cherry blossom trees

The four stages of health anxiety, as illustrated by the coronavirus outbreak

Well, the good news is that neither Terry nor I succumbed to Max’s Hand, Foot & Mouth disease  a couple of weeks ago. I did get YET ANOTHER freaking cold (and Terry still has the one he started a few weeks ago…), which allows me to continue my unbroken streak of Being Ill Almost Constantly Since November, but, having seen how rough the HF&M was on poor Max, I think we got off pretty lightly, all things considered. 

The bad news, meanwhile, is that it doesn’t really matter, because we’re all going to die from coronavirus now, apparently: or so it would seem from some of the news reports I’ve been reading, anyway.

Now, important disclaimer here: I suffer from health anxiety , and health anxiety has a way of making it completely impossible to rationalise risk, once the anxiety has been triggered.  And, wow, has it been triggered. 

If you don’t suffer from health anxiety, of course, this post is probably not going to make much sense to you: I just want to put that out there right from the very start, so you don’t waste ten minutes of your life reading something that will just end up annoying you. I mean, if you’ve even made it this far, you’re probably already itching to jump in and tell me that I’m more likely to die in a car crash than by catching coronavirus, or that there’s no point worrying about it, because everything happens for a reason, and  worrying won’t help, and so on and so forth.

(If you ARE thinking of saying any of things I will respectfully ask you to read this post first, please and thank you. ) (I’ll also just quickly point out that, like many health anxiety sufferers, I have an answer for EVERYTHING, and you will not like my answers, so … can we just NOT?)

If, on the other hand, you DO suffer from health anxiety – or are prone to ANY kind of anxiety, really – I’m guessing you just might relate to my feelings of terror right now, because, guys? I. AM. TERRIFIED. In fact, I’m beyond terrified.  Like, there’s ‘Terrified’, there’s a few thousand miles of road, then there’s me. And I’ve basically reached the stage where my immediate family members don’t want to talk to me about The Terror any more, so I’m going to talk to the internet instead. Please don’t hate me. 

the current coronavirus situation – or my reaction to it, rather – is a perfect example of how health anxiety works

As well as writing about this in order to hopefully connect with fellow sufferers who understand what it’s like to live with health anxiety, though, it also occurred to me that the current coronavirus situation – or my reaction to it, rather – is a perfect example of how this kind of anxiety works. For instance, there are several distinct elements of health anxiety which have been coming into play for me lately, and they include things like…
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STAGE 1:
OBSESSIVE / COMPULSIVE BEHAVIOUR

When my health anxiety was first diagnosed, the doctor explained to me that it’s actually classed as a form of OCD (Obsessive Compulsive Disorder). I was a little surprised by that at first, because, like many people, I’d always assumed OCD referred to people who wash their hands constantly, or like to keep their houses super-tidy. (Spoiler alert: NO, IT ISN’T.)

When I really thought about it, though, I realised that it makes perfect sense to classify it like that. In most cases, the OCD element of my health anxiety manifests itself as an obsessive compulsion to check for symptoms: so, if I notice a pain in my leg when I stand in a certain position, for instance, I will repeatedly stand in that position, to see whether or not it’s going to happen again. I’ll basically be doing this in a bid to reassure myself that the pain I felt was just a one-off, and has now disappeared, but, of course, by constantly doing the thing that aggravates it, I will generally just make it worse – which, in turn, makes my anxiety about it worse… and so it goes on. 

In the case of the coronavirus outbreak, meanwhile, there are no physical symptoms to check (So far, at least: my current cold started long enough before there were any confirmed cases in the UK for me not to be worried about it, but, obviously any new illnesses that spring up from this point on are going to send my anxiety spiralling…), so the OCD element has manifested itself in obsessive monitoring of the news about the virus, instead. 

the OCD element has manifested itself in obsessive monitoring of the news about the virus

Over the last few weeks, I’ve been refreshing news websites constantly: poring over every piece of information I can find, and then looking for more. I’m doing my best to try to stop this, because I know it only makes the anxiety worse – trust me, I KNOW – but there have been times when I’ve been picking up my phone to check the news every ten minutes or so: which is ridiculous, I know, but, again, I’m constantly hoping I’m going to read something that will reassure me… and constantly finding something that only serves to feed the anxiety, itself.

