Being worried sick is more than just a figure of speech. It’s also a medical fact: Anxiety has been associated with everything from migraines to tumor metastases.
But doctors thought that anxiety about health could be an exception. Obsessing about obesity might inspire you to exercise more, and stressing about lung cancer could get you off cigarettes.
Or it might just stress you out — and potentially increase your risk of poor cardiovascular health, as researchers found in some 7,000 Norwegians. In a study, published Thursday in the BMJ, the authors reported that health anxiety — what physicians until recently called hypochondriasis — increased the patients’ risk of heart disease by 73 percent.
That phenomenon is not so different from findings on anxiety in general. In crunching the numbers from 37 other papers, a meta-analysis from earlier this year found that overall anxiety was associated with a 52 percent increase in risk of cardiovascular disease — and in Thursday’s study, the effect of health anxiety was indistinguishable from that of other related disorders.
But this study serves as a wake-up call to physicians, who might make false assumptions about the health of anxious patients.
“Just because you have a patient who is a hypochondriac or has health anxiety doesn’t mean you shouldn’t take their symptoms seriously. We are sometimes biased,” said Dr. Martha Gulati, the head of cardiology at the University of Arizona, Phoenix, and editor of the American College of Cardiology’s cardiosmart.org, who was not involved in the study. “A patient who is on anti-anxiety medication comes into the emergency room, and people will say, ‘Oh, they’re just anxious.’”
It is notoriously difficult to study those whose anxiety about their health overshadows the problems themselves.
“Many people who have trouble with it don’t perceive it as a psychiatric problem, so if a psychiatrist calls and says, ‘Will you be in my study?’ they’ll say no,” said Dr. Timothy Scarella, a psychiatrist at North Shore Medical Center in Salem, Mass., who has done research on health anxiety, and who was not involved in this study.
In this case, the researchers used a large cohort of patients from Hordaland County, in southwestern Norway, linking their scores on a questionnaire about health anxiety to diagnoses of heart disease as reported either in hospital records or on death certificates. They excluded anyone who had previously experienced cardiac issues or who had heart trouble in the first year of observation.
To their surprise, they found that those with more health anxiety were no better at exercising, and tended to smoke even more. And they were at greater risk for heart disease, even when the effects of other predictors for cardiovascular trouble were statistically removed.
The finding presents challenges for clinicians who work with anxiety patients. These disorders are defined by a normal reaction to scary situations — which allows you to run faster and be more alert — going into overdrive and kicking in at un-scary times. A vicious cycle often ensues, with chest pain caused by anxiety in turn leading to yet more worry.
“I work as a psychiatrist, and we always tell our patients that it’s not dangerous to be anxious,” said Dr. Line Iden Berge, the study’s first author, a clinician at the Sandviken University Hospital and a researcher at the University of Bergen. “That might be true today, but it isn’t true over the years. We now know that it’s dangerous for their cardiovascular health. That’s the dilemma for treating these patients.”