Health Anxiety, Covid-19 and Overwhelming Services

great article in the Journal of Anxiety Disorders  by Asmundson and Taylor just published on this https://doi.org/10.1016/j.janxdis.2020.102211. The authors remind us that we can have too little health anxiety, for example leading a person to ignore requests for social ill distancing, but also too much for example panic buying sanitisers. The article reflects that there may be an overall increase in health anxiety as a consequence of the pandemic. This will likely lead to an increase in referrals.  

If everybody with a current health concern were invited to book a telephone assessment with IAPT or ring Mind,  ( I hear that the Government have given £5million to Mind) the services would be overwhelmed. But not only this, what direction would people be signposted to, and on what basis? The DSM-5 uses the term ‘Illness Anxiety Disorder’ , rather than ‘health anxiety’, its criteria help decide on whether a person is a ‘suitable case for treatment’ or a member of the ‘worried well’.  Helpfully it offers signposts, implying a ‘wait and see’ approach in our current situation with its criteria that an illness anxiety disorder’ label should not be applied  unless the ‘illness-related preoccupation has been present for at least 6months’ implying a normality of upsetting responses before this. Another of the criteria  is that ‘there needs to be ‘a preoccupation with a having or acquiring a serious illness’  [in the DIAMOND interview for DSM-5  https://giving.hartfordhospital.org/tolin-diamond-training-video this is operationalised as an hour or more a day as being clinically significant]. A further requirement is that there should be significant functional impairment in domestic or work roles as a consequence of the health preoccupation. The criteria help stop the pathologising of normality and make for a better use of scarce mental health resources.

But though CBT is recommended for health anxiety I could find no study in which clients had been independently evaluated to see if they were no longer suffering from what has been termed variously ‘hypochondriasis’, “health anxiety’ and now ‘illness anxiety disorder’ at the end of treatment, much less at follow up. So some humility is called for when, as is likely, CBT is vociferously advocated as a response to this pandemic. But the prospect of increased funding is likely to be too attractive to agencies.

 

Regards

 

Dr Mike Scott

 

 

4 thoughts to “Health Anxiety, Covid-19 and Overwhelming Services”

  1. I’ve felt overwhelmed with the amount of self help material flying around about coping with covid19 related anxiety. I feel what’s needed is human solidarity not expert advice.

    1. perhaps we should as Jonathan Sacks suggests in his book Morality replace self with other so it becomes other help and other esteem

  2. There’s a storm brewing.
    “Today, the Lancet Psychiatry published a “roadmap for research” on Covid-19 and its impact on mental health, co-authored by 24 people and coordinated by the Academy of Medical Sciences and the charity, MQ. Thomas Kabir, Head of Public Involvement in Research at McPin, was one of three authors contributing a lived experience perspective. The headline recommendations include the need for real-time monitoring of mental health on a scale never before seen, the creation of a neuropsychological database of Covid-19, the design of apps and digital programmes, and research to understand what makes people resilient in the face of this crisis. There is also a focus on understanding the effect of the coronavirus on the brain and nervous system, and suggestions for how to do this using biobanking (storing tissue, blood, or genetic material), and by using patient data. The team’s expertise spans bio-psycho-social interests and there is a strong emphasis on the need for multi-disciplinary research approaches.”

    Oh dear!

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