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Illness Anxiety in the Pandemic Era

By MICHAEL SHAPIRO, PhD

May 2020

I’ve never been a Harry Potter fan. In fact, I’m not even exactly sure what the Harry Potter series is about. My understanding is that it revolves around a bunch of kids who ride broomsticks and play some kind of anti-gravity version of basketball at a private school in some place that looks kind of like the Rocky Mountains, but with fewer Starbucks. Oh, and one of the kids has a scar on his head.

I also know that an important component of the storyline involves a “Book of Spells” or some such thing. Evidently, this book has all the rules or spells (or whatever) that adolescent magicians need to do their job or learn their craft (or whatever).

So, here in the equally magical world of Behavioral Health, we have also have mysterious book known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (known to you Muggles as “the DSM 5”). This single volume contains a detailed description of every mental disorder anyone has ever had, or could possibly have. These disorders span from the easily recognizable (like depression) to the obscure (like trichotillomania, or compulsive hair-pulling). I’ve often told people that if you look through the DSM 5 long enough, you’ll find some disorder that fits you, no matter how mentally healthy you may feel at the moment.

Anyway, in the DSM 5, there’s a diagnosis called Illness Anxiety Disorder. To qualify for that diagnosis, you have to be obsessively worried about the possibility of acquiring a serious illness. You have to be constantly anxious about your own health, and in an attempt to relieve that anxiety, you have to either engage in excessive health-related behaviors (for example, repeatedly checking your body for signs of illness) or totally avoid healthcare (e.g., staying away from hospitals and doctors’ offices).  Interestingly, another requirement is that this preoccupation with your own health has to be “excessive or disproportionate.”

Ah! Therein lies the big philosophical question: in the days of the COVID-19 pandemic, aren’t we all obsessively and disproportionately preoccupied with acquiring a serious illness? Aren’t we all engaging in health-related behaviors and avoiding hospitals and doctors’ offices?  In fact, haven’t we been ordered to do these things by our local governments? If so, does this mean that we are all suffering from Illness Anxiety Disorder?  More importantly, if we’re all doing these things, then is it really a disorder at all, or are we exhibiting completely normal behavior, just like everyone else?

I’m not exactly sure, but I think my head just imploded while trying to sort this all out. Personally, my hope is that our obsessive preoccupation with the coronavirus can still be considered a “disorder” because that’s good for my business. In fact, I’d like to take this opportunity to thank social media for contributing to my business by fanning the flames of anxiety with an inescapable, constant barrage of false, inflammatory, and often contradictory information. Thanks, Facebook!

But seriously, I have seen many patients over the last two months who are understandably worried and have expressed their anxiety through unanswerable questions and despairing comments like, “Am I going to catch this?”, “Will this ever end?”, “I’m afraid they’re going to lift restrictions too soon!”, and “I feel trapped!” This anxiety has been brought about by a stressful event, sort of like what happens in Posttraumatic Stress Disorder. However, with PTSD, the threat has already passed, and it was probably something very visible (like a tornado or other natural disaster). With the coronavirus, we have an invisible threat, we don’t know when it will end, and we don’t even know if it has touched our lives yet or not. In this respect, a global pandemic is unique amongst stressful events!

So, how can you calm yourself in the midst of so much uncertainty? Before answering that, let me first mention that we here at SR-AHEC are applied scientists–rigorously trained health care providers–who, I’m proud to say, do nothing that isn’t based on solid, verifiable science! We try to rely solely on treatments that have been tested and validated under the cold, dispassionate light of the scientific method! That’s why we don’t bleed patients with leeches anymore (well, except maybe that one time last year. But come on! I couldn’t think of anything else to do, and I made sure that it was covered by insurance first).

The practice of employing only scientifically proven medical techniques is known as “Evidence-Based Medicine” (EBM). What does EBM have to say about dealing with our anxieties in this time? Well, it just so happens that the Centre for Evidence-Based Medicine (no, I didn’t misspell a word. This place is located in the UK, where they spell some things rather oddly) has analyzed many scientific articles on the topic and has come up with the following evidence-based suggestions:

  • Minimize your exposure to the news and other media (I recommend no more than an hour per day to get caught up on the day’s events).
  • Use trusted sources to access information about the pandemic (as I said in my last blog, you can pretty much trust anything that has been bears the CDC seal of approval).
  • Stay connected with family and friends, online or via telephone (just don’t lose your temper when you can’t figure out how to turn on the audio).
  • Provide help and support to other people in the community (like your elderly next-door neighbor, who could use a little help with the groceries).
  • Practice meditation and mindfulness (this can be as simple as stopping whatever you’re doing, taking a deep breath, observing your own body for signs of tension, and asking yourself what you need to do next).
  • Look after your body by maintaining a healthy diet and exercising regularly (see our earlier “Guidance to Good Health” blog about exercises you can do at home. Oh, and keep your hand out of the Cheetos).
  • Avoid unhealthy coping strategies, like drugs and alcohol (interestingly, online sales of alcohol have gone up by 243% during this pandemic! Even sales of Corona beer have, ironically, increased by 50%! How weird is that?).
  • Keep doing activities you enjoy (preferably not playing video games or watching movies that involve death, destruction, or mayhem. Sesame Street is probably OK…just stay six feet away from Cookie Monster. I question his personal hygiene).

I would add to these a brief three-step cognitive behavior therapy exercise that I do with my patients:

Step 1: Ask yourself, “What is the worst possible thing that could happen to me?” Your answer may be something like, “I’m going to catch this and die.”

Step 2: Force yourself to consider the best possible scenario: for example, “I’m going to be completely OK. The statistics are on my side.”

Step 3: Consider the most likely scenario, and develop a plan for that: for instance, “I may get infected, but for most adults, the symptoms are mild. If I get sick, I’ve figured out exactly where to go for emergency care, and I might actually get caught up on all my Downton Abbey episodes while I’m recovering.”

These steps may all seem fairly self-evident, but once again, they are based in fact and have been verified by research, so I trust them. So, Illness Anxiety Disorder or just a “normal” reaction to a really abnormal situation?  Who cares? It’s what all the cool kids are doing. Just do what the science says. Oh, and for social distancing, just use Harry Potter’s “cloak of invisibility.” I think he has one of those.