3 Curative Steps to Help Your Client’s Hypochondria

The hypochondriac doesn't want to be ill, but nor do they want to be dismissed as 'just imagining it'. It's a tormenting psychological 'double bind'.

“Of all the liars in the world, our fears are sometimes the worst.”

– Rudyard Kipling

“Oh, I’ve had it all!” Lilly laughed bitterly.

“Thanks to Dr Google, I’ve diagnosed myself with almost every kind of cancer, multiple sclerosis, liver disease… even some illnesses I’m sure you’ve never even heard of, Mark.”

Health anxiety or hypochondria, a pathological fear of illness or even a psychosomatic creation of symptoms, is not, alas, uncommon. In fact, health anxiety may even be increasing.¹

‘Cyberchondria’, a tendency to self-diagnose symptoms from internet searches, may be partly to blame – as may increased media focus on illness during and after recent pandemics.²

Some monitoring of one’s own health is vital. After all, ignoring or never worrying about symptoms can be personally catastrophic.

But Lilly, like so many others, was ruining her life by obsessing about her health, which was, according to multiple and repeated tests, fine.

I could see that barely hidden within her obsession was an overriding and fatalistic assumption.

“I’m doomed!”

Stress can give us a sense that something terrible is about to or bound to happen.

Unless it is focused on some immediate threat (think lion prowling towards you!), stress makes the imagination fire, creating scary scenarios which then give shape to that formerly free-floating stress.

If there is no real focus for our stress, we make stuff up – and, because we’re stressed, we believe it. We become convinced that “My partner is about to dump me!” or “I’m going to get fired!” Or, in this case, “I am terribly ill!”

Conversely, general relaxation – lowering base arousal levels – can switch off such self-harming imaginings.

Lilly was in her early thirties. When I met her, she was permanently convinced that her immediate future held unspeakable medical horrors. She actually told me she felt doomed every day!

But this wasn’t Lilly’s only fear – she was also concerned about her mental health.

Psychotic versus imaginative delusions

“Am I mad, Mark?”

I was pleased to be able to tell Lilly she was as sane as I was (which I hope was reassuring!).

A hypochondriac may appear delusional, as may a chronically jealous person or anyone consumed by obsession. But these disorders are characterized by imagination colluding with emotion to produce beliefs, not by distortions of perception in which hallucinations are experienced.

A psychotic person will commonly see and hear things that are not there, such as voices, or wholeheartedly believe things that are simply impossible, such as that they are being controlled through the TV.

Hypochondriacs, on the other hand, see reality as it is but then interpret that reality with unwarranted assumptions. They don’t experience hallucinations of what doesn’t exist.

So we can’t properly call hypochondriacal beliefs delusional in the psychotic sense, however irrational they may seem to the outside observer.

Sometimes the hypochondriac may even recognize that their beliefs are irrational. But there is a kind of Catch-22, almost a cognitive dissonance, to hypochondria.

Double-thinking fearful thoughts

The hypochondriac doesn’t want to be ill, but nor do they want to be dismissed as ‘just imagining it’. It’s a tormenting psychological ‘double bind‘.

The paradox of hypochondria is that the sufferer often knows they’re a hypochondriac even as they maintain that they are justified in believing they’re really ill. This kind of ‘doublethink’ is at the heart of many obsessions.

Merely trying to reassure someone directly seldom works because while they may, on one level, agree with you that they are overworrying, on another level they feel they must be gravely ill.

So what causes chronic health anxiety?

Common causes of hypochondria

“My mother was constantly terrified I had something serious,” Lilly confided. “She was always taking me to the doctor’s.”

Lilly’s mother had always suffered terrible fears around her own and her family’s health. She still did.

Unsurprisingly, research shows that hypochondria runs in families. Family members ‘teach’ each other attitudes which then get passed down the generations.³

It also won’t surprise you that people are more likely to suffer hypochondria if they’ve witnessed serious illness.⁴ A male client of mine (who you can see inside Uncommon Practitioners TV) told me both his parents had died of brain tumours, and a cousin now had one too!

