Can grief trigger health anxiety?
I kept my head low; my breath was sticky and sour as I inhaled the paper mask. I looked around, that hospital blue. I could colour match it in my sleep. The doctor was kind, reassuring, as she told me once again that I was fine. There was nothing wrong with me.
I should have been elated. The small rash that had appeared, overnight, on my left breast wasn’t cancer. It was just a minor skin infection. But I was ashamed. I left the ward with angry sentences circling my head. How am I back here? Have I not left this behaviour behind? Will every minor grievance become my death sentence? Is that just how my brain works now?
Health anxiety, also known as hypochondria, is “when you spend so much time worrying you’re ill that it starts to take over your life” (according to the NHS website). It’s hard to find official statistics on it, as most of the research available is related to generalised anxiety but it is believed that over 8 million people in the UK are experiencing an anxiety disorder at any one time. When I asked Claire Williams, specialist grief counsellor and founder of Therapy Finders, if she’d seen a rise in the number of patients experiencing health anxiety in recent years she said she had, particularly post pandemic. And, when I asked my (relatively small) Instagram following if they had ever experienced it I was deluged with messages.
But while a lot has been written about what it is, how to recognise it and how to overcome health anxiety, there’s very little discussion on what causes it. That was until I watched Lewis Capaldi open up about the impact that his grandmother's death and aunt's suicide - that both took place in quick succession during his formative years - had on him as an adult. It was only in his twenties, and struggling with the pressures of his newfound celebrity and music career, that he realised how these two familial losses had shaped him on a deeper, long-term level. In his new film, How I'm Feeling Now, he discusses his own physical and mental health concerns, including being a "huge hypochondriac" and how they interplay with one another.
His experiences rung true with me. How much impact the health of the ones we love can have on our psyche. When I was 19 my mum was diagnosed with a brain tumour. There had been very little sign of this ticking time bomb, she was – up until that point – healthy. And… then she wasn’t. She was given days to live. Of course that’s going to impact the way I view my own health; I’ve been shown, in the crumbling of the person I loved the most, how vulnerable we really are.
But if grief, or a loved ones illness, is a trigger for health anxiety, does it help us to know that? Can finding the cause help us to conquer it?
Constant checking
Three times a year Patil books herself in for a full body, all over check-up. “Every little thing I feel in my body, my mind takes it to the worst case scenario,” she says. “I’ve had three endoscopies, I get my ovaries checked twice a year…” These tests are mostly covered by her health insurance (Patil lives in Dubai) but she will pay herself on the occasions they aren’t – but they help keep her mind “at peace.”
“For the past five years I’ve been dealing with stomach issues and my mind immediately goes to cancer,” she says. “It’s definitely got better but the fear is always there.” It makes total sense that Patil’s brain would always jump to the worst conclusion. Her mum passed away from stomach and ovarian cancer. Like me, Patil knows that illnesses can lurk within us, without us having any idea that it’s there.
So, is it always the case that health anxiety is triggered by a loss or illness in your life? “Not necessarily,” says Williams. “If someone has grown up in a family with somebody else, who has a health anxiety issues, this can become learnt behaviour. Particularly if it's experienced from a young age and it just becomes your normal way of thinking. But for sure, it can also be life events. A death can definitely be a trigger.”
From a young age we know that death happens. We’re taught it in school, or (for those of us who are lucky) a pet dying leads to our parents, or guiding figures in our lives, to talk to us about death’s reality. And yet, in general, as a society death is a hushed up, unspoken about thing. I write a newsletter about grief and I hear the same thing, every time, from the people I interview: they felt they had to keep quiet about the impact their grief has had on them. Why? Death and its impact feels taboo in our culture.
“We don’t spend a lot of time thinking about death, but it is going to happen to all of us,” agrees Williams. “So when we are presented with it, someone close to us dying, it can lead us to question 'okay, this is exactly what’s going to happen to me'. Particularly if the person had a lot of suffering before their death.”
A tricky thing to manage, if you have health anxiety triggered by grief, is that grief itself can cause a range of physical symptoms. In the aftermath of a bereavement (though these symptoms can show themselves later on, particularly in cases of delayed grief) you can feel anything from physical pain to breathlessness, heart palpations and panic attacks. When discussing our health we tend to try to separate our physical from our emotional, but the two are bound so tightly they often can’t be unpicked.
I’m someone who holds my stress in my stomach. I’ve been physically sick due to grief, and, like Patil, been for multiple tests and an endoscopy to see what was wrong (all showing up that I’m fine). Yet the symptoms I was feeling were real. Like the rash on my breast, it’s never been that I just panic over absolutely nothing.
"I spiral if I get a headache, convinced I have a brain tumour," says Kali, who has found her health anxiety symptoms appearing in the past two years. "I've convinced myself multiple times that I have sepsis. I even stopped going to the gym for a while thinking I needed a knee replacement. But the thing is, I get so anxious that I get chest pains and feel nauseous..."
