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Health Anxiety With Psychologist, Dr. Jesse Spiegel





Dr. Jesse Spiegel is a licensed clinical psychologist in Los Angeles, CA. He specializes in the treatment of children, adolescents, and adults struggling with obsessive compulsive disorder (OCD), anxiety, depression, insomnia, and other behavioral challenges. Dr. Spiegel is also a clinical instructor in the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA.


What is health anxiety?


Health anxiety typically manifests in two primary forms: illness anxiety disorder and somatic symptom disorder. Formerly known as hypochondriasis, illness anxiety disorder involves an excessive preoccupation with one's health and the fear of having a serious illness. Individuals with this disorder often go to great lengths to confirm or prevent the illness from worsening. This can involve constantly searching the internet, frequent doctor visits, and the need for reassurance from medical professionals. The constant need for reassurance may result in multiple medical appointments and phone calls.


Somatic symptom disorder differs slightly, as individuals may experience one or more distressing physical symptoms that disrupt daily life. The physical symptoms may or may not be associated with a diagnosed medical condition. The individual has excessive thoughts, feelings, and behaviors related to the physical symptoms that are out of proportion to their severity. The person genuinely experiences and is preoccupied with the physical symptoms.


Health anxiety vs generalized anxiety


Generalized anxiety can involve health concerns but typically doesn't reach the intensity seen in health anxiety disorders like illness anxiety disorder. Those with generalized anxiety may also worry about work, relationships, and other life stresses. Unlike health anxiety, which often fixates on specific illnesses, generalized anxiety can encompass various worries.

In health anxiety disorders, individuals may obsess over multiple medical issues, from unfounded brain tumors to imagined skin cancer or nerve damage from minor incidents. These concerns can shift from one catastrophic scenario to another, but they remain predominantly focused on health.

Can functional medicine make health anxiety worse?


Dr. Mary explains that one of the shadow sides of naturopathic/ functional medicine can be seen when we look at clinics that over test and over treat their patients. Functional medicine doctors may offer additional testing to patients that may or not be necessary. While this is often rooted in trying to provide answers to individuals, if the person is struggling with health anxiety than regardless of the answers the additional testing and continued treatments may create more hyper vigilance in the individual, perpetuate seeking behaviors and worsen the anxiety that is at the root.


For example, let’s say Joe comes into a functional medicine practice with the complaint of brain fog and fatigue, and he has seen an endocrinologist, a rheumatologist, has had an MRI and does not have any answers. He is worried he has a brain tumor that is causing his symptoms. The functional medicine doctor tells him he needs to do a $500 stool test to find answers so he does. The stool test comes back with a bunch of markers that are “out of range” and the doctor tells him this is likely contributing to his fatigue and they need to treat it. Joe is relieved because he finally has answers. He starts taking the 15 supplements the doctor gave him, and he starts to feel better.


He feels better for several weeks, but then starts to regress so he returns to his functional medicine doctor who says they should repeat the stool test, $500 more… now they find a different imbalance that they suggest treating… so he takes 10 different supplements. And symptoms get better.


… but the fatigue and brain fog get worse again, and he believes the brain tumor is growing.


You can see in Joe’s case the little bits of reassurance he is getting after each stool test helps him to feel better, but only for a little bit, then things get worse again.


This is a pattern I have seen again and again. And is also why I am now very cautious about avoiding unnecessary testing, and suggest against using unvalidated tests that may give misleading information that lead to over treating.


If you run hundreds of markers/tests on a single person, it’s not if you will find something, its just when will you find it.


If in this example, the doctor had identified that Joe has health anxiety, and treated him for that. Joe may have noticed more anxiety in the very beginning as he went through exposure therapy but in the long term, anxiety would likely improve greatly.


In illness anxiety disorder, the quest for reassurance resembles applying a Band-Aid to a wound—providing short-term relief but ultimately failing to address the underlying uncertainty. Despite reassurance or online research offering temporary respite, doubts persist, fueling compulsive behaviors that never fully alleviate anxiety.


Health anxiety treatment

In treatment, exposure therapy plays a pivotal role. Patients confront their fears directly, abstaining from compulsive behaviors to build tolerance to uncertainty.

While statistically unlikely scenarios may provoke distress, learning to manage uncertainty is paramount for long-term improvement.


Accepting uncertainty doesn't entail dismissing potential risks entirely but rather acknowledging that absolute certainty is unattainable. Through exposure therapy and cognitive reframing, patients can develop resilience in facing uncertainty, a crucial step in their journey toward recovery.


Acceptance and Commitment Therapy (ACT), offers significant benefits. A key aspect of this therapy involves aligning actions with personal values and goals. For individuals grappling with health anxiety, exploring their life aspirations—be it nurturing relationships, pursuing parenthood, or traveling—can shed light on whether their current behaviors align with these aspirations. By reframing their focus from immediate medical concerns to long-term fulfillment, patients can find meaning and purpose beyond their anxiety.


Maintaining structure and engaging in meaningful activities can also mitigate anxiety. Smart individuals prone to overthinking may benefit from establishing routines and pursuing activities that provide a sense of purpose. Recognizing that struggles with anxiety can manifest differently for each individual underscores the importance of tailored approaches in therapy. Even if someone doesn't meet the criteria for a specific anxiety disorder, addressing their challenges and facilitating personal growth remains crucial.


Is there a way to get family members/systems involved to help those with health anxiety?

Ultimately, the crux of the issue lies in the realization that reassurance-seeking behaviors aren't effectively aiding patients. The goal shifts towards helping patients set limits on these behaviors. However, as a provider, controlling such actions within the clinical setting proves feasible, but patients may continue these habits independently or seek reassurance from other sources. This underscores the need for collaborative care among all involved medical providers and mental health practitioners.


It's crucial to approach patients with empathy, acknowledging the distress driving their actions. They engage in reassurance-seeking due to the overwhelming fear of catastrophic outcomes impacting their lives and loved ones.


Avoiding shaming and instead gently setting clearer limits is essential in guiding them towards healthier coping mechanisms.


Patients often feel an urgent need for answers, exacerbated by the constant accessibility of information through smartphones. The instant gratification culture perpetuated by mobile devices can intensify this sense of urgency, making patients resort to extreme measures.


There is a pervasive nature of urgency-driven behaviors in managing uncertainty in those struggling with health anxiety. Helping patients navigate this cycle involves not only setting boundaries but also fostering resilience in tolerating uncertainty and gradually shifting away from immediate reassurance-seeking.


What trends on social media could be making health anxiety worse?


While social platforms can offer a sense of community, they also present risks. People often turn to social media seeking answers, connecting with others who may share similar experiences. However, it's important to remember that not all sources on social media are reliable.


Influencers and content creators may excel at marketing themselves but lack expertise in medical matters.

Seeking confirmation of medical conditions from unverified sources online can perpetuate anxiety and lead to the adoption of harmful behaviors. Thus, for those with anxiety disorders, minimizing exposure to social media may be beneficial for their overall well-being.


Questions? Let us know below. We're happy to address them on our socials for everyone to benefit.



Disclaimer:

The information in this blog is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this blog is for general information purposes only. Modrn med and Dr. Mary Pardee make no representation and assume no responsibility for the accuracy of information contained in or made available through this blog, and such information is subject to change without notice. This blog does not provide medical services, diagnosis or counsel. You are encouraged to confirm any information obtained from or through this email with other sources, and review all information regarding any medical condition or treatment with your physician. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this information.


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What about social anxiety

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social anxiety is very common, it just wasn't the focus of this podcast. Dr. Spiegle does help people one on one with social anxiety as well.

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