Illness anxiety disorder: how to become more rational?
post by completely_irrational · 2020-01-03T21:05:34.703Z · LW · GW · 3 commentsThis is a question post.
Contents
Answers 12 remizidae 7 shminux 6 rosyatrandom 1 Ustice None 3 comments
Disclaimer: When I think about dying I mostly think about cancer (I don't know much about other diseases). In the following, I'll be refering to "cancer" to point at deadly diseases where early detection is crucial.
[Epistemic status: thinking out loud; trying to debug my irrational mind.]
Situation I strongly believe that I have final stage cancer. When I touch my pectoral muscles, I can feel lumps. I have been suffering unbearable anxiety for the past one year and a haf or so, feeling that something very wrong is happening.
Medical Evidence One year ago, a cardiologist told me my heart was fine and didn't see anything from ultrasound. In the past two months, I checked two GPs. The first one said "it's probably just muscular". The second one (extremely talented, known as Dr. House) recommended additional ultrasound/computed tomography.
Internal Evidence It feels real. It hurts. It's cumbersome. It affects the left part of my chest and my left arm. Whenever I touch it I can feel that my left chest is of a very different consistency compared to my right one.
What happens I can't do any meaningful work. My mind is immersed in daily pain and the possibility of a final stage cancer. When I think about doing the additional tests, I'm TERRIFIED by the idea of having a doctor tell me "you have 4 months left". Yesterday, I managed to make an appointment for an ultrasound. However, I'm broke, and it turns out that the particular doctor is really expensive and has really bad reputation online (3/5 google reviews) so I ended up canceling it this morning. Also, I spend a lot of time in self-loathing, insulting myself for not having done any medical exams sooner, when the disease was "not yet deadly".
What I tell myself when I'm trying to be more rational I check the actual statistics of having some kind of cancer in my left chest. For males, breast cancer is 100 times less likely than females. I'm in my 20s, so the probability of having a cancer is smaller than for old people. When I look at actual symptoms of breast cancer, I have none. Most importantly, after checking actual cancer statistics, there's the chance of having a thing and still surviving (probability depends on the type of cancer and stage).
Also, I've been feeling pain for about one year and a half. So if it was something like a cancer, the actual pain would only appear at end, and wouldn't keep on going for a year. Plus, Dr. House not being impressed by my lumps is some evidence that they are not so impressive. And when I touch my right chest, I can also feel weird things when I search enough. The pain in the left chest could be something a psychosomatic phenomenon (at least to some degree).
What I actually tell myself I'm dead. The lumps are actually there. Look, when you press here you can feel this really strange thing. It's gross. It's getting worse and worse. It's very large. Oh my god it's a final stage cancer. I won't survive. I'm such a piece of shit for not having gone to a doctor. It's been over a year. Fuck. I should be doing more tests. But I'm broke. And the outcome of doing more tests will be one of the following:
1. The doctors are not able to identify my disease and I'll keep being in pain / anxious / dying.
2. They identify something and tell me "you have four months to live".
What I'm asking you I need help. I know most of what I think doesn't make sense, but it FEELS very real. It's like having some really strong internal evidence that something bad is happening. I know that doing more tests if the way to go. But because it takes 2-3 weeks to get an appointement for a good GP, so there's always the bias of trying to avoid to think about death and procrastinating the appointment. And there's this additional cost of having to borrow money to do any test to begin with, which is painful to think about.
In short It feels like I'm Pascal Mugging myself when thinking about death. But I'm also the complete opposite of a hypochodriac that would go see a ton of doctor because he is in distress. I FEAR going to a doctor because I'm afraid he will either not find anything or tell me I'm dead. It's unbearable, so I need to debug my brain.
What should I tell myself to become more rational?
Answers
Action cures fear. Stop ruminating and do the thing. Ultrasounds are always expensive IME—still, if you can come up with the money it seems worth it.
In the longer term, one thing that has helped me is to list all my nagging fears, along with their outcomes. I can go back and see how, often, the thing I was afraid of didn’t exist at all or wasn’t nearly as bad as I feared.
↑ comment by completely_irrational · 2020-01-04T13:00:02.403Z · LW(p) · GW(p)
Action cures fear. Stop ruminating and do the thing.