Now, I know perfectly well that I shouldn’t be doing this. The first rule of health anxiety, after all, is don’t talk about health anxiety THOU SHALT NOT GOOGLE… and the second rule of health anxiety is, NO, SERIOUSLY, STEP AWAY FROM DOCTOR GOOGLE, I’M NOT GOING TO TELL YOU AGAIN, WOMAN.

In the case of coronavirus, of course, hitting up Google is a particularly bad idea, because the reporting from some sectors of the media has been irresponsible to say the least. That’s the thing about a compulsion, though: it’s … well, compulsive. So I read the news, and then I refresh it to see if it’s changed, and, when I’ve done refreshing news sites, I move onto forums: because if the World Health Organization can’t reassure me on this one, there’s a good chance Marjorie from Cardiff will be able to do it, on a thread called, ‘Should I bulk-buy face masks, or just kill myself because we’re all going to die anyway?” Amiright?

(NOPE)

So: videos of people apparently dropping dead in the street.  Rumours of global conspiracies and cover-ups. Scare-mongering “news” reports which you think are going to contain actual information, but which turn out to basically just be about what random people on Twitter have been saying. Forums filled with people who are stockpiling resources and buying up facemasks in preparation for the end of the world. Other forum threads in which people say the facemasks are useless, and, also, will most likely be sent from China, so if you buy one, you’re basically paying to have Amazon deliver your coronavirus. Endless Amazon reviews of facemasks. More videos: this time of doctors and nurses claiming the situation is far, far worse than we’re being told, and that we’re now facing a Walking Dead scenario, only without Daryl and his trusty crossbow to save us. 

And so on and so forth. 

Honestly, I think all of this would scare someone who ISN’T predisposed to anxiety, if they were exposed to enough of it. As for me, meanwhile, I have exposed myself to a LOT of it. Like, I could probably go on Mastermind with, ‘Unsubstantiated Rumours About Coronavirus’ as my specialist subject at this point.  And, once I’ve scared myself witless with all of the forums, and the conspiracy theories, and the tabloids, I move onto Phase 2:

STAGE 2:
SEEKING REASSURANCE

Another big element of health anxiety for me is the Seeking of Reassurance from People Who Aren’t Actually Qualified to Give Reassurance, But Hey, Let’s Ask Them, Anyway! I’ve no idea why I capitalised all of that, but I guess it just seemed important enough for it, so let’s just run with it. 

This phase is, of course, merely an extension of the first one, but, instead of looking for “facts” online (I’m putting the word “facts” in inverted commas here, because it’s not often you find the words “facts” and “online” in the same sentence, is it? I mean, I might be terrified, but I’m not insane…), I extend my mission to include Other People, who, sorry if you’re one of them, will now be called upon to reassure me over and over again, until either the scare is over or we all die of old age/coronavirus/whatever comes first. 

This phase is particularly annoying for the Other People involved, because I will ask for their reassurance, but – and here’s the kicker –  I WILL NOT BELIEVE IT when it’s offered. In fact, I will most likely argue with it, citing all of the “evidence” I’ve gathered in my fact-finding mission above, and also that one video I saw on Twitter that everyone said was most likely fake, but WAS IT REALLY, THOUGH?

“BUT YOU HAVE A MUCH HIGHER CHANCE OF CATCHING REGULAR FLU!”
Yes, and I worry about that too: there is, however, a vaccine for that, and we all get it. No, it doesn’t protect us from ALL strains of flu, but it does give me peace of mind about quite a few of them, and somehow makes me worry less. 

“BUT MORE PEOPLE DIE IN CAR ACCIDENTS THAN HAVE DIED FROM CORONAVIRUS!”
Yes, but car accidents aren’t infectious, and viruses are: not really the same thing, are they?

(I should add here that not all health anxiety sufferers seek reassurance exclusively from people who aren’t qualified to give it, obviously: some seek advice from doctors, and other health professionals, but, well, we don’t really believe them either, so the end result is always the same, and Marjorie from Cardiff – or any other random forum poster – is still held to be the Ultimate Authority on all things health-related…)

Why are we more likely to believe the people who confirm our fears than the ones who refuse to? It’s a good question: if you figure it out, please let me know…

 The advice I always give to fellow health anxiety sufferers is to try to resist asking for reassurance, because all it does is make people hate you.

