Health Anxiety

What is Health Related Anxiety?

Health anxiety is not a disorder. However, there are several disorders that are defined by excessive anxiety related to somatic symptoms or an illness or condition. For youth with these disorders there is a preoccupation with one or more somatic symptoms or having or getting a serious illness or condition. Naturally occurring sensations are often misinterpreted as evidence for illness, and consequently the child is easily alarmed about their health. This typically leads to excessive checking behaviours to ensure they aren’t sick, such as frequent visits to medical professionals and use of home devices (e.g. a blood pressure machine or thermometer), as well as persistent questioning of others to determine whether or not they are ill, and other behaviours. Alternatively, the youth may avoid medical attention completely due to fear of what may be discovered. Even when a child does have an illness or condition, the degree of worry and related checking behaviours are far more extreme and time consuming than would be expected given the situation. Although many youth may worry about health and general wellness on occasion, for youth with health related anxiety this worry is excessive, ongoing, uncontrollable, physically draining, and significantly negatively impacts the quality of life of the child and family. 

 

Fear or Fact Seeking: Chronic Medical Conditions and Worry

While children with health anxiety do not always have a medical condition, some do. If your child has a chronic medical condition such as asthma, food allergies, diabetes, and others, s/he can also have a health anxiety disorder. But how do you tell what is reasonable worry that can understandably occur with a life threatening allergy to peanuts, versus whether your child might have a health anxiety disorder? In order to make this determination it is recommended you seek an assessment by a medical or mental health professional. However, as a parent you can contribute to that assessment by starting to observe whether your child’s behaviours are a result of fear or fact seeking. Children with excessive anxiety about their medical condition are ruled by fear. Fear tells them not to go to a friend’s home because their medical condition might flare up, or convinces them to stay home sick from school because the teacher might not be able to help. Fear bosses them about on a daily basis even when you have provided information to calm their worries, many, many times, or have explained why their behaviours are unnecessary. In fact, you know fear is in charge when you seem to be providing the same information repeatedly but your child never feels better. Fact seeking on the other hand allows a child with a chronic condition to understand the dos and don’ts to managing and living with his/her condition. Although s/he may have some worry about how to cope, s/he seeks out relevant facts that make him/her feel confident to cope and thrive. This can include identifying community members who will help when you the parent are not available, and reasonable precautions outlined by your child’s doctor to ensure his/her condition remains stable. As a result, your child is able to engage in his/her daily life with minimal disruption and if s/he experience small doses of worry, this creates little interference.

SIGNS & SYMPTOMS

Thoughts (very young children may be unable to identify fear thoughts):

  • What if my cold turns into pneumonia and I die?
  • I’ve had three headaches this year. I’m sure I have a brain tumor!
  • What if that pain means I have cancer?
  • I don’t think my doctor is qualified enough
  • No-one understands me

Physical feelings:

  • Irritablity
  • Tired or fatigue
  • Muscle pains
  • Headaches
  • Stomachaches

Emotions:

  • Anxiety/worry
  • Sadness
  • Anger
  • Frustration
  • Guilt

Behaviors:

  • Tantrums
  • Difficulty falling or staying asleep, or disturbed/interrupted sleep
  • Excessive body checking
  • Reassurance seeking
  • Researching illness and treatments
  • School refusal

 

COMMON SITUATIONS OR AFFECTED AREAS

  • School absenteeism
  • Frequent trips to medical professionals
  • Inability to participate and enjoy recreational activities and clubs due to trying to prevent exposure to perceived germs or illnesses
  • General decline in quality of life- less involved in activities, limited interests, time spent worrying
  • Unusual or overly focused interests- frequent research of medical illnesses and treatments, becoming an expert on identifying diseases, etc.

Be sure to watch our video below for more information...press the play button to start.

 

Illness Anxiety Disorder Video

How health related anxiety impacts the child at different ages:

Young children typically worry about a single symptom like a headache or stomach pain, or a condition they have, rather than a specific illness. For some this worry stems from a lack of understanding, and can be managed through basic education, but for others the worry persists. As children mature, but while their capacity for abstract reasoning remains undeveloped, some children may engage in extreme leaps of logic such as worrying about dying from a cold or catching cancer. As children get older, however, their thinking evolves and specific worries may become more complex or future oriented. For example, “What if that pain means I have Leukemia?” or, “What if the effects of MSG and GMO foods build up in my blood stream and I get cancer in my thirties?” Despite the variation of what worries youth, most youth with health related anxiety are unable to recognize that their chronic focus on symptoms or illness, and related behaviours, is unreasonable because they are so anxious. The anxiety trumps logic. In addition, the negative impact of the ongoing, constant worry becomes more disruptive and pervasive over time. It may take less energy to reassure your seven year old that leg pain is probably bone growth and not cancer when the worry has existed for a week; whereas when it has persisted for months or even years, your child may become increasingly demonstrative and aggressive in his demands to have a second or even third opinion from a “more qualified” professional. The bottom line is that excessive and uncontrollable worry about health is not a typical characteristic for youth, and left unaddressed can significantly negatively impact his/her quality of life.