Thanks, that's the boost I needed.
In the longer term, one thing that has helped me is to list all my nagging fears
Sounds super useful for the long run, will start today!
I know a few people who are like that. They are convinced (often for years) that they have a terminal illness that would kill them within days or weeks, yet they don't go get it checked, just are stuck in self-blame, fears of dying and often self-punishment. Nearly all of them also have been through severe childhood trauma stemming from persistent abuse and/or neglect. Not sure how your childhood was like, but it is definitely a good idea to see a therapist, rather than a GP or a specialist. It is entirely possible that all you need is some skills you can learn through CBT or ACT for your quality of life to markedly improve. And a therapist won't attempt to diagnose your physical condition, alleviating your fears of being either invalidated or condemned to die. It also looks like you are ready for "debugging your mind", so your odds of success are above average.
↑ comment by completely_irrational · 2020-01-04T13:37:24.136Z · LW(p) · GW(p)
Thanks for the comment! It really helps to know that other people are in a similar situation.
My childhood went fine. I did spend the past 3/4y midly-to-severely depressed/anxious and saw a CBT therapist for about 6 months this year though (stopped it last month). We mostly worked on how to build self-confidence and avoid self-loathing through the three columns technique. I also did the exercises from "Feeling Good". We did not focus on my illness anxiety (never mentioned it to her to not sound too crazy and because we had other things to fix first). Never heard of ACT, will check it out and think about doing a therapy more anxiety focused.
alleviating your fears of being either invalidated or condemned to die
I really like how you phrased this, especially "invalidating" (never thought of it that way).
"It is entirely possible that all you need is some skills you can learn through CBT or ACT for your quality of life to markedly improve. [...]
It also looks like you are ready for "debugging your mind", so your odds of success are above average."
Thanks for the optimism. When I apply CBT techniques right now and try to fix my biases, I still have this creepling anxiety telling me: "hey, if you don't act now you're likely to die in the next months/year. It's probably already hopeless". It's like if both my body and mind were already convinced that something was happening in my body. Whenever I look for new evidence (by touching etc.) my mind adapts the reality to match its story (e.g. the thing I'm feeling in my chest MUST be cancer because it would explain what I feel). I feel like the only way to be completely alleviated would be to do a full scanner/ultrasound.
Yesterday, I managed to make an appointment for an ultrasound. However, I'm broke, and it turns out that the particular doctor is really expensive and has really bad reputation online
This is tangential, but part of the problem here is that your healthcare system is evil.
You should be able to see doctors for worries of this magnitude, and get the treatment/checks/referrals that you need, without this bullshit.
I don’t think that more tests are necessary. You’ve had two doctors look, and you have had your chest imaged. The chance that it is cancer given two strong pieces of evidence against, given that your baseline risk is very low, is extremely low.
You’re privileging your hypothesis, and are only looking to conform rather than looking to disprove your hypothesis.
The problem isn’t your beliefs though. It sounds like you logically understand that you are very likely fine, but your aliefs are misaligned. Those are harder to change. More evidence isn’t going to do it though.
Do you have a psychiatrist or a therapist? That’s the doctor that I’d turn to in your situation.
Depending on your level of probing, is it possible that you’ve injured yourself causing some scar tissue in the muscle, with possible inflammation? If you probe the location often, have you considered covering it with some rigid material to block unthinking probing?
For anxiety like this, cannabis can be an option. It may help with the pain that you’re experiencing too.
↑ comment by completely_irrational · 2020-01-04T13:59:16.298Z · LW(p) · GW(p)
You’ve had two doctors look, and you have had your chest imaged.
To give a bit more context, whenever I had the GPs "touch" the parts that I feel were alarming, they never managed to "feel it" or "grab it" the way I do. So I don't feel like I gave them enough evidence. And for the "chest being imaged", it was about one year ago (things might have changed since then), and the doctor did it quickly looking at my heart, not really looking precisely at the part that I'm concerned about.
(I know that I sound a bit like "the medical evidence is wrong, they didn't find anything because they weren't doing it right, I know what I truly have", but that's how I honestly feel).
your aliefs are misaligned. Those are harder to change. More evidence isn’t going to do it though.
