Health Anxiety Disorder

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 students 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 your student becomes easily alarmed about his/her health. This typically leads to excessive checking behaviours to ensure s/he isn’t sick, such as frequent visits to the school nurse and use of home devices in school (e.g. a blood pressure machine or thermometer), as well as persistent questioning of you, peers, and other school staff to determine whether or not s/he is ill. Alternatively, the student may avoid medical attention completely due to fear of what may be discovered. Even when a student 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 his/her life at school and beyond.


Fear or Fact Seeking: Chronic Medical Conditions and Worry in the Classroom

While youth with health anxiety do not always have a medical condition, some do. If your student has a chronic medical condition such as asthma, food allergies, diabetes, or another illness, 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 student might have a health anxiety disorder? In order to make this determination, it is recommended you consult with your school counselor and speak with your student’s parents to gather the necessary information. An important element of this determination is assessing whether the student’s behaviours are a result of fear or fact seeking. Students with excessive anxiety about their medical condition are ruled by fear. Fear tells them not to go to go on the field trip 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 allay their fears, 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 the student never feels better. Fact seeking on the other hand allows a student with a chronic condition to understand the dos and don’ts to managing with his/her condition in school. 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 school staff that will help when you the teacher are not available, and reasonable precautions outlined by the student’s doctor to ensure his/her condition remains stable. As a result, the student is able to engage in his/her academics with minimal disruption and if s/he experience small doses of worry, this creates little interference.

Downloadable Resource: Coping Strategies for Supporting Students

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Mrs. 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 and that she knew every child who had a peanut allergy and where they kept 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 lest Mrs. Ho have 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.