The advice I always give to fellow health anxiety sufferers is to try to resist asking for reassurance, because all it does is make people hate you. I obviously don’t feel the need to take my own advice on that, though, so if you happen to have seen me in the past week or so, and I’ve casually tried to bring coronavirus into the conversation, so I can find out if you think we’re all going to die or not, I am so very sorry, seriously. 

(DO YOU, THOUGH?)
The 4 stages of health anxiety

STAGE 3:
INTRUSIVE THOUGHTS / CATASTROPHIZING

Of all of the things that suck about health anxiety, I’d say the intrusive thoughts are my least favourite. They kill the joy in everything. So, these days, as I’m playing with my son, or watching TV, say, my mind will be endlessly cycling through all of the possible scenarios in which one or all of us contracts coronavirus and dies.  It’s a real buzzkill, to be totally honest.

There are many of these scenarios, each one more terrifying than the last, and while it’s easy enough to be all, “Well, just stop thinking about them, then, dumbass!” it’s unfortunately not QUITE as easy to actually do that. 

I have no idea how to stop The Thoughts. Yes, I’ve tried CBT. Didn’t work. And don’t even get me started about yoga , or mindfulness, or whatever it is you’re about to suggest. Trust me, if I knew of a way to stop myself worrying, and catastrophizing, and thinking all the damn time, I would definitely be doing that.  It’s not like I’m sitting here thinking, “Well, I could either be totally chill about this, and not give it a second thought, OR I could whip myself into a frenzy in which I will struggle to function because of The Panic. I think I’ll go with The Panic! It’s not like I actually needed to be able to function normally after all, is it?”

(No, worrying doesn’t help, you’re right. We don’t worry because we think it’s going to help, though, do we?)

The big problem here, of course, is that the intrusive thoughts can ALSO get caught up in the OCD cycle, and, when that happens, there’s really only one thing for it:

STAGE 4:
SHEER PANIC

Panic accompanies every stage of health anxiety, obviously, and it’s THE WORST, really, isn’t it? Once you’re firmly in the grip of a health anxiety attack, though, it’s easy to feel like panic is the only reasonable response: like, I genuinely don’t understand why everyone isn’t panicking right now. How are you all just sitting there reading this stupid blog post when the world is about to end? HOW?

My pet hate here is the sheer number of people who’re just all, “Oh, it’s fine: it’s just the over 65s and people who are immunocompromised who are at risk from it, so I’m not worried!” Which, I mean, cool, I’m glad you’re alright, Jack, but my parents are both over 65, my husband is immunocompromised , and I know no one’s mentioned toddlers specifically, yet, but my child is only 2, and I. Am. Terrified: not because I’m worried that this virus will kill me, but because I’m worried that it will kill all of them, and I’ll be the last woman standing basically. 

So, right now, I’m in a state of barely-controlled panic: to the extent that I really wanted to keep Max home from nursery today, and would 100% have done it if Terry hadn’t been there to talk some sense into me. (I did, however, convince him to add some canned goods and paracetamol to the online shop this week. So that’ll help.)

right now, I’m in a state of barely-controlled panic…

I obviously (OBVIOUSLY) understand the importance of hand washing and other good hygiene practices, but, while that might help me, again, it’s not really me I’m worried about: it’s my nursery-attending two-year old, who isn’t old enough to be trusted to use a tissue then dispose of it responsibly, and whose hands are permanently in his mouth. Given that his nursery staff won’t have the time to wash his hands every time he touches something someone might have sneezed on, and also given that our entire family has been ill almost constantly since he started there (Events which I suspect are not unrelated…)… yeah, I’m worried.  Er, just in case you hand’t worked that out by now…

*

There is, of course, a 5th stage of health anxiety, and it’s the one that involves standing down the vigil,  and moving on. It’s just… we obviously haven’t reached that stage with this one, yet. So, tell me: are there any other health anxiety sufferers out there? How are you coping? 

 

More posts about health anxiety:

My health anxiety story

11 things not to say to someone with health anxiety

9 things you only understand if you have health anxiety

Dealing with focal migraines when you have health anxiety

COMMENTS
  • Nicola

    REPLY

    I don’t have health anxiety but I do have generalised anxiety and so much of this post was way too relatable. I have nothing of any value to offer here, but I can appreciate the stress you’re dealing with at the moment and wish you love and support 💛

    February 3, 2020
      • Emma

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        Hi my anxiety and journey is identical. I can’t see how others are getting on with their normal life’s….

