Illness phobias most commonly the subject of enquiries to Anxiety Care are – heart disease, cancer, brain tumour, asbestosis, AIDS and a general, and intense, fear of dying. Occasionally the diseases feared have been multiple. For example, where panic symptoms cause dizziness and stomach problems, the fears might be a brain tumour and stomach cancer. Symptoms of illness phobia include ruminating endlessly about the disease (or death); avoiding anything in the way of radio, TV, newspaper, or magazine coverage on the subject; or, very occasionally, obsessively collecting such information. Possibly repeated bodily examinations – personally and through any medical practitioner who can be persuaded to carry them out; and constant demands for reassurance that the disease is not present, from family, friends and doctors.
Illness phobias could be placed nearer obsessional/compulsive disorders than most other phobias as the accompanying rituals can be as troublesome as any generally found in OCD, and the ruminations about the illness are like an obsession in many ways. Very often this phobia is found in people suffering from depression and may fluctuate according to the level of the depression. Sometimes there are no other symptoms. Research shows that, when associated with depression, this phobia can be quite short lived, less than a year in some cases. However there is no reliable data on the duration of illness phobia where there is no depressive problem. There doesn’t seem to be one particular cause of illness phobia; but people contacting Anxiety Care with the phobia have detailed a number of similar, associated problems apart from depression. These include a close family member or friend with, or who had recently died of, the feared illness. A tendency to fear certain illnesses in their family. Various personal problems such as feeling unwanted, of little value, being lonely or over protected or extremely self pitying. There have also been ‘practical’ aspects such as poor general health or persistent pain. In the case of pain which tended to ‘prove’ to the person that there was something wrong, this could have been imaginary; part of the pains, twinges and gurgles we all experience every day (illness phobics are extra alert for, and alarmed by, their bodily sensations); some genetic and harmless quirk of their body; or even a symptom of something else, like an emotional pain or guilt. Other practical problems have included misunderstanding doctors comments or silences. This is not hard to understand given that the person is attuned to the slightest alarm that could be triggered by tone of voice or a look when the dreaded subject is under discussion, and that they may have consulted this fed-up doctor many times with the same fear.
Most phobics avoid the dreaded situation or object, escaping quickly from the stimulation. This instant relief of tension by escape rapidly becomes a habit and maintains the phobia. Proven successful treatment involves helping sufferers to face the fear by staying in the feared situation via a personally appropriate desensitisation programme. Simply, this is fitting as many steps as needed between what the person can do and wants to be able to do, and working through them, accepting the level of anxiety generated each time. However, illness phobics cannot avoid their feared stimulation because most of it – in the form of thoughts and bodily pains – is inside themselves. The anxiety does not reduce even though this person cannot escape it, and is likely to be more permanent and so more of a problem. It does not respond well to ‘desensitisation’ treatments and alternatives could include psychiatric counselling.
Avoidance with resultant anxiety reduction, that might respond to such treatment is that involving escaping from discussions or media stories about the illness; checking that people and objects the person comes in contact with are not ‘contaminated’ by the illness; and seeking constant reassurance, from family and doctors, that the person has not got the feared illness. Steps involving stories might include reading about the problem, perhaps just a few words at first, working up to full stories. With contamination, it could include not avoiding utensils such as knives and forks, or being in the company of people with the illness.
Therapy reported to Anxiety Care for a cancer phobic using this method, involved the person visiting a cancer ward, shaking hands with and eating with cancer victims and looking at pictures of cancerous cells; and eventually handling a receptacle containing cancerous tissue. Steps that can reduce the need for reassurance might involve teaching the family to respond with set phrases such as “We agreed that I would not reassure you”, or “The hospital has said (or, we agreed) that I must not reassure you”. (Offered kindly but unemotionally, never with anger). This can sometimes be very difficult, as the family concerned is likely to care deeply for the sufferer and the person will be aware of the best ways to obtain such reassurance from them, using this caring. In this case, those concerned might have to role-play asking for and refusing reassurance until the pattern is established, which might take a number of sessions. Or they could do this under the supervision of a professional such as a clinical psychologist or psychiatrist. GPs and other non-psychiatric professionals who are closely involved with the sufferer, might also have to learn to refuse reassurance in this way.