Dear Therapist:

I have always been a bit of an anxious person, particularly when it comes to my health and the health of my family. For a while I was pretty obsessive and was constantly going to doctors "just to make sure" I was ok. Any little ache or pain I made an appointment and had it looked at. At some point in my life, I realized that I was making myself (and my doctors) crazy and I learned to control myself, essentially learning to ignore and pay less attention to these things. The problem is that recently it came to light that I was actually ignoring something that was real and I was diagnosed with a pretty serious medical condition (I don't want to go into specifics to make sure I remain anonymous). This has left me feeling really confused and guilty for not catching this earlier. It also has made me revert back to my old ways where I pay attention to every little thing. How can I tell what is something really worth worrying about and what isn't?

Response:

Fear and obsessions related to medical issues are quite common. For some, these fears and the thoughts, beliefs, and actions that follow can become overpowering. They can become debilitating.

In last week’s column, I mentioned the fight-or-flight response that we all have, which allows us to react decisively in anxiety-provoking situations. As I mentioned, when anxiety is triggered, our bodies react by enhancing things like strength, speed, and sight. These abilities are manifested via increased heart rate and respiration, the draining of the blood from non-essential body parts like the face, and other physical effects. When we are in a truly dangerous situation, these reactions help us to fight or to escape. When our fight-or-flight response is inappropriately triggered in normal circumstances, we are left with the negative aspects and none of the positive ones.

Basically, our fight-or-flight response is there for a reason. But there are times when it gets triggered unnecessarily. Sometimes, medically-related fears can cause an acute fight-or-flight response. At other times, it becomes more of a chronic low-grade concern. This is not a true fight-or-flight response, so I will refer to it as a fear response. Although this fear response may technically be anxiety, it often feels more like a legitimate concern. This can be due to the lower level of anxiety (which allows it to appear more realistic), as well as the fact that there is a specific physical symptom to which it is tied.

When anxiety is medically motivated, it can be easy to get caught up in the symptoms. If I have a general “chronic” fear of becoming ill, a headache or stomachache can easily trigger this fear. Also, as the fear increases, this often causes the pain to increase (through an unconscious process), leading to yet more fear. The vicious cycle specific to that specific situation can then transfer to other fears, ultimately leading to a larger, more general cycle of medical symptoms and fears.

When caught in this type of emotion-thought-belief-action cycle, it can be difficult to distinguish real problems from those that are emotionally based. You mention that you learned to “control yourself.” I wonder what the process was through which you controlled your fears. Was this something that you slowly worked through, feeling continuously less anxious over time? Or was it more abrupt? For example, did you simply feel like you had enough, and simply refused to respond to your fears?

Even if you worked slowly through your fears and they gradually dissipated, this is no guarantee that it was done “properly.” However, it is much more likely that this would have led to your ability to determine which symptoms were truly troublesome. If, however, you suddenly decided to ignore your fears, it is far more likely that—to some degree—you shut down your fear response (at least as relating to medical symptoms).

There are times when someone with ADHD presents with largely OCD symptoms. This can be  due to their desire (usually in childhood) to treat the ADHD symptoms. Instead of working with these symptoms, they teach themselves to hyperfocus in order to obliterate them entirely. On rare occasions, I have seen this lead to severe OCD, with literally no overt ADHD symptoms.

In your case, you may have done something similar. Instead of focusing on the problem (your fears, errant thoughts, erroneous beliefs, and resultant actions), you may have buried the problem. If this is the case, you likely taught yourself to ignore physical symptoms entirely. The return of your symptoms once triggered by a real medical problem would make perfect sense.

Perhaps this is not the case, and you properly identified and worked through your fears. Maybe your failure to pick up on the symptoms of your condition is perfectly normal. If so, it is quite possible that your reversion to your old ways will wane as time goes on. However, you are now dealing with a serious medical condition, which can become a constant trigger. So you may need a “refresher course” in order to bring yourself back to an equilibrium.

It sounds more likely, however, that you never really focused on your fears, allowing yourself to properly challenge them and thus differentiate between actual concerns and inappropriate anxiety. In this case, I would urge you to see someone who could help you to properly treat the anxiety that you thought you had treated, but actually only swept under the rug.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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