 

 Click here for My Anxiety Plan (MAP)

 

Thomas' Story
Maya's Story
Mrs. Ho's Story

Thomas is a nine year old “man.” He is a walking Gray’s Anatomy of medical information, and can produce the names and related treatments for over 25 diseases. His interest was sparked after a classmate’s parent, a surgeon, spoke to the class about cancer. Initially Thomas’s parents found his interest endearing, but after months of time spent researching the Internet for information, and a conviction that he would die before his tenth birthday, Thomas’s parents became concerned.

A visit to their family physician and complete physical check-up only seemed to calm Thomas for a few days. He soon returned to his Internet research, continuing to insist he was dying of leukemia. When the blood panel the doctor ordered came back negative Thomas demanded a bone scan. Understandably their family doctor refused. By now Thomas was sleeping poorly, refusing to play with friends, and seemed to enjoy very little. Thomas’s parents were at a loss of what to do. Thomas begged them to pay out of pocket for the bone scan, and eventually they agreed hoping this would convince him he was healthy. The results were negative, and Thomas was relieved and finally stopped worrying. He started sleeping better, spending time with friends, and seemed more like his old self.

After a few months, however, the worry crept back in. This time Thomas became certain he was at high risk for cardiovascular disease. He saved up his allowance and bought a blood pressure device. Unfortunately, this only increased his worry, as the device would frequently give a false reading sending Thomas into a spiral of fear and panic. Although his worry decreased after his parents confiscated the device, Thomas remains highly anxious and alert to any bodily changes that might signify a stroke or related heart problems.

Maya is a 14-year-old high school student who is one of four children all diagnosed with asthma. Maya has been diagnosed with a mild case of asthma, and only uses an inhaler during softball season and in the wet winter months. However, Maya worries about her asthma more than all her siblings combined, and while they average about one doctor visit per year for asthma related appointments, Maya’s average is five. In fact, her mother is convinced that Maya’s worry actually causes at least some of her asthma attacks.

Since she was young, Maya’s parents have provided Maya with ongoing reassurance that her body is strong enough to cope, and that should her respiratory system weaken, help will be available. Yet Maya’s worry has only increased. She is hyper-focused on vague sensations and pain she claims to feel in her lungs and throat, carries multiple inhalers with her at all times, and each week conducts an elaborate check to ensure each inhaler is operating properly. She refuses to participate in any sports aside form softball despite expressing an interest in trying new things, fearful that unnecessary exertion will compromise her health. Although Maya agrees that some of her safety measures might be a little over the top, she is reluctant to give anything up, convinced that were she to do so it might be the very thing that could have saved her life.

Ho is a 30-year veteran Kindergarten teacher in the public school system, and during her long career she has experienced many changes in the education system. One of these changes has been the dietary needs of youth.

In her early years of teaching Mrs. Ho recalls that peanut butter and jelly sandwiches for lunch was the norm, yet now peanuts are banned from most schools. Since this rule went into effect she has been careful to ensure there are no nut-based snacks coming into her classroom. She can identify every child with a peanut allergy, and knows where they keep their epi-pen. These minor adaptations had seemed sufficient until this year, but since Lucia joined her class she has started doubting this former wisdom.

Lucia insists that Mrs. Ho wash her hands at the start of school before she gives worksheets incase Mrs. Ho has traces of nuts on her hands. In addition, she has overheard Lucia asking other students to wash their hands, and Lucia refuses to play with kids who mention having eaten peanut butter for breakfast. In fact just last week Lucia became so upset during lunch her father had to be called. After the drama had subsided Mrs. Ho learned that another student had been drinking almond milk next to Lucia and Lucia was convinced this was a violation of the no-nut policy and was endangering her life. Mrs. Ho feels sad for Lucia as this young girl is in a constant state of vigilance, certain that she is at high risk of dying at any time, although Mrs. Ho knows Lucia is only mildly allergic to peanuts and has never required use of her epi-pen.