Everyone worries about their health from time to time and is afraid of physical illness as well as fear of mental illness . Each of us has wondered if a certain symptom, such as a headache , could depend on the tiredness of the day just passed or on something much more serious. Worry is functional to our health. Having overcome certain limits and transformed into anxiety (with all its physiological, cognitive and behavioral correlates), however, it gives rise to a real anxiety disorder .
Health anxiety, more commonly called hypochondria , is a well-known disorder. It is classified in diagnostic manuals and affects a percentage of the population between 1% and 5%. The main symptom is the worry of having or contracting a disease in the future .
According to Salkovskis and Warwick (1986), hypochondriacs have a continuing tendency to catastrophically interpret physical symptoms, physiological changes and health information. This trend is maintained by various factors. Between these:
- selective attention to information that could confirm the dreaded disease
- a range of protective behaviors that include controlling, seeking reassurance, and avoiding situations that can trigger worry
Concerns about mental illness
It has recently been suggested that people may have extreme or persistent concerns about their mental health as well . This is similar to how other people care about their physical health (Anderson, Saulsman & Nathan, 2011; Rachman, 2012). Rachman says that, in addition to cancer, heart attack, AIDS and stroke, the fear of mental illness is a more common variant than is believed. Perceived threats to one’s mental health can be painful and crippling as much as threats to one’s physical health. There is an increasing number of studies that argue that the concept of health anxiety must include the fear of mental illness (Anderson et al., 2011).
Concerns regarding mental health may be present in some of DSM disorders 5 as panic disorder , the Obsessive-Compulsive Disorder and Disorder Depersonalization(APA, 2013). The “fear of losing control or going crazy” is listed as a possible symptom of panic attacks in Panic Disorder. Individuals with Depersonalization Disorder may worry that the feeling of not being in full control of their actions may mean they are going insane. Likewise, people with Obsessive Compulsive Disorder fear that having certain intrusive thoughts mean they may be “out of control” or “crazy” (Rachman and De Silva, 1978; Salkovskis and Harrison, 1984). However, in these disorders, fear of mental illness is considered a possible symptom or associated characteristic rather than the main problem.
Characteristics of fears of mental illness
Rachman provides clinical examples of fear of mental illness. For example, the fear of going insane , the fear of losing control of one’s mind or thoughts, and the fear of being institutionalized. The characteristics of mental health anxiety appear to be compatible with what Salkovskis and Warwick proposed for hypochondria.
Being forced from childhood to visit a seriously ill relative confined to a clinic is an example of an etiological factor. A dysfunctional belief could be the idea that “mental illness can be contagious”. Learning about mental illness or proximity to people with severe psychiatric disorders are examples of triggers. Avoidance of people with psychiatric disorders or places where they reside are examples of maintenance factors.
The vicious circles of maintaining anxiety about mental illness
Like those with physical health anxiety, those with mental health anxiety often see confirmation signs of their fear. For example:
- unwanted thoughts that prevent “correct” concentration;
- the feeling of loss of control of one’s thoughts;
- the tendency to screen nearly every mental event for the sign of possible mental illness.
This intensifies the worries, leads to behaviors seeking reassurance, control or avoidance. It also triggers a vicious circle of misinterpretations and catastrophic thoughts .
Often these people spend a lot of time worrying about their own mental health, mulling over the catastrophic consequences of this eventuality. They frequently have images of themselves suffering from severe mental illness and abandoned, isolated, in a psychiatric clinic. It becomes difficult, as in anxiety about physical health, to distract from the fear of the onset of a disorder even if a professional tries to reduce the risk. Often what is aspired to is the absolute certainty that the possibility of a mental illness will never occur.
Beliefs regarding mental health are strongly linked to this . These may depend on previous experiences that may have generated stable beliefs on the irreparability of a life affected by the presence of a psychiatric disorder. We often believe in the impossibility of receiving adequate help and imagine the serious personal consequences that this event could trigger.
Research into the fear of mental illness is still limited. But as we have seen, those who deal with health anxiety consider it important to broaden the field of investigation to include this type of concern as well.
Treatment of the fear of mental illness
The cognitive-behavioral therapy can also come to our help with this variant of the anxiety disorder to health . The standard cognitive treatment, according to the model of Salkovskis and Warwick, can in fact change the beliefs that support the symptoms. In addition, Wells’s (2009) metacognitive therapy , which places metacognitions at the center of psychopathology, can help. This can make significant changes in the processes involved in the disorder, such as brooding and metacognitive beliefs about thoughts.
Other third generation cognitive therapies such as ACT and mindfulness-based cognitive behavioral therapy, although they have only clinical findings, can also be a valuable aid in treating mental health anxiety disorder .