, repeated trips to doctors and specialists, reassurance seeking from loved ones or friends, hours of research on the Internet, etc.) Through gradual exposure to the feared thoughts, situations, and uncertainties, without engaging in the threat-reducing behavior, the threat-reaction (and associated distress and anxiety) is significantly diminished, allowing the person to emerge from the shackles of his/her OCD and regain and live the life they value.