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 youth 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 the child is easily alarmed about their health. This typically leads to excessive checking behaviours to ensure they aren’t sick, such as frequent visits to medical professionals and use of home devices (e.g. a blood pressure machine or thermometer), as well as persistent questioning of others to determine whether or not they are ill, and other behaviours. Alternatively, the youth may avoid medical attention completely due to fear of what may be discovered. Even when a child 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 life of the child and family.
Fear or Fact Seeking: Chronic Medical Conditions and Worry
While children with health anxiety do not always have a medical condition, some do. If your child has a chronic medical condition such as asthma, food allergies, diabetes, and others, 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 child might have a health anxiety disorder? In order to make this determination it is recommended you seek an assessment by a medical or mental health professional. However, as a parent you can contribute to that assessment by starting to observe whether your child’s behaviours are a result of fear or fact seeking. Children with excessive anxiety about their medical condition are ruled by fear. Fear tells them not to go to a friend’s home 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 calm their worries, 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 your child never feels better. Fact seeking on the other hand allows a child with a chronic condition to understand the dos and don’ts to managing and living with his/her condition. 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 community members who will help when you the parent are not available, and reasonable precautions outlined by your child’s doctor to ensure his/her condition remains stable. As a result, your child is able to engage in his/her daily life with minimal disruption and if s/he experience small doses of worry, this creates little interference.
SIGNS & SYMPTOMS
Thoughts (very young children may be unable to identify fear thoughts):
- What if my cold turns into pneumonia and I die?
- I’ve had three headaches this year. I’m sure I have a brain tumor!
- What if that pain means I have cancer?
- I don’t think my doctor is qualified enough
- No-one understands me
- Tired or fatigue
- Muscle pains
- Difficulty falling or staying asleep, or disturbed/interrupted sleep
- Excessive body checking
- Reassurance seeking
- Researching illness and treatments
- School refusal
COMMON SITUATIONS OR AFFECTED AREAS
- School absenteeism
- Frequent trips to medical professionals
- Inability to participate and enjoy recreational activities and clubs due to trying to prevent exposure to perceived germs or illnesses
- General decline in quality of life- less involved in activities, limited interests, time spent worrying
- Unusual or overly focused interests- frequent research of medical illnesses and treatments, becoming an expert on identifying diseases, etc.
How health related anxiety impacts the child at different ages:
Young children typically worry about a single symptom like a headache or stomach pain, or a condition they have, rather than a specific illness. For some this worry stems from a lack of understanding, and can be managed through basic education, but for others the worry persists. As children mature, but while their capacity for abstract reasoning remains undeveloped, some children may engage in extreme leaps of logic such as worrying about dying from a cold or catching cancer. As children get older, however, their thinking evolves and specific worries may become more complex or future oriented. For example, “What if that pain means I have Leukemia?” or, “What if the effects of MSG and GMO foods build up in my blood stream and I get cancer in my thirties?” Despite the variation of what worries youth, most youth with health related anxiety are unable to recognize that their chronic focus on symptoms or illness, and related behaviours, is unreasonable because they are so anxious. The anxiety trumps logic. In addition, the negative impact of the ongoing, constant worry becomes more disruptive and pervasive over time. It may take less energy to reassure your seven year old that leg pain is probably bone growth and not cancer when the worry has existed for a week; whereas when it has persisted for months or even years, your child may become increasingly demonstrative and aggressive in his demands to have a second or even third opinion from a “more qualified” professional. The bottom line is that excessive and uncontrollable worry about health is not a typical characteristic for youth, and left unaddressed can significantly negatively impact his/her quality of life.
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