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How Worrying Can Actually Make You Sick (time.com)
128 points by jb1991 on Dec 12, 2016 | hide | past | favorite | 41 comments



I'm currently enjoying a book called It's All In Your Head by an Irish neurologist called Suzanne O'Sullivan - review at https://www.theguardian.com/books/2015/jun/07/all-in-your-he.... Summaries of some of the clinical stories themselves are at https://www.theguardian.com/society/2015/may/16/you-think-im...

It's mind boggling (no pun intended) how far psychosomatic illness can go, even as far as resulting in blindness, seizures, and paralysis. I was never familiar with the idea of repressed memories and psychological trauma causing physical illness before and initially dismissed it as arm-wavey pseudoscience, but the amount of evidence is striking even if our level of understanding is poor. This also explains why so many people with undiagnosable pain disorders seem to get referred to psychiatrists here in the UK - people misinterpret this as doctors thinking their illness is all imaginary, it's not, but the cause of it often well can be.


> It's mind boggling (no pun intended) how far psychosomatic illness can go, even as far as resulting in blindness, seizures, and paralysis.

While I don't have physical symptoms as severe as those you listed, that's pretty much how my health anxiety manifests. I don't just have obsessive thoughts over being sick. I actually feel things. And my anxiety is not thoughts -> symptoms, it's the other way around. I start having a bunch of symptoms, give it some time hoping they will go away, but they don't. So I can't help but think something is seriously wrong. There are instances where I've dealt with a set of symptoms for a whole year.

A few examples:

- When I'm anxious over a brain aneurysm or brain tumor, it's because I started having visual distortions, tingling, my mouth won't widen on one side when I smile, etc.

- I was once worried about carotid artery dissection, because I could hear my pulse in one ear and it would stop when I pressed against my carotid on the same side (a telltale sign of CAD). MRIs in the ER revealed nothing.

- My heart acts up with PVCs every now and then, and they are so unpleasant that it's nearly impossible not to think I have a serious heart condition. PVCs can be common when people are really anxious or stressed out, but in my case they just come about in my most serene moments it seems.

- I start worrying about colon cancer whenever I get alternate bouts of diarrhea and constipation, coupled with frequent abdominal cramps. This particular anxiety gets to the point where I see blood when inspecting my output in the toilet, only for it to disappear when I blink. Mind you, it's not "hm I think that tiny spec might be blood". I actually see streaks of blood when I first look at it.

- At some point last year I started having sudden weakness in my right arm. I couldn't hold parts of it flexed, and things just seemed heavier. I was sure I had a degenerative disorder of some sort. But then it just went away after several weeks.

I could go on and on and on. It's horrible. Friends and family don't understand me, no matter how much I try to explain to them that I'm not just thinking about being sick (I'm actually trying hard NOT to think about it), but I'm really feeling a whole bunch of stuff. They always revert to "stop thinking about it and it will go away". So frustrating.


You may want to consider the possibility that you have generalized anxiety disorder. The symptoms are vast, constantly changing, and often different from person to person. Some of the things you've described like PVCs, digestive issues, muscle weakness, and obsessive thoughts are quite common symptoms. The best way I know how to manage this without pharmaceuticals is cold showers, believe it or not.


I developed something like this health anxiety starting back in April, after a severe bout of flu/some unknown and moderately severe viral illness coinciding with a bacterial skin infection. I had a very tough couple of months where I would worry about every minor physical "deviation" that I noticed. I also had constant heart palpitations, which caused more anxiety, thus triggering more palpitations. I'd spend upwards of a half hour at a time on Google, looking up symptoms and trying to figure out whether my headache was due to a common cold or a brain condition...

One thing that personally helped me recover mentally was weightlifting. Part of what helped was that I could relatively easily attribute any random (and benign) ache/pain that I might otherwise worry about to "oh, well, I just lifted recently, so my body's repairing/sore/etc" as opposed to some serious condition I found on Google. Sticking with caffeine even though I was worried about palpitations also helped me through some form of "exposure therapy," where I eventually (re)learned that caffeine is safe to consume.

Talking with my therapist helped. As did consciously reminding myself that, for a lot of rare or potentially deadly conditions, the symptoms would be much more severe than I'm experiencing, and that some symptoms (fast heartrate is a big one) can be attributed to anxiety alone.

For example, last night while lying in bed, I felt a sudden twitching on the left side of my chest at about twice my resting heart rate. I instantly jumped to the conclusion that it was my heart having rapid contractions, which triggered a burst of anxiety, but when I stopped and thought about it (the twitching seemed to be intermittent and didn't feel internal like a heart problem might, it felt external), I successfully convinced myself that it was my muscle twitching -- a totally benign occurrence. Maybe I was dehydrated.

