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This time I really am sick

Updated: Mar 29, 2022

The jury is still deliberating whether health-related OCD obsessions are a sub-set of OCD or whether they are a separate condition altogether, i.e., Hypochondriasis. Suffice to say that health-related concerns present very frequently in our OCD client base, either as a primary or secondary concern. That is to say, for some, it is their major worry, whereas for others, it lurks in the background. What we have noticed, as therapists, is that health related fears tend to crop up even in those clients who have been managing their OCD well for extended periods. In these cases, there’s almost a sense of being caught out by the OCD!

There are a number of reasons for the ‘stickiness’ of this set of worries. The first is that health concerns are consistently at the forefront of media attention, and as we’ve seen with COVID, can be relied upon to whip the most rational of folks into an emotional frenzy. The other probable reason is that health worries aren’t quite as bizarre as some OCD fears and sit only just this side of irrational. When it comes to health, the matter is highly subjective and emotive, and as a client once said, sometimes there is a fine line between cautious and crazy.

I’ve seen articles that seek to differentiate between OCD and Hypochondriasis on the grounds that hypochondriacs won’t have other unrelated obsessions & compulsions. Well, we realise that hypochondriacs might not have OCD but the question is, do people with OCD have Hypochondriasis or are their health obsessions a sub-set of OCD? I’m personally leaning towards the latter but from a treatment perspective, the answer doesn’t necessarily matter. I would imagine that Hypochondriasis and health-related OCD fears would be similarly treated with CBT (Cognitive Behavioural Therapy) and a healthy (sorry!) dose of ERP, supplemented with ACT (Acceptance Commitment Therapy) and Mindfulness. In any case, this is one of those rare situations where the OCD symptoms are identical to those of another disorder and they are:

  1. Constant scanning for physical or mental symptoms, e.g., lumps, aches, pains, forgetfulness, etc. This may include standing in front of the mirror, counting freckles or lumps, daily breast exams, mental reviewing of previous situations, amongst other compulsions

  2. Catastrophising each new suspected health symptom so that there will be a noticeable leap to panic and dread, bypassing concern. We have noticed that there are recurring illness themes which often vary according to media concentration and are currently cancer (particularly throat, skin or brain tumours), Alzheimers/dementia, heart disease, COVID, stroke, HIV and sudden onset blindness

  3. Seeking reassurance is almost always a feature and this will take the form of expressing concerns to friends, family members or partners, often accompanied with questions relating to their own health, for example, ‘Have you ever felt dizzy, breathless, strange, nauseous, sore., etc? There may also be some mutual examination of physical symptoms leading to……….

  4. …extensive Googling of symptoms or case studies. This will be carried out by the person with OCD or, if they are too anxious to ‘learn the worst’, they may ask someone to Google for them

  5. Frequent visits to the doctor or specialist. Sadly these professionals are unlikely to realise that the concerns may be OCD-related. They will uphold their duty of care by taking the matter seriously, offering detailed explanation and analysis, suggesting tests and various alternative diagnoses, all of which will exacerbate the situation. Some doctors may sense the presence of a mental health imperative but only after repeated visits

  6. Outside the episodic health ‘crises’, there is likely to be ongoing health and safety hypervigilance which manifests as checking food ingredients, researching household chemicals, checking sell-by-dates, investing in numerous health supplements, following health regimes that gain media attention, etc.

  7. Avoiding likely sources of injury, illness or disease such as hospitals, doctor’s waiting rooms, adventure sports, public recreation facilities, the homeless, animals and pets, children and people who are unwell or suffering

  8. Avoiding films or TV shows about illness or disease, particularly life changing or terminal illness

  9. Excessive exercise or highly restrictive diets (Orthorexia) may feature and will deteriorate over time

I remember a conversation with a client who had been coping impressively well for years with their OCD who called me regarding an ongoing health scare. They were awaiting the results of a test and wanted me to know that their news might be quite bleak. I was initially concerned for them. Then they said, ‘This time, it’s not OCD, this is a real fear! Health is a very real issue!’. Sure enough, their test was negative and it transpired that their family had suspected OCD throughout. Health is an issue of course, but in the case of Hypochondriasis, or OCD-related fears, it turns out that mental health is the real issue.

See our recent Health OCD post on Instagram

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