I didn't know about the concept of alief, that's really cool, thanks!
Do you have a psychiatrist or a therapist?
Not now, definitely needed. I feel like someone specialized in illness anxiety would help more with the anxiety than a psychiatrist, but the psychiatrist would know what's psychosomatic and what's not.
possible that you’ve injured yourself causing some scar tissue in the muscle, with possible inflammation
I'm unsure how much you could injure yourself from just probing daily (with different levels of intensity) for like 6 months. That's definitely something I considered. When I probe my right chest, it's painful for like 10-20m, but I almost never do it. When I saw the first GP, he told me the region I was pointing at was near a tendon in the "pectoralis major".
If you probe the location often, have you considered covering it with some rigid material to block unthinking probing?
Interesting. I haven't reached the point where I do it every hour. For now, it's maybe 10m in bed, so not too constraining. I also have enough self-control to not do it during the day (even more now that I wrote this post).
For anxiety like this, cannabis can be an option.
Word. I'm the kind of person to develop new anxieties with cannabis though.
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comment by leggi · 2020-01-04T14:56:46.874Z · LW(p) · GW(p)
I am not a doctor and this is not medical advice! To you I am just some random ...
I was a veterinary surgeon so do have some mammalian clinical experience and I do have a lot of lumps over my pecs. I think I can explain them, they are benign. But your lumps are yours - so you first.
You say duration approx. 18months anxiety. Is that when you first noticed the "lumps"?
When I touch my pectoral muscles, I can feel lumps
Describe the lumps.
Take a deep breath in through your nostrils a few times to relax a little. You'll be fine.
Then really feel the lumps Number size type distribution
hard-soft?
smooth-irregular?
solitary-connected?
round-elongated-chain?
fixed-movable?
Let's start there.
Replies from: completely_irrational↑ comment by completely_irrational · 2020-01-04T17:01:43.436Z · LW(p) · GW(p)
I starting feeling anxious about left chest pain about 18 months ago. I would say I started touching/feeling lumps maybe one year ago, and I started being really concerned (touching more) six months ago.
Number/size/distribution
- #1 and 2: they're both soft, smooth, connected in a chain, movable and more elongated than round. Size: kind of a cylinder of length approx. 1cm and diameter 5mm (each).
- #3: also soft, smooth, movable, but solitary and length is more like 2-3cm.
↑ comment by leggi · 2020-01-04T19:29:33.315Z · LW(p) · GW(p)
Movable suggests something located in subcutaneous tissue rather than muscle tissue. Soft, smooth, solitary all 'nice' characteristics for lumps.
You say you've had a heart exam, so assuming cardio. is OK. The lumps are most likely benign - do some research on fibrous lumps/ fibrosis.
And research the diagnostic capabilities of ultrasound before paying for an expensive one.
(House was a comedy about incompetent doctors IMO)
A full history and clinical exam should always be done before expensive tests. - Do it yourself if you want. Start a list of pains and niggles, past illness, injuries, falls, surgery, trauma etc... Feel all over your body for lumps and thickenings, tender spots etc - in all sorts of positions. Positioning can affect the ability to feel some things.
It's a long while since I used ultrasound (and it was an old machine for even back then), but bone reflects ultrasound so over the ribs imaging is commonly distorted as the waves are bounced back. (unless this ultrasound is capable of scanning to a depth of less than skin to ribs).
- - --
A possible explanation:
Chest pain can come from muscle pain. intercostal muscles, rectus abdominis muscles especially. Can be sharp and stabbing. Can be tight or shooting.
The lumps are fibrous, benign thickenings in subcutaneous connective tissue over your pecs. Possibly developed 'to take the strain' when the trapezius muscles aren't sufficiently supportive.
Promotion of my hypothesis/the best advice I can give:
Have a look at this anatomy: main muscles [LW · GW] and think about how you use your body, how balanced and aligned are you? Do you have a full range of movement or do you have tensions and restrictions? (I've written a lot more but a few pictures and a bit of self-touching will get you started.)
Give it a bit of thought over some days, feel how you move.
- --
If nothing else, you should be able to find the lumps more easily again if you do decide to get further examinations.