Basically, I was able to help myself by using logic and trying to match the severity of my personal diagnosis with the severity of the symptom I was experiencing. I imagine this wouldn't be possible if I suddenly had symptoms as severe as GP, but it can help me stem these threads of anxiety before the anxiety itself causes more issues than the original problem.


> Sticking with caffeine even though I was worried about palpitations also helped me through some form of "exposure therapy," where I eventually (re)learned that caffeine is safe to consume.

However, it is a well-known fact that caffeine and anxiety don't blend very well. Be careful.


Yeah, that's true for sure. If I feel extra anxious for whatever reason (happens from time to time), I'll skip my cup or two that day. And if I have more than two cups in a day, bad things tend to happen. But I was at a point for a while where drinking a cup of decaf would make me extremely anxious (or having a green tea, I swear, even the tiniest bit of caffeine would set my heart pounding), so I'm extremely glad to be past that.


Sorry about your plight, man. How do you cope?


I just do. I used to do psychoanalysis before coming to the US and that helped a ton. I haven't looked for a therapist here, so it's a little worse now.

One thing that helped me deal better with it was getting married, and specifically getting married to a woman who had a child. This suddenly took a lot of my focus out of myself, since now I have to care for others. It also puts me in a "I can't fail" mental mode which has me worrying somewhat less than in years past. But it's still pretty bad, I just don't panic as much anymore.

Another thing that made a significant difference was starting an exercise routine. It makes me feel healthier and therefore less worried about coming down with a terrible disease.


You should start seeing a therapist, and I can help you with that. It worked then, and it will work now.

Send me an email and I will walk you through this. You may feel that you have to think it over first, but that will only exhaust you in a wash-cycle of rumination. Send the email as soon as you reach the end of this sentence.


I'm going to have to check this out. While not affecting my health currently, I definitely worry too much about the outcome of just about everything. Always glass half empty view of things, and I need to change it.


I recommend trying to be at peace with the worst case scenario. I.E. I used to worry about people stealing my things while I was asleep but then thought through how I would handle all my things being stolen and how hard it would be for someone to steal all my stuff (i.e. they can't take it all). Once I realised I only needed to replace a few key items which were quite affordable and relatively easy I stopped worrying about it.

Not sure if that works for everything but I'd figure the uncertainty is often why we worry. Realising that even in the worst case people will be able to muddle along can be a weight off one's mind.


I do this too. "Okay, the worst thing that can happen is XYZ. What would I do if that happened? I'd do ABC. Okay, I know how to handle it. Moving on."


Stoicism has been useful for me:

https://www.reddit.com/r/Stoicism/wiki/faq


For me it was Zen, which I heard is in some ways quite similar to Stoicism. A good start is Alan Watts' "The Way of Zen":

https://www.amazon.com/Way-Zen-Alan-W-Watts/dp/0375705104


I dunno, maybe I've completely missed the point in his writing, but I just tried reading "The Wisdom of Insecurity" and it seemed like almost complete nonsense to me. There were definitely a few passages that were very insightful, but the other 90% (at least to me) was incoherent rambling.


I didn't mean to recommend Alan Watts in general, though I generally like him. I just think Zen can be a bit hard to get into without some introduction and I consider Watts' decent.


>In those 12 years, about 3% of people developed ischemic heart disease—which includes heart attack—but 6% of people who had health anxiety did. “We found there was a surprisingly strong association between levels of health anxiety and the risk of ischemic heart disease,” Berge says.

Isn't it more likely that people had anxiety about their health conditions because they were in poor health, and that is why they developed heart disease? This seems like a very poorly constructed study.


The very next sentence in the article reads:

>Even when the researchers controlled for established cardiovascular disease risk factors, they found about a 70% increased risk of ischemic heart disease in the years of followup.

Your point isn't invalid, but the authors do seem to have made efforts to address it. Though admittedly it is difficult to evaluate the validity of their controls without reference to the actual study.

Generalized anxiety has been shown to be a reliable predictor of coronary heart disease[1], so it doesn't seem like a stretch that the subset of health-related anxieties would as well.

[1] See, e.g., https://www.ncbi.nlm.nih.gov/pubmed/22075746


I think the problem lies in

   for established cardiovascular disease risk factors
As the great American philosopher D. Rumsfeld once famously pointed out [0], there are known knowns, known unknowns but there also are unknown unknowns :-)

So I would not dismiss the argument at this point.

