Imagine living many of your days with this unshakable fear – fear that you could be sick, fear that you are sick, fear that you or your doctors might be missing something important that could make the difference. I think it can be difficult for those without anxiety to understand. I’m a pretty logical person, and yet when in the thrall of one of my health anxiety episodes, all my reasoning capacities seem to disappear. The result? I drive my family crazy seeking reassurance that “I am going to be okay”, desperately trying to feel safe again.
Dealing with Uncertainty
Health Anxiety (previously referred to as Hypochondria) is the unrealistic, excessive and disruptive fear of having or developing a serious medical condition. Our bodies have all sorts of strange sensations, smells, sounds and spots. My health anxiety has often misled me into thinking these common sensations could be significant health issues.
We all live with uncertainty. Most things can’t come with a 100% guarantee, especially when it comes to our health. As John Allen Paulos says,
Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security.
If you’re like me, chances are you’ve turned to your loved ones and physicians seeking reassurance for your anxiety and support. My reassurance seeking is a type of ‘safety-seeking behavior’ that I do to protect myself. I want to make sure that everything will be fine and that there’s no need to worry.
Excessive Reassurance Seeking in Health Anxiety
Excessive reassurance seeking (ERS as the experts call it) is the constant need to ask someone again and again whether everything is Okay. I might constantly seek the opinions of my doctors on the same symptoms, ask family members the same questions even though I know they can’t possibly have the answers, or repeatedly look up health information on the internet.
Health Anxiety and OCD
My unrelenting need to seek reassurance is a type of compulsive behavior. This is a lot like the comfort seeking questions or checking behaviors that characterize OCD (Obsessive Compulsive Disorder). Several studies have looked at how severe health anxiety and obsessive-compulsive disorder share many features. There’s even debate whether these disorders are actually ‘two sides of the same coin’.
Information Seeking vs Reassurance Seeking
Isn’t it good to stay informed about our health? I think so! My doctor encourages me to understand the health changes I notice and to get her advice if I have any concerns. But according to the SLBMI Anxiety Disorder Centre, there’s a difference between information seeking or fact finding and reassurance seeking.
The Information Seeker
The information seeker asks questions to get informed. Consequently, they only need to ask one time. They understand that there’s limits to knowledge and therefore accept qualified or uncertain answers (if appropriate). With this information in mind, they’re able to make any necessary decisions and action steps.
On the other hand, reassurance seekers ask questions to relieve their anxiety. They repeatedly ask the same questions and are often looking for a particular answer rather than the truth. As a result, their search for information doesn’t really have an end – because it’s not so much about the response but whether it works to make them feel less ‘anxious’ and safe.
They have a hard time dealing with uncertainty and therefore insist on absolute and definitive responses (whether they are appropriate or not). It’s difficult to make decisions. They may believe they’re either missing something or hope for new and better information in the future.
The Reassurance-Seeking Continuum
According to the Centre for Clinical Interventions, it’s helpful to think about my checking and reassurance seeking health anxiety behaviors as a continuum. On one side are those who never ask health questions and ignore their symptoms. On the other side are those of us who are always checking and looking for health information. They suggest that neither extreme is ‘healthy’ checking and reassurance seeking. We hope to fall somewhere in between.
Reassurance seeking doesn’t really help health anxiety
If I’m honest, I know that constantly asking for reassurance isn’t really helpful and it’s often a strain on my relationships. I don’t want to ask. I hear myself asking the same questions, over and over. And I know that this can be tiring and frustrating to live with. Trust me, I live with myself. I’m tired and frustrated too!
But it’s hard to resist and sometimes I just can’t help but ask.
Aside from my doctor, my go to person is my father. He’s a rational voice, patient and supportive. He resists the temptation not to answer my phone calls, even when it’s the 6th time I’ve called that morning with the same “are you sure I’m okay?” question each time. He helps me to take a step back and try to rise above my worries and fear. Then he reminds me of the conclusions and action plans I already decided on the last time I called (which might be only an hour ago).
This helps. I’m able to take a deep breath. I feel a little better and a little less alone.
