by: Jaclyn Rink, LLP
It can be challenging when you are dealing with physical symptoms to know how to best approach them. For some people, it’s as simple as going to the doctor, receiving a diagnosis and following a treatment plan. For those that struggle with comorbid mental health symptoms, adding physical symptoms to the mix can make things feel quite complicated and overwhelming.
What does this symptom mean?
Does doing research make things worse?
When should I go to the doctor?
Am I overreacting?
When should I get a second opinion?
Am I dying?
These are the types of questions that swirl around in the minds of those that struggle with anxiety and somatic symptoms. What can be helpful in answering these questions is to know the differences between three types of health-related mental illnesses, as they all require different treatment interventions and approaches.
1. Somatic Symptom Disorder
2. Illness Anxiety
3. Health-Related OCD.
Let’s dive in!
Somatic Symptom Disorder: This disorder is characterized by an extreme focus on somatic symptoms that causes significant impairment in functioning. There must be at least one somatic symptom present, in addition to disproportionate and persistent thoughts about the seriousness of one’s symptoms. Many individuals will experience heightened anxiety or put a lot of time and energy into trying to understand or neutralize their symptom(s). People might engage in body checking behaviors or believe that their symptoms are more serious than they are, despite contrary medical evidence. Often, any physical sensation are experienced as life threatening.
Treatment: Successful intervention for somatic symptom disorder usually incorporates acceptance and commitment therapy (ACT). This therapy helps the individual to accept and work with their symptoms vs. resisting them, in order decrease long-term suffering. ACT focuses on building a life worth living regardless of what physical ailments the patient may experience, highlighting skills of mindfulness and gratitude. This is often an approach used with those that struggle with chronic illness, pain, and insomnia.
Illness Anxiety Disorder: Those who struggle with IAD present with preoccupation about having or acquiring an illness. Previously, this disorder was known as “Hypochondriasis.” In this diagnosis, somatic symptoms do not have to be present, but if they are, they are considered to be mild in nature. If there is a high risk for developing a medical condition (such as genetic predisposition to cancer, heart disease, etc.) the preoccupation with acquiring the illness is disproportionate to the probability or extreme in nature. Those with Illness Anxiety Disorder often engage in two very different behaviors: Some of them will obsessively bodycheck, research, and seek out medical care to manage their anxiety, while others will avoid visits to doctors, specialists etc. out of fear of what they may uncover. Individuals are often easily alarmed regarding their health status, and their anxiety must be occurring for longer than 6 months.
Risk factors include having a serious illness in childhood or witnessing a loved one struggle with health, interest in reviewing health related materials in your spare time, discomfort experiencing normal bodily sensations (acid reflux, fatigue, mild headaches, heart rate changes) or having a parent who struggled with IAD.
Treatment: Intervention for Illness Anxiety Disorder involves a combination of previously stated ACT therapy, in addition to Exposure and Response Prevention Therapy (ERP) to decrease anxiety symptoms. ERP helps the patient see that engaging in checking behaviors, visiting doctors, and obsessing about real or potential health concerns, only increases overall anxiety (which unfortunately can create MORE somatic symptoms!) Uncertainty is the biggest fear in health anxiety, and sitting with these feelings often feels like torture! Those with IAD often seek medical care initially, and it is only after repeated examinations and reassurance from their doctor(s) that they finally seek mental health support.
Health-Related OCD: This is an OCD subtype that focuses on contracting a life-threatening illness, when there are no symptoms or evidence present. It often involves fears of contamination and the 3 R’s: Research, Rumination and Reassurance. How does this cycle work?
1. Patient has an intrusive/unwanted thought about their health (this thought could be out of nowhere or in response to a situation, physical sensation, etc.) The patient asks themselves, “How do I feel?” causing OCD to respond with, “I’m not sure! Let’s investigate and find out!”
2. Patient then begins research about said health concern, conditions and symptoms (often leading them down a rabbit hole of inaccurate and unreliable information).
3. Patient begins to ruminate about this information and their symptoms, increasing their overall distress and obsession frequency.
4. Patient talks to others for support, visits the doctor, gets a second opinion, all looking for reassurance that their intrusive thought is valid and real.
Instead of these steps making the patient feel better, these compulsive behaviors exacerbate the obsessional thoughts, and the patient engages in more and more research and reassurance behaviors in order to minimize their anxiety. Generally, the compulsive behaviors that the individual engages in are usually not connected in a realistic way that would actually neutralize or prevent health related issues (e.g., not stepping on cracks, avoiding certain TV shows, wearing certain clothes, etc.) A previous diagnosis of OCD is NOT required.
Treatment: Health-Related OCD requires Exposure and Response Prevention Therapy (ERP) for symptom relief. ERP helps to break the chain between the patient’s obsession and compulsion, ultimately leading to less intrusive and obsessive thoughts. The most common exposure in Health-Related OCD is the exposure to uncertainty, without allowing the patient to engage in any reassurance seeking behaviors. No scrolling. No asking, No doctor’s visits, etc.
A new term: Cyberchondria, has emerged over the past few years, highlighting many people’s need to engage in online health related searches for medical information and advice. Researching online leads to increasing distrust of medical providers and promotes a roller coaster of anxiety symptoms based on the amount of information at your fingertips, and your own confirmation bias.
If you feel like you are struggling with any of the above symptoms/diagnoses, I urge you to meet with a mental health care provider (and not just your PCP) to discuss your concerns. They can help you tease out your symptoms and get you on a better path to feeling less worried about your physical health. At MFS, we specialize in treating OCD (and its subtypes), somatoform disorders, and anxiety disorders of all kinds.
*Please note that this information is mental health advice, and should not be used in place of medical advice. Please consult your physician regarding any/all physical or somatic concerns.