        February 11, 2020
  • Amy

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    My heart goes out to you and it sounds awful. I’m sorry.

    To answer, “Why are we more likely to believe the people who confirm our fears than the ones who refuse to?”

    I suspect it is Confirmation Bias. We are always more likely to believe things we already believe. Also, facts do not change our minds about things: https://www.newyorker.com/magazine/2017/02/27/why-facts-dont-change-our-minds

    I haven’t read the news for years, not because of anxiety, but because of compassion fatigue. I cannot help anyone outside of my immediate circle and it breaks me for helping my circle if I’m too worried about literally everyone else. I don’t share this link to help you per se, but it might be interesting while you continue to flesh out your understanding: https://markmanson.net/why-you-should-quit-the-news

    You’re always impressive to me that you can share such challenging and personal things with such clarity and insight. 🙂

    February 3, 2020
  • Claire

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    Amber forgive me if this is too personal a question but have you ever tried any anxiety medication? I finally caved in and tried it about six months ago and it’s no exaggeration to say it has given me my life back. I still get anxious about some things to a lesser degree, but the constant, exhausting mental chatter and catastrophizing has largely disappeared. I didn’t realise how debilitating it was until it stopped.

    February 3, 2020
      • Elaine

        REPLY

        I really feel for you. I have had anxiety on and off for may years and suffered very badly from post natal depression when I had my first child, which resulted in me being completely unable to sleep for a whole actual WEEK – lost 4 stone and my mind . I am very prone to becoming obsessed over sleep even 15 years later – there is no rational thought behind it – I wont die if I don’t sleep for a night but the panic is REAL. When I was around 9 years old I watched some programme about someone who got trapped and had to have their legs cut off – I then spend the next few months obsessed that this would happen to me. I could list many very unlikely scenarios that I have obsessed with over the years ie when some boy got trapped down a well in Spain and died I was terrified about this for months – I grew up if Fife so they are very few wells – so not sure where I thought I was going to suddenly fall down one but there we go, nothing could convince me otherwise. Enough of my ramblings just know that there are lots of people out in internet land who understand the panic – and it is terrifying. Hoping you reach that 5th stage of “standing down” as quickly as possible x

        February 4, 2020
      • Rich

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        I can relate to everything you talk about, I work as a cleaner in a shop, I’m now struggling with panic and worry my hole body is tense I can’t sleep. I’m constantly looking for info on the virus I’m speculating I’m telling myself it’s a bioweapon created to kill off some the the population because the world is over populated I’m on the verge of having a break down, I can’t see a doctor because I don’t want to go where there are potentially sick people, I’m never going to get over this, I’m trying CBT but don’t think it’s having much effect.

        March 13, 2020
  • Mary Katherine

    REPLY

    I am lucky enough to not suffer from anxiety, either health or any other kind. So I find it really useful to read your blogs about it to give me insight into the minds of my loved ones and others who DO. Your blogs have really helped hammer home to me to STOP GIVING ADVICE! And while we’re at it, stop being so $%^&* judgemental.

    Anyway, I can’t do a danged thing to help you get through this except to send positive karma, moral support, and gratitude for giving us a window into your world.

    February 4, 2020
  • M

    REPLY

    I’m so sorry that you are suffering so much – I know what it’s like to be paralyzed with fear. it’s soul-crushing. Hugs to you!

    I have general anxiety that sometimes becomes health related. It seemed to show up the most after the birth of my daughter, and peaked when she was about 9 or 10. It was probably triggered by hormones and the fact that I had a lot of loss pretty early in life (between the ages of 14 and 19 I lost my father, 2 uncles, and both grandfathers. My grandfathers were both elderly and ill, but my father and uncles were all young and died suddenly and unexpectedly). Two things have really helped; EMDR therapy (trauma therapy), and my faith. The EMDR helped me work out the traumas in my life that were predisposing me to uncontrollable fear, and my faith helps keep me in that better state of mind. I actually sleep with a rosary next to my pillow, and say it when I wake up at 3am with night terrors, (which happens quite frequently). I do find that the more I pray (and the more I stay off the computer), the less anxious I am.