If you experience something horrible, your brain may wrongly tag the event as being much more likely to occur again – a case of once bitten, twice shy. Possibility gets confused with probability.

So, was Lilly’s hypochondria typical?

Well it was, in at least one way.

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Immune to reassurance?

A key feature of hypochondria is the inability to be reassured by relatives, friends, or even medical experts for any significant length of time. Medical tests can become addictive but only serve to reassure momentarily, quickly giving way to thoughts of “What if they missed something?” or “What if they mixed up my results?”

This described Lilly to a T. She’d be okay for a time, but sooner or later the doubts would grow back, like recalcitrant weeds choking out her hope and happiness.

Her hypochondria was classic. Her mother had always been extremely anxious about health. When Lily was 25, her father had been diagnosed with cancer and tragically died a few weeks later. This was a huge shock to Lilly and greatly intensified her fear of illness, rippling out to affect her family, social, and love life.

Lilly’s health anxiety, like any emotional difficulty, didn’t just affect her.

“My husband is being driven to distraction and I worry that my eldest son Sam is starting to talk about his health; he’s only four!”

Her husband had “the patience of a saint” but she found he could rarely reassure her. “His well-meaning words just bounce off my brain!” she said. “Or they stick for a little while but then fall off again!”

Sometimes well-meaning words and advice can actually make matters worse. There is one piece of advice I steadfastly avoid when working with hypochondriacal clients, and I think perhaps you should too.

Fight monsters wisely

The worst advice you can give is: “Try not to think about it.” Why? Because trying not to think about something is still focusing on it.

Research has found that thought suppression (and not just the type done by tyrannical institutions!) can bring the thought back with a vengeance.⁵

Trying to push a thought from consciousness can, paradoxically, make it grow in strength, like some hydra of the mind – the more heads of the monster get cut off, the more grow back!

But don’t misunderstand me.

Distraction can be a great technique for diminishing anxieties. But it needs to happen in such a way that the distraction feels natural. Otherwise, it’s just a case of: “I know I’m trying to distract myself from the fear of what that headache may mean…”

So how do we help the hypochondriacal client?

Step one: Discover when it started

Your client may always have had a tendency to be concerned with their health, or there may be a moment or moments in which this overriding fear was inculcated.

For my client in UPTV whose parents had died from cancer, surprisingly enough this wasn’t the moment that had instigated his terrible health anxiety (though it likely helped set the scene). He recalled that his anxiety had really ramped up after a particular conversation with a work colleague in which she had seemed to suggest that a symptom he had might be pancreatic cancer. Her husband had died from this illness.

This had served as a kind of accidental hypnotic suggestion. He ended up wishing he’d never even met this co-worker.

Once we uncover hidden trauma, then we can help the client process that memory so it no longer troubles them, and this can help stop the anxious obsessionality with health.

Lilly had traumatic memories of her father’s diagnosis and death. Once we worked on these memories, she began to worry less about her health almost immediately.

It’s not so much what someone thinks as what they feel. So that is what we need to focus on.

Step two: Dig deeper and reframe

Classically trained cognitive-behavioural psychotherapists may try to treat hypochondria by getting sufferers to analyze and alter their thoughts.⁶

Certainly, challenging negative thoughts can be extremely powerful. But it’s not the thoughts so much as the feelings that are the main problem here. Once you deal with the feelings, the thoughts take care of themselves.

Feelings so often drive thoughts, not the other way around, at least when it comes to really powerful feelings.

I asked Lilly whether she was more likely to worry about her health when she was generally stressed.

“Yes. We went on a great holiday last summer and I actually didn’t think about it at all… but recently I’ve been really stressed at work and it’s come back really strong.”

I talked to her about the fact that it doesn’t matter what you think so much as what you feel when you think it.

