Hannah Bowles is a healthy 25-year-old but last year she started to believe that having a cup of tea would kill her.
“I fiercely believed that the caffeine in it would give me a heart attack, and that cooking my family a meal with dairy would give them food poisoning and they’d die”, she explained. “I worried about my health and my family’s health constantly.”
Fearing for her health to this degree is a relatively new experience for Hannah, who lives in Bookham, Surrey. On a bad day she will spend all day “on the brink of panic”, inspecting her body in case she has any lumps, and if she gets a palpitation or a small ache, “I can’t be alone in the house because I want to know someone is there in case I go into cardiac arrest”.
She adds: “The irony is that I’m healthy, not over or underweight and without a family history of heart disease, but at those times I feel that anything could kill me or my family and it’s hugely distressing.”
Worrying about our health isn’t unusual, but Hannah has health anxiety, otherwise known as hypochondria, where worrying about illness is all-consuming. Health anxiety sufferers often seek reassurance from family and friends, check their bodies for symptoms and find out so much about illnesses they fear they have, even when there seems no medical reason to worry and all the right tests have been done.
Vicky Potts, 45, from Irby, Wirral, regularly wakes up in the night in a panic, convinced her heart is about to stop and that she’s a few seconds away from death, despite the fact her heart has been checked by many doctors. “It’s extremely scary,” the 45-year-old tells i. “I have a complete obsession with my heart and think about it too much every day, how my chest feels, how fast or slow my heart is beating, if it’s skipping or palpitating.”
While health anxiety is relatively common, the pandemic and the idea of mass-contagion has caused it to intensify for many, or has sparked it in people who never felt especially anxious before.
Dr Heather Sequeira is a consultant psychologist who says that she’s had at least four times as many referrals for health anxiety since the pandemic began. Her clinical practice in Milton Keynes is full, with a waiting list until October.
“Many people are seeing me with so much fear they are not currently leaving the house or even opening their windows,” she says. “Some spend many hours washing themselves and/or ‘disinfecting’ their home. Unfortunately, this is often with hazardous substances such as bleach or Brillo pads and scalding water that have potential for damage that far exceed the risk of Covid in their home environment.”
Her clients often experience intrusive thoughts about themselves or their loved ones dying from Covid, “and can focus on little else”, having repeated unnecessary Covid tests, seeking repeated reassurance from their GP or just “wasting hours consumed by worry”. She says people have left jobs, or have avoided physical contact with their young children, among other life-changing responses.
Women are nearly twice as likely to experience anxiety as men, a global review revealed in 2016. Its University of Cambridge authors say that as well as women, young people under 35 and those with health problems are particularly affected.
They estimate that four in every 100 people have anxiety. For Natalie, 41, who has long had health anxiety and has gone to “endless doctor’s appointments” to have every blood test possible, the pandemic has brought with it some huge setbacks, and confirmed some of her greatest fears. Her doctor of 35 years, who always gave her “peace of mind”, died of Covid, and before that, in February 2020, her mother died suddenly of a heart condition that nobody had seen coming. “I have googled everything about Covid when I can’t sleep at night, and my throat feels like it’s closing up.”
One of the really difficult problems with health anxiety in the pandemic, says Dr Sequeira, is that people misinterpret regular anxiety symptoms for Covid symptoms. “It’s important to note that the same symptoms produced by anxiety include breathing changes, heart rate changes, chest pain, headaches, dizziness and muscle pain. This can be a very difficult trap to get out of as the more anxiety a person experiences about Covid the more physical anxiety sensations they feel and the more convinced they feel that they are ill.”
This is something that epidemiologist Joe Brew thought about when creating his cough-detection app during the pandemic. Brew, who worked for the Florida Department of Health, this year launched Hyfe in the UK, a phone app that uses artificial intelligence to detect and track users’ coughs.
The app “listens” for coughs among the thousands of background noises created each day, and collects data on the sounds, allowing people to monitor their own cough frequency, and the type of cough it is. The idea is that individuals can work out whether their coughs are normal for them, or something to seek medical advice about.
“I think we all probably had at least a moment at some point in the pandemic when we got a little cough, felt a little unwell,” says Brew. “Could the app maybe reduce anxiety? You might think your child has been coughing a lot. Imagine the app listens to the coughs and says, ‘Hey, don’t worry, this is a really low probability of that thing you’re really worried about.’
“Or maybe you feel that Covid has made you pay so much more attention to symptoms, and if you could work out that you normally cough on average 40 times a day, then the day you feel worried because you have a headache, you can see whether you’ve also coughed more or whether you’re just noticing your health more. Maybe it’ll help you relax a little bit.”
