May 30, 2024

Cyberchondria – Health anxiety in the digital age

According to the NHS, health anxiety is ‘when you spend so much time worrying you’re ill or going to get ill, that it starts to take over your life’. Everyone worries about their health now and again, and often a trip to Dr. Google tends to calm some nerves, however, for those suffering from health anxiety this googling can become obsessive. Paired with body checking, a preoccupation with illness and constantly seeking reassurance, health anxiety can seriously impact someone’s daily life and relationships.

Research has shown that up to 1 in 5 people attending medical clinics suffer from health anxiety, although only 1 in 10 people are diagnosed with the disorder.

A lot of the time people struggling with health anxiety tend to feel humiliated about what they’re going through. Having been told by friends or even doctors ‘it’s all in your head’, it can be hard to articulate your very real concerns when faced with people that ‘just don’t get it’.

 Back in 2017, there were calls from researchers at both Imperial College London and King’s College London for NICE to recognise health anxiety and produce guidelines for managing it. Fast forward to 2024, and while there is in-depth guidance for more generalised anxiety disorders there is still no clinical guidelines for health anxiety, despite its now proven impact on physical health.

A recent study in Sweden showed that those with health anxiety could potentially die earlier than others. Examining the records of 45,000 patients, those with the disorder were likely to die up to 5 years earlier than those without it, highlighting how the anxiety almost becomes a self-fulfilling prophecy.

Interestingly, health-anxious people are either driven to over-rely on health services like the NHS or completely avoid GP surgeries or clinics of any sort.  Research in 2017 found that tackling health anxiety could save the NHS over £420 million a year, just by alleviating pressure on outpatient departments. Therefore, it is now more important than ever to bring these conversations to the forefront of medical discussions – mental and physical health will always be deeply intertwined.

‘Cyberchondria’: A Vicious Cycle

While the internet can be a space that allows people to have more control over their health and how they access their information, cyberchondria demonstrates the downsides of this accessibility.

The term was first coined in 2014 by McElroy and Shelvin who describe the condition as ‘a multidimensional construct encompassing searching that is distressing, repetitive, interrupts other activities, and leads to a doctor consultation’.

For people with health anxiety a key feature of their lives is seeking reassurance, be that from people around them, medical professionals, or the internet. With the ease and speed at which the information is readily available, along with the anonymity it provides, many turn to Google when they feel asking partners or friends about symptoms seems ‘silly’. However, while Google provides information quicker than any human could, it will not always act as a comforting friend, instead Google often makes matters worse. I’m sure anyone reading this will have at some point Googled a symptom to find that they could have cancer, heart disease, or pretty much any illness under the sun. For those with health anxiety, this only leads to more searches, for more answers that never really fix the original problem. This feeds into a vicious cycle where links can take you to new links which take you to different pages and soon you’ve diagnosed yourself with 10 new diseases. Cyberchondria raises important questions of how people access health information and how they act on it. More recently, social media has become a key source of sharing information, including that of healthcare. However, like Google, it sometimes does more harm than good.

Trapped in a web of algorithms

In our last blog on women’s health, we spoke more in-depth about (mis)information surrounding women’s bodies and diagnosis. While researching that blog, we found that from a survey of social media users, 42% thought that TikTok was the most accessible platform for health-related content. A further 50% detailed how they went on to take action, booking a GP appointment for example, after seeing these videos. Perhaps on the surface, this is a good thing, however, with how common misinformation is on social media, people may be seeking out consultations based off incorrect guidance.

TikTok can be an important place for people to share their experiences with different illnesses, and audiences can learn about incredible health journeys from all over the world, however, it is not commonplace to be exposed to so much content in such a short space of time. As with anything on the internet, it is easy to fall into rabbit holes, with hashtags that can take us to thousands of videos on a single topic, many become trapped in the algorithm. For example, if someone who is worried about their tonsils stumbles across a video of a girl talking about how she had them removed, then clicks on a few comments and other videos on her page, the TikTok algorithm has now learnt they are interested in that topic. Cue a whole string of health-related videos about tonsillectomies that, while making them anxious and worried, they just cannot seem to stop watching. Social media is designed to keep you on your phone for as long as possible, so the longer you look at posts the more it will show you. For people with health anxiety, this trap can even lead to physical problems such as panic attacks or waves of nausea. It is clear that the big social media giants don’t have the health-anxious person in mind when creating algorithms, however it raises the question of how healthcare practitioners along with those in the digital comms world can help those suffering from this anxiety and use the online space for good?

