When caution becomes concerning: the relationship between health anxiety and mortality

Concern for our health exists on a spectrum. At one end, those who lack health awareness may disregard advice to lose weight or avoid smoking and may miss opportunities for prevention and treatment of diseases by skipping recommended check-ups and avoiding the healthcare system altogether. It’s easy to see how this lack of awareness can result in poor health outcomes and shorter lifespan. Anyone reading this newsletter is likely on the more health-conscious side of the spectrum, paying closer attention to your body and following health recommendations as best you can in an effort to support early detection and prompt treatment of issues. However, when health awareness crosses into health anxiety, it can lead to excessive worry and hypervigilance that, as shown in a study by Mataix-Cols et al., may actually undermine health and quality of life by fostering increased stress.¹

When health-consciousness reaches extremes

At the extreme end of the health-consciousness spectrum, health awareness can turn detrimental, evolving into hypochondriasis – a chronic psychiatric condition marked by a persistent and intense fear of having a serious illness. Unlike the proactive use of screenings and appropriate follow-ups, individuals with hypochondriasis frequently pursue medical tests, imaging, and procedures in an effort to alleviate their worry, often with little lasting relief. This anxiety-driven overuse of medical resources does not stem from a balanced pursuit of health but rather from a deep-seated belief that something must be wrong, regardless of test results. For those affected, any reassurance is temporary, and the cycle of fear and medical intervention continues, often placing strain on both the individual and the healthcare system.

About the study

The retrospective analysis by authors Mataix-Cols et al. sought to identify whether any relationship existed between diagnosed hypochondriasis and both all-cause mortality and cause-specific mortality. In other words – was being diagnosed with hypochondriasis associated with higher rates of death in this population? And if so, were they more likely to die of a particular cause? 

To accomplish this, the authors pulled data on diagnosed cases and controls (ages 6 and above) within the Swedish population from January 1, 1997 through December 31, 2020. For each hypochondriasis case included (n=4,129), ten demographically matched controls were added to the analysis (n=41,290). In their analysis, the researchers adjusted for confounding factors like age, country of birth, highest level of education, marriage status, family income, and presence of other psychiatric disorders.

Results using this adjusted model demonstrated that hypochondriasis was associated with a 69% higher risk of all-cause mortality than controls (HR=1.69; 95% CI: 1.47–1.93). When broken down into natural and unnatural causes of death, both had increased risk (natural HR=1.60; 95% CI: 1.38-1.85; unnatural HR=2.43; 95% CI: 1.61-3.68). To dig deeper into the particular diseases ailing these individuals, the authors ran the analysis for specific causes (i.e., diseases of the circulatory system, nervous system, respiratory system, cancer, etc.). For cause-specific mortality related to natural deaths, those diagnosed with hypochondriasis had a 52% increased risk of circulatory diseases (HR: 1.52; 95% CI: 1.21–1.92) and a 133% increased risk of respiratory diseases (HR: 2.33; 95% CI: 1.50–3.61). Suicide was the largest contributer to unnatural deaths (HR=4.14; 95% CI: 2.44-7.03). Collectively, these results indicate that higher health anxiety correlates with higher mortality risk, but what might explain such a link?

Interpreting these data

Health anxiety, like generalized anxiety or chronic stress, may be linked to various detrimental physiological changes. For example, higher levels of the stress hormone cortisol can suppress immune function and lead to metabolic issues such as insulin resistance. In the cardiovascular system, anxiety can increase heart rate and blood pressure via sympathetic nervous system activation (the “fight or flight” response), elevating risks for hypertension and heart disease. These are just a couple of possible ways that prolonged anxiety can impact physical health.

Despite the plausibility of the mechanisms, this study has inherent limitations – like all observational research, it can identify associations but cannot prove causation. The findings show a link between hypochondriasis and increased mortality risk, but it remains unclear whether health anxiety directly influences mortality rates or if other underlying factors contribute to this association. Another consideration is the potential for reverse causality, as those who are at higher risk for certain diseases might therefore become more anxious about their health. Individuals with a family history of early mortality may be more prone to health anxiety due to heightened awareness or fear of genetic predispositions, which could amplify their health-seeking behaviors.

The study may also suffer from biases in its participant pool. The cohort was limited to a Swedish population, which may not reflect the prevalence or characteristics of hypochondriasis in more diverse global settings. Furthermore, hypochondriasis is likely underdiagnosed, meaning only the most severely affected individuals were included in the hypochondriasis group. This leaves many mild or moderate cases of health anxiety undetected in the general population, and they may even be in the control group. As a result, we don’t know the mortality risks for individuals with less severe health anxiety, which might not impact their health as intensely.

Grounded health practices that deliver

Let’s take a deep breath and ground ourselves in reality. It’s obviously important to pay attention to your health, but it’s also easy to feel overwhelmed by health concerns or to get caught up in the latest wellness trends. Where do we find a balance? 

The truth is that there are simple, effective practices that yield great returns for your health and well-being. These practices don’t require extreme measures or a biohacker’s mindset – they’re approachable, sustainable, and often free or low-cost. (See my thoughts on “biohacking” in a newsletter from earlier this year.) Importantly, key habits like regular cardiovascular, strength, and mobility exercise offer immense benefits. Being mindful of eating habits and not being overnourished is another sustainable habit with great returns on investment. Regular health screenings and recommended tests are foundational, as they allow us to catch potential issues early and address them proactively.  

Being curious, observant, and proactive with your health can lead to substantial positive outcomes without needing to obsess over every small detail. This approach encourages a sense of balance, allowing you to engage in health-promoting behaviors without tipping into excessive worry. But it’s also important to recognize that managing health anxiety or hypochondriasis is not a matter of fault; these conditions are often deeply ingrained and require thoughtful, compassionate approaches. For those with health anxiety, working with a mental health professional can make a significant difference, helping to reshape thought patterns and reduce the need for constant health-checking behaviors.

Recognizing when health vigilance becomes problematic can be challenging, as each person has a unique tolerance for how much focus on health feels right. A potential red flag is when health concerns lead to physical symptoms like fatigue or compulsive behaviors or when they disrupt daily activities. Mental health is not only tied to our healthspan but also our lifespan, making it essential to seek support if health anxiety or other mental health issues are interfering with life. Approaches like cognitive-behavioral therapy (CBT) for health anxiety are highly effective, offering tools to manage and reduce anxiety over time.

Find your sweet spot

A balanced approach to health is key. While vigilance can certainly play a role in preventing and detecting health issues early, an overly anxious focus on health can actually be counterproductive. Despite limitations in the study by Matraix-Cols et al., the idea that chronic stress and anxiety affects your physical health is well-established, and the notion that this link extends also to health-related anxiety is entirely probable. Engaging in foundational health practices like regular exercise, mindful eating, and routine screenings offers the best returns for overall well-being without tipping into hypervigilance. For those who find health anxiety to be a persistent struggle, seeking professional support, such as CBT, can be invaluable. Ultimately, taking care of both physical and mental health enables us to live healthy, balanced lives, in which health is a priority but not an all-consuming concern.

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