Brew says he used the app on his three-year-old son a couple of weeks ago, when the toddler had a bad cold which turned into pneumonia and a hospital stay. “He’s fine now but I put the phone by his bed and it was interesting for me to see in the morning that while I was sleeping he coughed 26 times between 4am and 5am.” The longer-term idea is that the app will gather data on coughs across the world, creating a cough database that medics and data scientists will use to help detect diseases such as TB. “Of course, we’re not there yet,” says Brew. “It’s a regulatory minefield. There’s a lot of technical challenges along the way. But that’s our hope.”
Even more ambitiously, Brew and a team of scientists dream of seeing if they can one day use the cough data to detect an outbreak of a respiratory virus. “We think that knowing when and where people cough could help us even identify the next pandemic – so the next emergent pathogen before we even have a name for it before we even know what we’re looking for, and therefore we don’t have laboratory tests for it. Imagine if you could just see a heat map of the people in an area, there’s been a 67 per cent increase in coughs that’s way outside of the statistical norm, something’s going on…”.
Whatever part Hyfe plays in spotting a pandemic before it becomes one, the reality is that the very idea of a virus outbreak threatening the NHS has terrified many, but particularly those living with health anxiety. NHS England data this week show a record high hospital waiting list in England as 5.1 million people need treatment, and the number waiting a year to start treatment is 35 times higher than last year.
These are the kind of headlines that people such as Amber Connaught, a Scottish blogger who writes about her mental health struggles, says fuelled her fears, even if doctors across the country were still in reality able to see people, and A&Es were emptier than usual in many places. “I worried about both Covid itself, and the possibility of becoming ill with something else, and not being able to get treatment for it.” Hannah Bowles felt similarly: “I didn’t read newspapers for months because I couldn’t face the worry that if I did have a medical emergency I wouldn’t be seen.”
Of course, even without suffering from health anxiety, the pandemic has been an intensely stressful, fearful and distressing time for many. So it is important not to mistake being concerned about one’s health with health anxiety. Dr Sequeria is keen to emphasise that people’s medical concerns shouldn’t be batted away. “Seek advice from a doctor and, in the case of Covid, have a test. However, if tests come back negative, and you remain consumed with anxiety that you have Covid, despite being told that you do not have Covid then it may be very helpful to seek assistance for health anxiety.”
Dr Sequeira’s tips on coping with health anxiety
Keep a diary of how and when the intrusive thoughts come up and your responses to these. Log the frequency of checking symptoms, asking loved ones or doctors for reassurance, researching information on the internet, or avoiding normal activities such as going outside or touching everyday objects.
Turn the thought around and look at the ‘cost’ of worry – for example, to look at what worry is taking away from life in terms of enjoyment, relationships, work and home life. People who worry a lot tend to have the assumption that worry ‘keeps them safe’. In reality, worry does nothing to keep us safe and actually costs us hugely in terms of the quality of our life and lives of our family.
Write down the intrusive thoughts and a compassionate ‘sensible’ response to them. The aim is to get a balanced view of Covid risk, to take the standard recommended precautions, but to minimise the excessive worries and actions that are undoubtedly lessening the quality of your life.
It is important to stay busy with normal activities such as exercising, or calling a friend. If you find that you are avoiding doing certain activities such as going for a walk or touching your own door knobs, try to start doing these things again. Although you fear that your anxiety is too high, it will significantly drop the more you do it. All these are good ways to start getting your life back even during a pandemic.
Why do some people become debilitated by health worries, while others don’t? “There are a whole host of reasons why someone might experience more health anxiety than another,” says Dr Sequeira. “A low tolerance for uncertainty tends to stem from previous experiences such as serious health issues in themselves or family (especially as a child), or trauma or loss earlier in their life, or perhaps a parent or carer who had high anxiety or difficulty tolerating uncertainty.”
Early childhood memories loom large for Natalie, who remembers starting to obsess about her health after she got her inflamed tonsils out when she was six years old. She says: “Due to my fever I was in and out of hospital and was quite ill. I remember my mum talking to the doctor and crying, and that created an instant panic.” People tend to try to seek certainty through reassurance or by having tests, but, paradoxically, being reassured can make the problem worse. “This is a trap that many people can fall into,” says Dr Sequeira. “Instead, a skilled psychologist or CBT (cognitive behavioural therapy) practitioner will offer the person skills to move past the intrusive thoughts and the impulse to check symptoms and seek reassurance.”
Some people are able to improve their health anxiety, and get to a point where it is less all-consuming. “My anxiety does go through peaks and troughs,” says Amber, “and I’ve been fortunate to not have anything trigger it recently – and being vaccinated helps too.” Natalie has regular therapy and has stopped googling Covid as much as she had been doing. “I am no longer scared to say I am not OK. There is still such a stigma around it, and some people close to me refuse to acknowledge it and will say, ‘Just get over it’. I’ve had this for 20 years so I assure you if I could I would have a long time ago.”
For advice or support, visit No Panic