It’s Not Just “Hypochondria”: Health anxiety in a public health crisis

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The pandemic has taken a toll on everybody’s mental health, but those with health anxiety have been more severely affected. How can we continue to keep the public safe while also understanding the impact of COVID-19 on those with health anxiety?

By this point, we all know the feeling. You’re on a bus, or a train, and after touching a surface, you become unnaturally aware of your hand. You reach for your little bottle of sanitizer, but in the meantime you’ve touched your phone and your bag – does that mean it’s too late? Have you contaminated your belongings already? And how effective is your hand sanitizer, anyway?

A few minutes later you go to adjust your mask but then realise you’ve used that hand, and it doesn’t quite feel safe. Existing in and using public spaces, even with masks and increased hygiene precautions, has become charged with a new and justified sense of anxiety, especially for those of us who are more vulnerable to the virus. But what about those who were anxious before anyone had even heard of COVID-19?

What is health anxiety?

Health anxiety, previously known as ‘hypochondria’, isn’t talked about as much as other mental illnesses, but that doesn’t mean it’s any less real. Before the pandemic, it’s estimated that about 5% of the population experienced severe anxiety about their health, but in 2020 that figure has risen to 15% – and that’s even higher amongst the clinically vulnerable. 

It’s not just those with health anxiety who may be finding 2020 an incredibly difficult year. Advanced hygiene and social distancing measures, while of course crucial in terms of suppressing coronavirus and saving lives, can also trigger those with mental illnesses like Obsessive Compulsive Disorder (OCD). Even pre-COVID-19, many people with OCD found that stringent measures around health and hygiene often led the symptoms of their disorder to worsen, or new obsessions or compulsions to develop. 

My personal experience

Personally, the first lockdown created a perfect storm in regard to my health anxiety. I’d had bad experiences with it before – aged 18, during my A-Level study leave, the hours upon hours I spent at home ‘revising’ led inexplicably to panic-googling of vague symptoms that didn’t really exist. I spent afternoons convincing myself I had an inherited heart condition which meant I was going to drop dead any second (because I’d had one bout of palpitations worrying about exams). I was suddenly convinced that I had become the youngest recorded case for motor neuron disease (because my pinkie fingers were, naturally, less agile than the rest), or a brain tumor (because I was having repeated stress headaches). 

It seems ridiculous recounting it now, but back then I was genuinely convinced that I must, for one reason or another, be on the brink of death. I was convinced that I wasn’t going to make it to my 21st birthday. One of the most difficult things about my health anxiety, back then, was that the irrationality and bizarre specificities of it meant I felt like I couldn’t tell anyone. When your history teacher asks you if you’re okay after a particularly quiet revision session, it’s not exactly like you can respond: “No, I’ve persuaded myself I have a rare form of cancer, thanks for asking” without receiving a very confused look.

As hard as it was, at least I knew it was an irrational fear. On the rare occasions I did disclose these worries to my mother, she would just tell me I was being silly and that I should be going to the doctors for anxiety, not any other physical illness. For a few days, that would set my mind at ease before I inevitably found something else to convince myself I had. 

An unexpected relapse

After A-Levels and the long summer after them had ended, I moved away for my first year of university and found that my anxieties rapidly eased after a change of scene and all of the excitement that came with being a fresher. I’d almost forgotten how hard that period of my life felt until lockdown arrived. Suddenly, I was back at home again facing hours upon hours to fill with nothing but worry – except it wasn’t just me this time. After weeks of postponing lockdown and downplaying the significance of the crisis, the UK government U-turned and implemented measures, and with it the media became overwhelmed with story upon story about COVID-19.  

It didn’t feel ridiculous or unjustified to spend an afternoon scouring the Internet, trying to find out if having a slightly stuffy nose was a sure sign I had the virus – to a degree, everyone else was too. I remember particularly dark moments of trying to calculate my personal risk level and that of my parents, panicking whenever the media reported the death of somebody my age and convincing myself that in a few weeks, that could be me, or one of my friends.

How can we help those with health anxiety?

I’m not the only one whose previous mental health problems have been especially triggered by the pandemic. Others with OCD, Generalised Anxiety Disorder or health anxiety find that it’s a lot harder to label their compulsions or fears irrational when the entire world now seems to share them, and TV and newspapers now seem to be validating them. 

Unfortunately it’s not really an effect we can mitigate, in my opinion. Social distancing and hygiene measures will be needed to protect the lives of the vulnerable and the elderly, until either a vaccine has been found or the virus has been significantly suppressed. Mental health has far too often been used as a straw man by anti-lockdown protestors and right-wing journalists, who would previously not have commented on or cared about the topic at all. They ignore the fact that coronavirus spreading through the population unsuppressed and causing far larger death tolls would be even worse for national mental health, and especially the mental health of the clinically vulnerable. Even though some media reporting upon the virus has been irresponsible, it’s overall far better for the majority to be concerned by the virus, and thus take measures in place to suppress it seriously, than for the public not to adhere to measures at all because the virus’ severity is being downplayed. 

What we can do is acknowledge that disorders such as health anxiety and OCD are real and far removed from their often minimised or stigmatised portrayals in the media. The UK is facing a mental health crisis at the moment, with levels of anxiety and depression increasing rapidly, while access to already-underfunded mental health treatment is still overwhelmingly virtual.

Going forward, we need to acknowledge the impacts of the pandemic upon national and individual mental health, but particularly amongst those who have developed specific health-related anxiety, or whose existing health anxieties have been exacerbated. We need to be careful that media headlines and public health messages are accurate and designed to promote caution and adherence to restrictions, not uncontrollable fear. Perhaps, if future public health messaging and restrictions are made with both physical health and mental health firmly in mind, the new normal can be a kinder one.