Thinking Errors in Health Anxiety
Written By Dr. Kat Harris, PhD, LCP
Thinking errors, also known as cognitive distortions, are basically thinking patterns that can be problematic in that they are often inaccurate, unhelpful, and can be harmful to someone’s mental health. Individuals with Health Illness Anxiety Disorder (formerly known as Hypochondriasis) tend to engage in specific types of thinking errors that we try to target in treatment.
Of note, feeling anxious and worried about health can be a normal experience for many people over the course of our lives. And, anxiety itself is not necessarily a bad thing and is meant to protect us in the face of actual danger. It becomes a problem though when it becomes excessive, distressing, impacts quality of life, and when it occurs in response to unlikely or unrealistic threats. Individuals with Health Illness Anxiety Disorder tend to experience excessive anxiety, both in terms of intensity and frequency of that anxiety, and their fears tend to be out of proportion to the actual likelihood and cost of having what they are afraid of occurring. Their fears also tend to persist, despite reassurances that their fears are unlikely to occur (e.g., via doctor’s visits, tests, etc.).
Intolerance of Uncertainty
Individuals with Health Anxiety often feel that they must have 100% certainty, that they must eradicate all doubt, and that 100% certainty is possible as long as they figure out a way to achieve that certainty (e.g., researching, obtaining reassurance from others including doctors, body scanning, etc.). Any possible doubt that their fear could be true is considered intolerable and unacceptable. Any bodily sensation that is not readily explainable by a benign explanation is considered potentially threatening.
Catastrophizing (Fortune-Telling and Negative Interpretations)
Individuals with Health Anxiety tend to make catastrophic assumptions and/or future predictions about the meaning of their physical symptoms (e.g., this back pain means I have cancer, trouble remembering things means I have Alzheimer's). The meaning we assign to anything that happens to us has so much importance in the way we feel about it, and in Health Anxiety this is very much true. If an individual experiences back pain and assumes the meaning of this pain is likely due to something non-threatening (e.g., I must have slept wrong, I might have pulled it when I was exercising) versus assuming the meaning is something sinister (e.g., cancer), then that individual would be less likely to experience anxiety, panic, and distress.
The Big 3
The Big 3 Thinking Errors tend to be common across all anxiety disorders including Health Anxiety:
Overestimation of the Cost: Individuals with Health Anxiety tend to overestimate the consequences of their feared outcomes
Overestimation of the Likelihood: Individuals with Health Anxiety tend to overestimate the likelihood of bad things happening
Underestimation of Self-Efficacy: Individuals with Health Anxiety tend to under-estimate their ability to handle feared outcomes
Overestimation of Responsibility
Individuals with Health Anxiety tend to take on a lot of responsibility for ensuring that they are not responsible for missing a “sign” that something is wrong with their body. For many individuals with Health Anxiety, it’s the one, two punch of being afraid that they will have some serious or terminal illness AND that they couldn’t live with themselves if they had missed the opportunity to heal/address that illness if only they had caught it earlier.
Perfectionism and Black and White Thinking
Individuals with Health Anxiety have little tolerance for normal “body noise” or imperfections/deviations from the way they believe their bodies should behave, and often set their bar for being worry free as being only when they have the absence of all symptoms, disease, injury, or pain. And as we age, we experience more and more “body noise” and other minor ailments which increases distress and anxiety for individuals with Health Anxiety. Examples of body noise can be temporary pain, temporary changes in sleep patterns or appetite, temporary stomach/GI distress, temporary orthostatic changes in blood pressure, etc.
They tend to also have perfectionistic standards for their doctors and other medical professionals, and may not feel satisfied despite multiple tests providing contrary evidence to their fears. They may spend significant time finding the perfect doctor or the perfect tests, and may feel unsatisfied that tests/procedures they have received were accurate (e.g., “the doctor seemed distracted while he was performing the test so I don’t trust the results”). They may also feel unsatisfied unless they have a complete explanation for all of their symptoms, and believe the lack of explanation or “knowing” means that their fears are true or that it means something serious is occurring.
Exposure-Based Cognitive Behavioral Therapy is a treatment approach that attempts to alter these thinking patterns/errors via learning principles and the development of safety associations. See our Health Anxiety page to learn more: https://www.oakheartcenter.com/health-anxiety.html