As an article in Advances in Psychiatric Treatment explains, that’s what makes reassurance seeking so addictive. I’m worried and feeling isolated, so naturally I look for a way to get rid of the doubt and sense of insecurity. Hearing “you are okay” can give me a sense of relief in the short term. But there’s a problem. Since there’s no promise that I will always be healthy, that wonderful feeling of “I’m alright” doesn’t last. My mind wonders back to those same questions about my health and my anxiety returns. Then the reassurance seeking cycle starts again.
How to stop reassurance seeking – what can I do instead?
We can’t control everything that happens to us, but we can control how we respond to things we can’t control.
Avis J Williams
According to Dr. Kennard from HealthCentral, since I can’t get rid of uncertainty, one way to help my anxiety is to learn how to tolerate all those ‘what if’ questions. How do I do that? I practice being okay with uncertainty by changing how I respond to it. According to an article, How to Tolerate Uncertainty by Anxiety Canada, one theory (Cognitive-Behavioral Therapy) suggests that “our thoughts, feelings and actions are all inter-connected, and that if you change one, you can change the others.” So the idea is that if I can change my behavior around uncertainty, I can eventually change how I feel and think too. I decided to give Dr. Kennard’s suggestions a try:
1. Recognize our reassurance seeking anxiety behaviors
The first step is to identify all my reassurance seeking health anxiety behaviors. Am I asking my spouse the same question over and over? Do I search out 4 or 5 medical opinions on the same symptom? Do I excessively search the internet for health information? Or perhaps I seek help in online forums? Do I check things again and again?
2. Evaluate the risks and benefits of our behaviors
Next, he suggests I evaluate how helpful my reassurance seeking behaviors actually are. I can ask myself:
What are the advantages of doing this behavior, as frequently as I do it?
What are the disadvantages of this behavior? Do I need to stop or maybe do it less often?
3. Make new behavior goals
Last, to break the reassurance seeking health anxiety cycle, I need to try setting some new behavior goals. Dr. Kennard reminds us to make our goals small and achievable or start with something that is easier to change. For example, I might decide that googling my symptoms only makes me more worried and upset. As a result, my goal is to stop using the internet for health information. When I have a health concern I’ll go see my doctor. In the meantime, I’ll do some calming activities like coloring, yoga or try out a new guided meditation.
There are several free resources available online that helped me evaluate and set new anxiety reassurance seeking and checking behavior goals. Two of my favorites are:
Module 6 from the Centre for Clinical Intervention’s Helping Health Anxiety workbook
The How to Tolerate Uncertainty pamphlet published by Anxiety Canada
Wishing you peace and infinite possibilities,
I’m not an expert. If you have any concerns about your health, you should always consult your doctor or other qualified health-care provider and don’t disregard or delay seeking professional medical or mental health advice, diagnosis or treatment because of anything you read on this site. Wishing you well.
Anderson, R., Saulsman, L., & Nathan, P. (2011). Helping Health Anxiety. Perth, Western Australia: Centre for Clinical Interventions.
Halldorsson, B., & Salkovskis, P. M. (2017). Why Do People with OCD and Health Anxiety Seek Reassurance Excessively? An Investigation of Differences and Similarities in Function. Cognitive Therapy and Research, 41(4), 619-631.
Hedman, E., Ljótsson, B., Axelsson, E., Andersson, G., Rück, C., & Andersson, E. (2017). Health anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe health anxiety: An investigation of symptom profiles. Journal Of Anxiety Disorders, 45, 80-86.
Kennard, Jerry. “How to Lessen Reassurance Seeking When Anxious.” HealthCentral, February 17, 2016.
Osborne, D., & Williams, C. (2013). Excessive reassurance-seeking. Advances in Psychiatric Treatment,19(6), 420-421.
“Distinguishing Information-Seeking and Reassurance-Seeking.” Anxiety Disorder Center, St. Louis Behavioral Medical Institute, April 18, 2016.
“How to Tolerate Uncertainty.” Anxiety Canada.