As strange as it might sound, it’s fine to think about horrible possibilities if you feel relaxed when you do so. When we are calm, we can imagine anything without it affecting us. This was a revelation to Lily.

I suggested that authors who write horrors or thrillers could think about nasty possibilities without their feelings having to ‘buy into it’. Or, as is more true, the fantasies she created when she felt stressed didn’t have to automatically be believed.

Hypochondriacs feel stress then fantasize about bad stuff, because stress needs a ‘container’ – something to give it shape. Once scary scenarios have been created, thanks to the imagination, the worrying that ensues has people looking for any signs that seem to confirm the fantasies as real.

This is how scary beliefs are created.

So what exactly was Lilly imagining?

Step three: Help them relax with the (formerly) upsetting fantasies

This is how Lilly ‘did’ her hypochondria: She would habitually awaken in the early hours, imagine her symptoms, then start to find she could feel the imagined symptoms. She told me she’d always wake up and then get the symptoms, rather than being woken by them.

Sometimes, of course, symptoms can be real – but even then the hypochondriac will tend to assume they are attached to much more serious conditions then they really are.

Lilly would imagine herself getting sick; being diagnosed by sympathetic but grim-faced professionals and told there was no hope; becoming ill, weak, and soon incapacitated; seeing her husband and son crying. Eventually she’d imagine her own death, how devastated her family would be, and how her friends would describe the tragedy. She’d vividly picture her own funeral.

Not exactly the kind of thoughts that promote a return to sleep!

“Wow! That’s a lot to try not to think about,” I suggested.

So… I encouraged her to think about it.

Psychotherapists call this a ‘paradoxical intervention‘ – you can call it crazy if you like, but it worked for Lilly.

Feeling the best while thinking the worst

It’s easier and much more powerful to disentangle feelings from thoughts than to try to stop the thoughts directly.

So I taught and encouraged Lilly to relax deeply and then, while totally relaxed, to imagine her usual fears over and over, projected onto a screen. This helped her unhook her imagination from the feelings and distance herself from them.

She could then experience the thoughts, but with the fearful feelings greatly diminished. It was very strange for her to imagine the same old scenarios while feeling calm.

Emotions are like neon lights or a buzzer, demanding we pay attention to them. Once the emotions are gone, the thoughts naturally become much less compelling because there is nothing left to ‘power’ them. Without the emotions, there is no purpose for the thoughts (unless we plan on writing some scary or depressing story!).

I also hypnotically rehearsed with Lilly doing other enjoyable activities rather than searching the internet in attempts to self-diagnose. She hypnotically, and then for real, began to spend more time with her son and husband.

There was something else we addressed. Something important.

Lilly’s leap forward

At least one piece of research unexpectedly shows that hypochondriacs are less likely to look after their health.⁷

It seems that many hypochondriacs smoke, drink (perhaps in an attempt to calm frayed nerves?), and rarely exercise (for fear of injury?). Lilly was always seeking medical tests but, because she’d fallen into feeling helpless about her health, she’d stopped being physically active or eating well, and was drinking more.

With therapy, Lilly spontaneously reported taking care of her body better. She became more active and drank much less.

She began to see her body as her friend rather than some malevolent entity out to get her.

She also stopped overmonitoring her body, and started to feel able to assign non-lethal causes to harmless aches and pains while still being calmly mindful of her health. As we all should be.

Eventually she said to me, “I keep forgetting to even think about my health now.” She paused for a moment, then added, “I don’t just think life is for living, I feel it too.”

Help Your Clients Relax Out of Restrictive Mindsets

The wonderful thing about knowing how to use your language to relax your clients is that it doesn’t matter what emotional state they bring to your session. Once you know how to artfully weave your words in a way that naturally brings them to a peaceful and calm place, they feel better immediately and you can work more effectively. Learn how with Mark’s online course Uncommon Hypnotherapy.

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About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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