    February 4, 2020
  • Antonia

    REPLY

    Oh Amber, do I feel all of this.

    I really thought I had my HA under control until last year when a doctor – a *doctor*! – triggered it into being at its very worst, so I’m pretty ill-prepared to deal with a virus outbreak. I’m going to take the last part of this post literally, so here’s how I’ve been coping:

    1) Avoiding crowded spaces wherever possible, even if it means making life difficult for myself (I keep having to do the minimum-order-£25-online shops when I only need one thing because I’m refusing to go into stores… far from ideal). It’s just not worth the extra anxiety.

    2) When there’s no avoiding a crowded space (such as collecting a prescription), using anti-viral foam, hand sanitiser, touching nothing, and keeping my head turned away from others.

    3) Thoroughly washing my hands whenever I get home.

    All of the above are extreme, but they’re my coping mechanisms at the moment, and I don’t really think they’re that harmful (except for the shopping one, but even then it’s arguable as I tend to stockpile things the household will definitely need in order to meet the minimum spend threshold). I’m generally rundown and in a bad mental health space anyway, so all of these are helping me keep myself together.

    However, by far the biggest contributor to my coping is that I’ve stopped reading the news. I’ve subscribed to a single subreddit that is dedicated to the virus; said subreddit benefits from a group of knowledgeable users who are willing to bust any outlandish rumours pretty quickly, which I find very reassuring. I only let myself check this once a day and that aside, I’ve COMPLETELY cut myself off from all news: I won’t even wander onto The Guardian website to read other news without asking my husband to scan it first and tell me which sections to avoid in order to make sure I don’t get virus information.

    Finally, I’ve been trying to do something my therapist (different from CBT, which I found absolutely useless) suggested: I’m trying to be nice to my intrusive thoughts. They are, after all, trying to protect me and my loved ones from danger. In the past I’ve always treated intrusive thoughts as these horrible things that are ruining my life, but seeing them as an attempt to protect me has… it’s helped, a bit. I’m kinder to them now, thank them, but then tell them to stand down. My therapist compared intrusive thoughts to a friend who needs to tell someone something REALLY IMPORTANT, but the person they’re trying to tell just won’t listen or tries to dismiss the thoughts (as I always used to) so they get louder and louder in an effort to be heard. I can’t say that reframing intrusive thoughts as helpful has made them vanish, but it has lessened their severity.

    Apologies for the length of this (fast typist + subject close to my heart = novel!), and hope things calm down soon! x

    February 5, 2020
      • Antonia

        REPLY

        Firstly, this has been playing on my mind since I sent this comment: I realise that my long description of the prevention measures I’ve been using is *so callous*, as I somehow managed to miss the entire section about Max and nursery when reading your post first time. It was only when I went back and re-read that I realised that I’d listed a bunch of stuff that doesn’t apply to your scenario and I’ve felt like a monster ever since*. I’m lucky in a way in that I don’t really go out much in public anyway bar medical stuff due to my stupid fail of a spine so it’s been pretty simple for me, really, to tell my husband (who is the one who actually goes out) to follow the measures above and do the handwashing etc; I’m a lot more in control of my environment and I just… didn’t think. I’m so sorry :/

        Just to add, re: reading the news… can you blame yourself? There’s this big new thing, surrounded by misinformation and conspiracies. You can’t see it; you don’t even know if it’s near you; you have really legitimate concerns about how it might impact your family… what can you do but read about it? I’m basically trying to say “give yourself a break”; no one with OCD gives in to these compulsions because they make us happy; they satiate a need. Sure, we should fight them and BE STRONG AT ALL TIMES, but sometimes, there’s no fight left and you have to do what helps you get through the moment.