  Generalized anxiety has been shown to be a
  reliable predictor of coronary heart disease
What the parent said applies here too. A statistical "predictor" isn't a statement about causation.

What would need to be shown is a mechanism. How is the brain doing all those things that it is being blamed for? or is it really just sensing something and reacting, instead of causing it as is claimed? Why are so many people in those discussion satisfied as soon as the brain (or something much more fuzzy!) has been "identified" as the actor causing the problem? How is that an explanation for anything? I'm not in the medical field, but I've taken many medical courses, including neuroscience courses (plural, because I found it so interesting). I find those "explanations" baffling to say the least. All I see is that they are just shifting the problem somewhere else and calling it a day, sort of like Douglas Adam's "Somebody Else's Problem (SEP) field" that makes things invisible. [1]

Also, that soooo many people take a statistical "prediction" as a real prediction, meaning an established causation, without question, always in similar discussions when people start citing stuff found on PubMed. Statistics is more like blood test measurements: It's a tool, to get a diagnosis you use it - but you don't base your result on it (just because a value is inside or outside some "standard range" doesn't mean much by itself). Not unless it's extreme, in which case you probably don't need statistics to begin with.

.

[0] Just for the fun and the memories: https://en.wikipedia.org/wiki/There_are_known_knowns and 35 seconds of video https://www.youtube.com/watch?v=QaxqUDd4fiw

[1] http://hitchhikers.wikia.com/wiki/Somebody_Else's_Problem_fi... and https://en.wikipedia.org/wiki/Somebody_else's_problem for the more serious description


Sorry, but... Fuck This. I went to my Dr last week because of acute and chronic pain in the testes, ensuing insomnia, etc. He pulled the psychosomatic card and suggested I was manifesting my own problems. I politely argued to no avail, then politely and permanently dismissed him as my doctor. Two days later I visited the ER, where it was confirmed that it certainly wasn't psychosomatic. It may be difficult to understand, but someone who is truly suffering and seeks help only to be told "it's in your head", can very well be the victim of an external psychological disorder, not anxiety. For how many years were innocent and otherwise perfectly healthy people persecuted, neglected, or ridiculed when they complained of stomach pain, i.e. an ulcer? Until Barry Marshall[1] came along and deliberately infected himself with H Pylori to successfully prove the actual cause of most ulcers, probably far too long. I advise that when pointing this self-righteous etiological finger at others, do so cautiously. I know I didn't quit distance running, my job, and adopt a life of sleeplessness to secretly spite myself and binge on artificial misery.

- Irritated patient

1. http://discovermagazine.com/2010/mar/07-dr-drank-broth-gave-...


I think the balance lies in between. I find it insulting to hear that it is all in my head because the pain is real: It is even more insulting to tell me this without doing any sort of testing whatsoever. If, after medical testing, they still don't know what it is - or if my ailment is often stress related - I don't mind trying different things, including mental health options - to take care of it all.

After all, this is why a competent mental health professional will do medical testing and MRI's and other such things so that they can rule out a physical reason for a psychological problem. Depression and anxiety can be caused by hormones, after all, and psychosis of different sorts can be a tumor.


> I find it insulting to hear that it is all in my head because the pain is real

Many people dismiss mental health issues as less serious or outright illusory, hence "It's all in your head".

Instead of blaming psychosomatic dysfunctions for existing, we should question why mental health issues are seen with shame and called "insulting"


Indeed. What if your body harbors some dormant weakness that originates in some old injury or some unfortunate genes? And so what if it was your divorce that was the last straw, and now that weakness has manifested and is now a Real Problem? Ok doctor, I also wish I wasn't getting divorced and no shit that was stressful, but the resulting digestive/auto-immune/neurological condition that it triggered is real, and that's why I'm here.

I sometimes have the feeling that if doctors can in some plausible way blame any non-simple affliction on stress, that's their ticket to victim blame, recommend yoga, and call it a day.


In my experience, general practitioners will diagnose you as having the most common illness which exhibits symptoms remotely similar to yours; if you have anything except diabetes/acid reflux/high blood pressure, they will never find/investigate it. WebMD is a far more reliable diagnostic tool than the average GP (for every non-hypochondriac who can use the internet).


Not to mention that when conditions are said to be brought on by stress, there is a chicken and egg issue : being in pain causes stress.


I had to deal with this last year. I had some traumatic times, scared shitless to die of heart failure, went to see doctors "you have nothing". One even dared me to reproduce my problem on sight. I was speechless (too tired to rage but ..).