COVID-19 and its amplification of health anxiety

It is no secret that the pandemic impacted mental health along with public health. Studies have clearly shown the increase of anxiety for those in the UK and around the world, with problems such as isolation, job insecurity and fear all playing a part in a generalised sense of anxiety towards the unknown. However emerging data is beginning to explore how anxiety about the pandemic itself has impacted and is still impacting people’s lives today. The widespread health-based coverage on news outlets as well as social media, along with the prolonged period of time spent at home being able to obsess and check the internet meant the pandemic intensified worries for those already predisposed to anxious feelings. COVID had such an impact on anxiety, that the Coronavirus Anxiety Scale (CAS) was created in order to measure people’s response to the pandemic and aid healthcare professionals in diagnosing those with COVID-related mental health issues. Studies have since explored this correlation between the pandemic and anxiety.

A study carried out in 2020 found that the levels of cyberchondria and information overload were clearly higher among those who used social media as a source of information during the COVID-19 crisis, demonstrating the close relationship between health and digital spaces.

During the pandemic, the internet and social media became a source of comfort for those feeling lonely or isolated. It became a place where people could connect with others, share up-to-date information, and most importantly take part in the latest TikTok trend. Although for many it was not a useful tool but one that aided and amplified anxious tendencies. With days filled staring at a computer screen, people with health anxiety had ample time to Google symptoms or search for the latest death tally during the height of the crisis. With the government’s (important) campaign for checking symptoms and being safe, it is no wonder that many developed anxieties not just around COVID-19 but health in general. This intersection between health anxiety and the internet is vital for understanding what being health anxious means today and how we can use the digital space to create more supportive methods of helping those who suffer from the condition.

Short-term gain, long-term pain

The internet provides short-term relief for those worried about their health however it is never actually fixing the root of the problem; understanding why people are becoming anxious about their health in the first place. The NHS website offers small self-help activities that can alleviate symptoms and also recommends CBT (Cognitive behavioural therapy) for those who want a more long-term solution to the problem. However, the problem of getting people to admit they have anxiety and into a room with a therapist is always difficult, especially if their health anxiety has made them wary of any clinical settings. When these people do eventually make it to surgery, HCPs can then work with the patient to figure out where this anxiety stems from and point them in the right direction for psychiatric help. There is a push for terms to be more defined and well-known, as many people still refer to the condition as ‘hypochondria’ which carries all the negative connotations from years of being thrown around in health settings. Proper education and comprehension of this specific anxiety would lead to more helpful diagnosis and pathways for the patient, whilst simultaneously taking the pressure off already overloaded health services. Health anxiety highlights the clear link between physical and mental health and shows how integral the cooperation between those working in healthcare is for public well-being.

We can’t stop people searching?

From a digital communications perspective it is easy to believe that people will always search for what they want, so is there anything that can really be done? Of course there is. If people can so easily Google symptoms and be told they could have cancer it should be just easy to Google symptoms and find accessible content with evidence-based advice to help people act proportionately. An interesting study from 2020 in Australia looked at the effectiveness of ‘symptom checkers’ available on the internet. It concluded that while the correct diagnosis was given for 36% of searches, for triage advice these sites were not particularly useful. The mix of overseas sites and the lack of accessible medical language means that symptom checkers often lead to more of a burden on health services.

The Internet holds so many wonderful ways for people to access important information surrounding their health. As those working in the digital marketing space, we have the capacity and opportunity to make it a welcoming and safe space for all those who see it as a web of worry. Here are a few approaches that we use at Curious Health to tackle this. 

• Collaborate with those with the condition to investigate how people are using social media to learn more about conditions and what questions they have and are struggling to find answers to.

• Base content on a combination of the information needed by patients, as well as the message our clients want to convey.

• Ensure that all content we create is not just evidence-based but accessible. See an earlier blog on placing accessibility at the heart of the work we do as health communicators.

• Whilst being careful not to raise false hope, we also work with case studies to find the reassuring or positive parts of their stories – so even in the case of a diagnosis, people finding our content can take some comfort, as well as important information about a condition.

Curious about how to make the internet a safe and useful tool for all?  The team at Curious Health have expertise in several different therapy areas and experience in crafting unique and community-led campaigns that have an impact. Get in touch for a chat by emailing [email protected]