        *I also sent an apology via Instagram and then panicked/overthought about THAT and deleted it, so consider this an apology also for if you got a notification and then tried to figure out what had happened to the actual message…

        February 6, 2020
  • Hazel Dancey 🐻

    REPLY

    Hi Amber, I also suffer from health anxiety because I’m so squeamish, I find it helpful to only trust the NHS website and the BBC news. I just stumbled across newsrounds take on the coronavirus, maybe we shoud only stick to this for our news. I wish you all the best, take care. Hazel 🐻
    https://www.bbc.co.uk/newsround/51234497

    February 6, 2020
  • Hazel Dancey

    REPLY

    Not sure that was exactly the right link, it was supposed to be about why the coronavirus is not as scary as you may think on newsround. I’ll try again 🤔
    https://www.bbc.co.uk/newsround/51342366

    February 6, 2020
  • Anna

    REPLY

    Thank you so much for this. I have been to the doctors with a headache, (convinced I had brain tumour), swollen lymph gland (assured me it was just that, but I am still convinced it’s cancer), spotting in between my periods (told me it’s my contraception). I’ve been so pre occupied with the other issues that it was only today I started to panic about Coronavirus, and had a panic attack at work. This is the first time I have understood the OCD style cycle, and it now makes so much more sense.
    I have forwarded this to my partner and mother, who I think will also benefit from understanding it, before I completely drive them away, which I am scared I am not far off doing.
    Thanks again, I am going to spend tonight reading more of your amazing posts.
    Anna

    February 10, 2020
  • Helen

    REPLY

    So much of this resonates with me. And to add to this by the time I have googled ten thousand articles I shouldn’t have, despite knowing from previous episodes that it’s a really bad idea, the other issue is actually becoming quite knowledgeable on the issue. So ‘normal’ people who have looked at just one or two (reputable as they like) sites cannot even begin to reassure me, it is a non starter. I also hate the time that is lost by worrying, and totally get the not enjoying the moment due to worrying constantly. This has been a trigger for me.

    February 15, 2020
  • Yeah I’m starting to find it a bit scary too. My husband is a germaphobe and has been panicking for weeks!

    February 26, 2020
    • Debs

      REPLY

      I’ve struggled with general anxiety for many years and currently really struggling with anxiety over the Coronavirus health scare which has literally consumed my thoughts especially over the last week. I’m feeling very panic stricken and not sleeping at all well. Two of my sons have pregnant partners which is such a joyful feeling as I already have two grandchildren I adore but of course there’s now the added weight of worry and fear of them getting ill . Amber your post was like reading a description of myself. I know and promised myself to not trawl the internet and just stick to updates from one trusted source but after a day of refraining I succumbed last night and spent ages trawling through for new info and reassurance. I’ve managed a few hours sleep and now up for work feeling exhausted. I’m sure just being able to off load a bit here has eased my panic mode though so thanks for your blog. Sending you all positive wishes. My goal today is to not allow myself to be consumed by such negative thoughts x

      March 10, 2020
  • Poo pants Dave

    REPLY

    Well, I’m a relative newcomer to health anxiety. Reading this for the past 5 mins stopped my current bout of arse exploding and made me laugh so hard that I nearly went number 1. Well I believe that I’m the male version of you. My wife said to me the other day “well, at least this coronavirus will take your mind off the thoughts of cancer” my reply ” you’d think so wouldn’t you”. So now I know that the virus will kill me because my body has been weakened by the undetected cancer that I may or may not have. When the virus then gets my wife (which it surly will, trust me i have had the calculator out and everything), who will look after my daughter?

    March 16, 2020
  • Emily D

    REPLY

    Hi Amber,

    The last few weeks have been a living hell for me so I decided today to come out and look for other people suffering from health anxiety, and found you! I loved your essay and wonder how it’s going for you a couple months later. And I look forward to reading the rest of your posts.

    My own situation: I live in the US (though lived in England for 9 years and reeaaally miss the NHS!) and I’m an epidemiologist, so I’m torn between wanting to learn more about coronavirus in order to understand (infectious disease is not really my area) and winding myself up with bad, scary news. I’m also angry at our leaders for being so crap at dealing with all this but that’s another issue. In addition to being scared about my own health (I have asthma) I have a long-standing pattern in which I worry about getting other people sick. And I really worry right now about being able to do so little to protect people who are vulnerable and have to work in supermarkets and emergency rooms to keep the rest of us healthy.

    Anyway, take care and hope you’re coping!

    Emily x

    April 24, 2020
  • Kate

    REPLY

    Ah, thank you for writing this – it’s so comforting to know I’m not the only one feeling this way! Health anxiety sufferers unite 💪🏽. I mean this has to be the crappiest period in all our lives x

    May 1, 2020
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