It also doesn’t help that Googling symptoms often presents some form of rare illness or cancer (as one friend of mine who suffers similar says “if it’s a 1% chance of anything I convince myself that I’m in that 1%”) and the advice online is always “if you’re worried, check with your doctor.” Then (and this is where I really tie myself in knots) there’s the gender health gap. Women’s pain, particularly when it comes to gynaecology, is often dismissed and overlooked resulting in stories of missed and late diagnosis for a number of conditions.
I spent around two years, with a range of symptoms from dizziness to pain in between my periods, going from doctor to doctor, test to test, and being told I was fine. I knew something was up... but was it my body or my brain? Eventually I convinced myself that my health anxiety had reached its peak, that these symptoms were all in my head and the doctors’ visits were part of a compulsive behaviour. But, by that point, I had pestered my way to finally being referred for a scan, and decided if it showed up with nothing, I’d ask for help with my health anxiety instead. The scan found a large cyst, one that needed to be removed via operation.
We’ve seen, first hand, from ourselves, our loved ones and horror stories online, that late and missed diagnoses can kill. If we know that they happen in a system set up against us, how can we ever differentiate between what’s our health anxiety and what’s a real gut instinct that we need to get checked out? Particularly in the cases when we might need to push and keep going back to be checked out?
“With [triggered] health anxiety, anything in the future that unlocks a memory of how a person felt when they [were sick themselves, or witness someone else falling ill] can make them spiral again,” says Williams. “We know it’s an irrational worry as the doctor will have run the tests, given them the all clear. It’s the trigger that will send them into this obsessive worrying.”
But, she’s clear that – if you are someone who struggles with health anxiety – avoiding the doctor or simply dismissing how you’re feeling as your health anxiety is not the route to go down. “If you’re experiencing or feeling that something is wrong, you should get it checked out by a doctor. They will never turn around and tell you that you’re being ridiculous. Also as health anxiety is something that can be helped through a treatment like CBT, if the tests come back negative you can talk to your doctor and ask them for help with the anxiety itself.”
If you have any worries about anxiety, health anxiety or otherwise, your doctor should be able to help. As they can with the physical and emotional impact of grief. “If you are completely obsessive over your health, constantly obsess in an irrational way about being ill, check yourself over and over for signs of illness or constantly talk about your ailments, illness, then these are all signs of health anxiety,” says Williams. CBT can help as it involves discovering what triggers bouts, and finding practical ways to cope with these.
For Kara* having two rounds of therapy helped her realise how much her parents illnesses throughout her life had impacted how she viewed her own health. “When I was growing up my mum had a drinking problem and was constantly ‘ill’ locking herself away in the bathroom or spending the entire day in bed,” she says. “Her alcoholism eventually led to health complications, both physically, including seizures and mentally, with suicide attempts throughout my teens.” After moving in with her dad (during which time her mum got sober) he was diagnosed with cancer, something Kara was kept in the dark about (“he thought the stress of mum was enough.”) Her step-mum is also now currently dealing with the health impacts of alcoholism.
“I’ve had generalised anxiety for a really long time with a big tendency to catastrophise,” Kara says. “Triggers include getting phone calls from loved ones and assuming the worst, to hearing one of them even cough or sneeze and panicking that they’re not ‘healthy.’ During Covid this really amped up and, for the first time, I started doing it to myself, thinking every ache or itch was a sign something was wrong with me. It’s only through therapy that I’ve realised this all stems from spending most of my life thinking one of my parents is about to die or become seriously ill.”
Kali agrees that therapy has really helped as it uncovered the root of her anxiety. "I've reached a place where I'm really happy with my career. I'm so grateful for my life. But I had a childhood where I grew up in a toxic environment, always looking for something bad to happen. Now I'm happy and feel safe, my therapist thinks it's my brain thinking 'what's going to come and ruin it?' It really helps just saying it out loud and not keeping how I feel inside."
“Therapy can really help with anxieties around health, CBT therapists will give you all kinds of tasks to help you manage and cope,” says Williams. “Another step you could take is to write down your ailment and then make a whole list of other things it could possibly be. For example, if you have a headache think ‘have I had a lot of coffee today?’ ‘did I get a good night’s sleep?’ Just writing things down can help. But I’d also recommend not trying to self diagnose via the internet, as it’s so easy to misdiagnose yourself from most symptoms.”
For me, I’ve found the more I’ve spoken about my fears surrounding my health – and the ways I can twist and turn within it (is it my health anxiety or is it something real) the more rational I can be. I can recognise now that when I’m tired, stressed or have drank too much at the weekend it’s easy for me to spiral into a Google diagnosis hole. In those moments I try to capture and write down how I’m feeling, so I can check in in a few days, and if I still feel concerned then book in with the doctor. But mostly, just knowing others are experiencing similar helps, as Kara says: “for all the incredible therapists I’ve spoken to, nothing has quite the same impact or effect as speaking to those who have gone through it and understand it first hand,” she notes. “That’s not to say the therapists don’t understand but it’s the two way dialogue I find most helpful. The biggest barrier I’ve faced is thinking I’ve brought this up on myself, so understanding other people’s stories has helped me feel much less like it's my fault.”
You can follow Catriona on Instagram, and her newsletter where she discusses grief can be found here.
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