Tag Archives: Health Anxiety

Anxiety

One of the Friday Reflections prompts for this week is to write about anxiety. How does it affect me and what do I do to cope? I will write here about my experiences with various types of anxiety. It ties in nicely with last Monday’s post, in which I share tips for relaxation. However, throughout this post, I will share some coping strategies that have and haven’t worked for me too.

In the psychiatrist’s manual, DSM-5, there are various types of anxiety disorders. Now I don’t have a diagnosis of any of these disorders, but they are a good reference point for the various types of anxiety that people may experience.

Generalized anxiety disorder (GAD) is a condition in which a person feels anxious or worried about a variety of situations. This worry is accompanied by a feeling of restlessness, fatigue, difficulty concentrating, irritability, sleep disturbance and/or muscle tension. Generalized anxiety disorder often co-occurs with depression.

Though I haven’t had a diagnosis of GAD, partly because my owrrying can be explained by my autism, I have been a chronic worrier all my life and experienced many of the associated symptoms I mentioned above. Antidepressants can help this type of anxiety and in fact are more effective for GAD than for depression. I have been taking the antidepressant Celexa since 2010 with moderate success.

Some people worry about specific things happening to them. For example, I have a lot of anxiety about getting a serious illness. This is called hypochondria or health anxiety. In the psychiatrist’s manual, it is classified as a somatic symptom disorder rather than an anxiety disorder, but the symptoms overlap with those of anxiety disorders. Some doctors have tried antidepressants for health anxiety and documented significant improvement in their patients. It is also commonly thought that people’s health anxiety lessens, ironically, when they do get seriously ill.

My health anxiety is associated with compulsive behaviors. For example, when I was a child, I was afraid of contracting leprosy. As a means of keeping my worry at bay, I’d count my fingers and toes, since I heard that people who had leprosy had those fall off.

Later on, when I lived independently, obsessive worrying and the resulting compulsive behaviors extended to other situations. For example, I’d be afraid of carbon monoxide poisoning and would have to check that my heating was off and windows open at night. I often checked this twenty or thirty times a night.

Obsessive compulsive disorder (OCD) is classified in DSM-5 under its own category separate from anxiety disorders. The obsessive compulsive spectrum also includes disorders that aren’t commonly seen as anxiety disorders, such as hoardng and trichotillomania (compulsive hair pulling). However, OCD used to be seen as an anxiety disorder. Antidepressants can help, but so can exposure and response prevention. In this type of psychotherapy, the patient is gradually taught to lessen the compulsive response (eg. checking) to a feared scenario. For example, people who have hygiene-related compulsions gradually move from say a three-hour shower down to normal shower time, decreasing their time under the shower by one minute a day. For me personally, my obsessions and compulsions related to the risk of carbon monoxide poisoning decreased dramatically when I was hospitalized.

Another type of anxiety disorder is specific phobia. Everyone probably has something they are fearful of, but a specific phobia is only diagnosed when the fear and resulting avoidance of situations greatly impairs the person’s daily functioning. Similar to OCD, specific phobias are treated with exposure therapy, where the person is gradually intrduced to the feared situation or object and learns to endure the fear. For example, a person with a spider phobia might be first intrduced to pictures of spiders, then videos, then look at a live spider, etc. You can also be asked to simply imagine the feared scenario (eg. looking at a spider). After all, with certain phobias, it is not feasible for the therapist to take the client on to the real experience.

A final type of anxiety is social phobia. A person with social phobia is extremely fearful of social situations because of the fear of making mistakes or being criticized. As a result, people with social phobia avoid certain or all social situations. Many autistic people develop social anxiety as a result of their real social ineptness. I for one do not consider myself that socially anxious, but when I filled out a social phobia questionnaire online, it said I had very sevre social phobia. This is probably because I get overwhelmd by social situations easily and avoid them because of this.

People with social phobia, often children, may also suffer from a co-existing condition called selective mutism. This is an inability to talk in certain situations (eg. at school) while the child has adequate speech in other situations (eg. with parents). I displayed signs of selective mutism as a teen. Though this was in part anxiety-related, it also related to my autism.

There are still many other types of anxiety and related disorders, such as panic disorder and agoraphobia. Post-traumatic stress disorder (PTSD) also used to be classified as an anxiety disorder. I used to have a diagnosis of PTSD and still have some of its symptoms, but I may discuss this at a later time.

Reflections From Me
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Five of My Biggest Fears

One of the questions in the 31 days of BPD challenge asks us to list five of our worst fears. I just came across a journaling prompt that asks the same quesiton, but had me explore these fears more in depth. I don’t know where this will take me, but I’m going to list some of my fears and journal about them.

1. Demands. This is really my number one fear. I go crazy everytime a person expects me to go out of my comfort zone. It isn’t that I can’t go out of my comfort zone per se. I take leaps out of it on my own regularly. It’s more the pressure from others that I fear. For example, I tend to be far more capable as far as practical skills are concerned when no-one is looking. I also sometimes take the initiative to try new skills when people are looking but are not expecting me to do these things. On the other hand, when someone tells me I can do something and demands I demonstrate this ability, I freeze, flee or fight.

2. Growing up. Sounds weird for someone who is almost in her thirties, but I mean this in some ways related to the above one. However, it is different in that growing up for me means missing out on things expected of people my age as a result in part of my demand avoidance. I am not sure this dislike of growing up is truly a fear in the traditional sense of the word. It seems it’s more like a sense of dissonance, because in some ways, I’m still a teen at heart.