They have a point though, mental state can disrupt organ coordinations (heart rate, artery dilatation, liver hormones). Read about the sympathetic nervous system.[1] They put me under antidepressant and I felt a very subtle improvement in my case. I guess in yours it's extremely far fetched.

Most of them only do simple tests (blood sample, cholesterol) and tell you to go home if you're in range. For anything a bit twisted you're on your own.

[1] in my case I was so frail, I could feel the difference when trying to meditate to calm anxiety. 3 minutes would show tangible signs (warm blood rushing to my finger and toe tips, instead of blue and cold limbs).


I think it's unfortunate when people ignore the possibility of psychosomatic symptoms, but even more dangerous when they attribute every issue to it. It should be a tool in the toolbox, a possible explanation/approach to ailments that are sometimes simple and singular but often times complex and multi-faceted.

My N=1:

I have chronic back issues. At best it's general tightness and fatigue, but can also be sore and painful. In particular I had two incidents in 2011 (in a matter of seconds) and 2012 (over a couple days) where my back spasmed and left me crippled, unable to move without knife-stabbing pains and unable walk down hallways without holding onto a wall. Both lasted almost a month, and were followed by months of heightened soreness.

I was 23/24 at the time, with no preexisting health issues. I'm a regular runner and in great health otherwise. I tried to fix this with deep tissue massage and core/strengthening regimens, and largely those helped keep the pain levels down but really only halved the symptoms at best. A friend had been recommending Sarno's 'A Divided Mind' which is all about the psychosomatic diagnosis since the first incident, but I had dismissed it. Finally in 2013, as I felt a new round of the spasms coming, I gave it a shot. Lo and behold, it became the single most effective tool I've found to manage my back issues. I identified that each spasm came with a major emotionally loaded event. In 2011 it was unrealistic pressure to compete at a big running race I had been training for. In 2012 it was participating in the search and rescue for a dear friend who was lost (and died) in the wilderness. In 2013 it was a nasty falling out with my best friend (and brother) at the time.

I don't believe the mechanisms are fully understood, and I think Sarno in particular does too much hand waving. But using his approach was the first time in years that I had no discernible back issues. I liken it to getting butterflies in your stomach. Your mind and emotions can trigger physiological changes to blood vessels, nerves, muscles, etc. that in turn can cause real issues. I also don't believe it's the only factor. I started an office job in 2015, and back issues have come back that I attribute 100% to the office lifestyle. I've found no relief with the psychosomatic approach, but do better with a sit/stand desk, breaks, and daily exercise.

Overall, I think a ton of people could benefit from approaching health issues from a psychosomatic perspective as one of many possible diagnoses. I also agree there are so many other possibilities that assuming it is always in your head is ignorant, neglectful, and downright dangerous.


I have bilateral pars defect at L5 with a grade I Spondylolisthesis. Local doctors want to fuse L3-L5, or I will be in a wheelchair within 5 years. For younger people that may be their only option. Non-local doctors do not recomend fusion.

15 years later, no fusion, no wheelchair.

This is what I did and do:

1. Educate myself a. search: stuart mcgill waterloo university. b. Understand spinal stability and core excercises c. Walk! not stroll! (i do 6 miles at least 3 times a week. Sitting is the new Smoking! 2. Listen to your body! I have learned to recognise that my back is close to a traumatic event. 3. When my back goes out, a short rest, but keep moving. 4. Fully understand that excercising will cause irritation, but it is tolerable versus when my back goes out. 5. Medications: Soma, flexeril, and tramadol (NSAIDs such as ibuprohen trash my GI) After an event, I take the Soma and tramadol to help me keep moving. Daytime, they both will keep me awake. At night, flexeril. It works best on muscle spasms which exhausts the muscles which leads to pain. And it puts me to sleep. I will use these meds for a short period of time every 5-6 months! 6. Streching and doing it correctly is very important. 7. Getting out of a chair, use your legs! DO NOT lean forward to pull yourself upright! 8. You may want to wear a simple lifting belt. Not for support but to remind yourself not to put your lower back in a stressfull position. 9. Understand that "correct" posture sitting may not be a good idea for long periods of time. 10. If the problem is the lower back, educate yourself on the function and stretching of the Psoas muscle. It is a fast twitch muscle, and sitting contracts the muscle. Quick and sudden contraction puts tremendous pressure on the discs. 11. Try to keep your spine in its natural position, maintaining symmetry is critical. Yeah, it is uncomfortable, but the lack of symmetry will impede recovery. 12. If you have imaging done, demand copies on a CD. This will help you to seek additional opinions.