3. Abandonment. This is really the root fear that causes fear of rejection and on the surface fear of crticism in general. I am a terrible grudge-holder myself, but also tend to hold on to shame for a long time. As a result, I tend to fear that people are going to abandon me if they’ve been even slightly critical of me, because I tend to assume these people hold onto grudges for as long as I do.

4. Illness. I admit it, I’m somewhat of a hypochondriac. I fear falling ill with a life-threatening condition all the time. Then again, I also tend to be fascinated by this possibility. For example, I am drawn to reading books on people with life-threatening or life-altering illnesses. In this sense, my attitude towards this possibility has changed over time. In 2008, I was convinced I’d die that year and it scared the crap out of me. Now, I’m more fascinated than fearful.

5. Poison. I have mentioned this one before I believe. I have always had this irrational fear of being poisoned. I also may exhibit some magical thinking related to this. For example, I used to believe that tap water was really the latest poison I’d heard of. Because of my fear of poison, I developed some compulsive behaviors. For example, when I still had some sight, I’d check the color of liquids I was about to drink to make sure they weren’t poison. I did similar things in relation to the fear of illness I mentioned above.

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Mami 2 Five

Childhood Fears

Growing up, I was a bit of an anxious child, but in some ways, not like other children. I wasn’t afraid of monsters under my bed. Rather, I caught every single sort of bad news and imagined it happening to me.

At the time, early to mid-1990s, the Leprosy Foundation apparently had enough money for large television funraising campaigns. I hardly hear or see them now, so maybe people are more interested in a disease that affects people in the Western world, like ALS. In any case, leprosy was “hot” then. It’s this big, bad disease that magically causes your fingers and toes to fall off. That’s scary to an eight-year-old!

With my fear came rituals to counter the fear. I have never been diagnosed with OCD, but it might be that I had a mild case of it when I was young. So to counter my fear of catching leprosy, I’d sit up at night for hours counting my fingers and toes. Later, when I heard that leprosy causes loss of sensation first, I would make sure I was very aware of the sensation in my extremities.

The fear of catching leprosy got less when I was around ten or eleven, when my father convinced me no-one in the Netherlands gets it. Just then, I met a girl who said she’d had it and a classmate who had a mysterious disease with what I thought were similar symptoms. I had by this time heard that the bacterium that causes leprosy takes two to eight years to become active, so I wasn’t too worried of acutely losing my fingers or toes. But the fear remained at the back of my mind.

Other fears and compulsions took over by my teens. I remember I had this bad fear of getting CO poisoning, so I’d make sure my heating was off and my window was open even in the midst of winter. Maybe now I need some of that fear back as people complain I don’t air my room frequently enough.

Some form of fear and compulsion stayed with me for many years. Some are too embarrassing to discuss here, while others are more ordinary – like the fear of someone breaking into my apartment at night. The fears, however, almost completely disappeared when I was admitted to the psychiatric hospital. I still experience some health anxiety, but it is manageable, and the compulsions have completely disappeared.

Mama’s Losin’ It

Myths about Health Anxiety

In a chronic illness Facebook group I’m part of, a member talked about having “possible hypchondriac” written in her medical records. This led to a discussion of chornic illnes, hypochondriasis and illness anxiety, as hypochondriasis is now called in DSM-5, medical knowledge, imagining or faking symptoms. There are a lot of prevailing myths about health anxiety, which I feel compelled to write about.

First, this person had a known chornic illness. The DSM-5 criteria for illness anxiety disorder clearly state that, if a general medical condition is present or there is a high risk of developing such a condition (eg. strong family history), illness anxiety disorder should only be diagnosed if the person’s anxiety is clearly out of proportion to the medical condition. Also, the criteria say that people with illness anxieyt usually suffer no or only mild somatic symptoms. I am not sure how to interpret this, as everyone suffers somatic symptoms at times, and the DSM-IV specified that hypochondriacs misinterpreted real bodily signals. That’s not the same as somatic symptoms, I believe. Anyway, for these reasons, it is pretty unlikely that a person who has a known chornic illness, can be diagnosed with illness anxiety disorder.

Another prevailing myth is that knowing a lot about medical terminology indicates you’re ahypochondriac. Well, in such a case all doctors ought to be hypochondriacs. Also, talking, writing or reaidng a lot about illness is not a symptom of illness anxiety disorder, unless it’s accompanied by anxiety about having the acctual illness. I am not a hypochondriac for reading blogs about medical disorders that I don’t have. Yay!

Making up symptoms or creating them is also not hypochondriasis. People who fake illness to take on the sick role have a factitious disorder (aka Münchausen Syndrome). People who fake illness for secondary gains (eg. disability benefits), are malingering. These two need to be differentiated: factitious disorder, even in its harmful forms (ie. Münchausen by proxy), is a real mental illness and should be treated as such. Malingering is not. Doctors still have a hard time diagnosing certain cases of malingering due to having sympathy for the faker.

Lastly, please remember that having or being perceived as having a bad attitude about your health or illness, is not hypochondriasis. People deal with chronic or serious illness differently, and most of this falls within the normal range. Where it becomes distressing to the patient, it may be illness anxiety disorder (or depression or another mental illness). Being a pain in the butt for other people, may be too bad, but it’s not a psychiatric disorder.