You seem to have a practical outlook on the subject and I probably concur. I also think of, for example, the ascetic who self-immolates and does not succumb to the pain, but chars under the fire despite. Or the one who fasts for long durations enduring hunger and psychological torment but also atrophy and malnutrition. Or the putatively successful surgery substituting hypnosis for anesthesia. Certainly stress can weather a body or mind, and a salubrious head can fortify them. Perhaps there's an oxymoron or semantic trickster behind "drug. induced. psychosis.", and it could be referred to as "toxic state" instead. Regardless, not every individual is prepared for taking a Mind Over Matter approach to health, especially in terminal conditions. I think it might be a wiser approach to tout the possible benefits of applied psychology rather than indict the mind as the culprit of most illness. Also, thanks for the replies/comments.

Edit: "/comments"


I have had problems in back pain, and it's always been triggered by the back being in a bad position for an extended amount of time. Once the pain starts, it makes the muscles tense up, which only makes the pain worse.. It can be hard to get out of that loop. I bet your back pain had some physical origin too, but your state of mind helped keep your muscles relaxed, and let your back recover quickly rather than slowly.


That's because most doctors are pill-pushers and he couldn't prescribe you something that would have given him a nice kickback.


After an extremely stressful half at work, I developed heart palpitations, gastritis, insomnia, and a very distinct vitreous floater. All of these have more or less resolved, except the floater, which, since there's no known treatment, I get to keep as a constant visual reminder of one of the roughest times in my life.

Of course, it could all be a coincidence. The brain is good at finding patterns that aren't there.


I have no trouble believing that your mental state can influence your physical health. It's happened to me repeatedly. Prolonged stress (usually at work) seems to result in my immune system becoming less effective, and I start getting colds, coughs, mild flu-likes and so forth, plus whirly stomach and lots of toilet time.

Sure it's all in my head, but the thermometer says it's in my bloodstream too!


I have had frequent belching and heartburn problems for many years, often causing insomnia. After a lot of time trying to determine which foods were the cause, I ended up noticing the elephant in the room: food actually matters very little, my (subjective) stress level explains like 90% of the problem... if I'm relaxed (e.g. on vacation) I can eat practically whatever I want without getting problems, if I'm really stressed I'll get them even if I eat like a Spartan.

In fact, having a partner is the single best thing that has happened to my stomach and my insomnia. She reduces my stress levels and alleviates the symptoms very noticeably just by being by my side. Sorry if it sounds corny, but for me this is an observable reality.

The problem with all this is that, of course, stress is often something outside our control. Knowing what I know I try to keep it at bay as much as possible and take things easier than when I thought it was a food problem, but if there's lots of work and deadlines it's not like you can just wave stress away like you can avoid a given food...


The brain feels the body and both are affected by the environment(e.g.: if your body is bad and you can't feel pleasure anymore, or it's lowered, how are you gonna have happy thoughts? Same applies to the environment, which is something that seems to be frequently ignored), not only that, stress is a chemical and it acts on both your body and your brain.. is this conclusion a surprise to anyone?

Most of the comments here, people seem only capable of introjecting stuff as if the sole reason for stuff has gotta be personal issues(not saying this in a derrogatory manner) or a square diagnosis, this is absurd to me. Maybe it's cause I already came to the conclusion that I'm an ok mostly healthy animal plus gave up trying to fit the artificial into the natural(i.e.: I think our society is rotten. Also, how convenient it is that all problems must be seen as purely individual, huh?). History, classical thought -> good for the brain and body, maybe.


Exactly what I've seen after a year implementing software that ultimately failed - probably the worst professional period of my life.

During that period I was ok, probably surviving on fight and flight, but since I've had episodes as you describe, although one case with a super high temperature that left me unable to work for 3 days.


In California it's an at will state with unemployment topping out at 900 a month with the highest taxes and rent in the world. People die prematurely here from the extreme level of anxiety imposed on professionals I can't imagine how bad it gets if you have kids but worry is as big a contributor to early death as addiction.


I didn't see any mention of controlling for people that are worried about their health with reason. If a bunch of people in your family have health problems you would be more likely to worry about your health and be more likely to have health problems. This may be an issue of correlation not causation.


Closely related effect, with scientific references: [1]

[1] https://en.wikipedia.org/wiki/Nocebo


This are actually good news. If worrying can make you sick then worrying less can make you more healthy. Stop worrying today! Everything will be fine!





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