THE WASHINGTON POST – Before the pandemic, before “social distancing” and “flattening the curve” achieved ubiquity in our lives, before hand-washing became an hourly aerobic workout, before anxiety took up residence in so many homes, April Baker was already there.
“Welcome to the last 10 years of my life,” said Baker, 38, of Omaha, who works for a nonprofit. “This is how I live every day.”
Baker suffers from health anxiety disorder, also known as hypochondriasis. Obsessive-compulsive disorder, or OCD, is its frequent companion. Germs are the mortal enemy. Tony Shalhoub’s detective character in Monk, with his phobia of unclean surfaces and bountiful supply of sanitary wipes, is the disorder’s poster child.
Baker’s home is never without end-times supplies of bleach, hydrogen peroxide and the twin set of germ weaponry in our newly confined world order: dainty bottles of hand sanitizer and jeroboams of disinfecting wipes.
In recent weeks, her health anxiety Facebook group, which she helps administer for a few hours daily, experienced a 32 per cent increase in members (to more than 7,000) and an 80 per cent spike in posts.
Baker’s background is in health care. She attended nursing school and worked in psychiatric facility for a decade. Yet, “it’s a constant battle in your mind all day long,” she says. “I became obsessed with learning about all these diseases.” She’s been in therapy for seven years.
Health anxiety disorder is underreported, according to the Anxiety and Depression Association of America, and possibly affects 12 percent of the nation’s population. (The group’s annual conference this week was nixed due to the coronavirus.) Those who suffer from the disorder are usually thought of as hypochondriacs or germaphobes.
They are the worried well. The very worried well. Some sufferers worry less about germs, and more about gut health. Or vomiting. Or that every symptom is a sign of cancer – a worst-case scenario, WebMD-and-panic view of their health.
People with health anxiety are undertreated, experts says, with only a third consulting therapists. They’re the ones who have already figured out that their issues are psychological. Many sufferers seek help first in emergency rooms, with internists or specialists, in search of a physical diagnosis.
“In a very nice way, we screen people. What we do is keep them out of the office,” said John Stern, an infectious disease doctor at Philadelphia’s Pennsylvania Hospital. He tells people with no troubling symptoms, “You’re just going to have to trust me. You’re okay. I can’t make your anxiety go away, but I can reduce it.”
The current alarm about the coronavirus could be hard on OCD sufferers, prompting them to overdo it even more than usual. However, some people with health anxiety may be coping better during the pandemic than individuals who aren’t used to worrying about sneezing and coughing and handshakes and other casual physical contact, says Andrew Rosen, who runs the Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida.
“They’ve been fearful of dying from contamination for a long time. For these people, it’s not so much of a transition from peace time to wartime. They’ve already gone to wartime,” he says, the war being against germs, doorknobs, disease, the unknown. “They already have hypervigilant mechanisms.”
Rosen’s practice, with a clinical staff of 13, treats a panoply of anxiety disorders. In the past five years, health anxiety become paramount.
“Know why?” Rosen asked. “Dr Google.”
For every lump and cough, the internet sprouts forth potential scourge. During the past few weeks, his practice received a 25 per cent surge in first-time calls.
“I tell my friends, ‘You’re a little late to the party’,” said Monica, 41, a property manager in South Florida and one of Rosen’s patients. (For privacy, she asked that her last name not be used.) “I’ve been in this quagmire for a couple of years. I’m the boy in the bubble.”
Monica washed her hands 30 times a day before the coronavirus. Clorox Disinfecting Wipes are a decorating accent. When she meets a friend for lunch – not that she’s meeting friends for lunch now – Monica would first check the restaurant’s health and inspection report online. Once seated, she would wash her hands after touching the menu, her drink, the silverware, an ordeal.
“I already perceived the world as everyone being infected or a threat,” she said. The rest of us are merely catching up.
As happens with many people, whether they suffer from health anxiety or not, Monica became actually, seriously ill – a tumour on her adrenal gland, which she had removed in 2018. Treatment and prescriptions have compromised her immune system.
“Now I’m a germaphobe who has reason to be a germaphobe,” she said.
Real illness can be clarifying. “What happens when a hypochondriacal person actually gets sick?” asked Timothy Scarella, a psychiatrist at Beth Israel Deaconess Medical Center in Boston. “Their hypochondriacal behaviors actually decrease. They tend to refocus on the actual things they need to worry about.”
Ashley Smith, a therapist in Kansas City, treats clients with health anxiety by directly confronting the issue and altering behaviour. “The more you act on your fears, your rituals, compulsions and avoidance, the bigger the fears get,” she said.
So she has her clients “touching toilets, following hand-washing bans, eating with those dirty hands,” all in the name of healing. (Not that such experiments would be wise right now, during the pandemic. Definitely keep your home clean. Definitely wash your hands often.)
Anecdotal evidence suggests that the current national obsession with disinfecting and social distancing comes as a relief to those who already had those policies stringently enforced in their own lives. Los Angeles therapist Ken Goodman, who specialises in anxiety and OCD, said the people he treats are “feeling safer because everyone is more careful.” Only one of his 60 patients experienced an escalation in recent weeks.
“Everyone is doing what they’ve already been doing,” he says.
Anxiety welcomes company. “It’s less isolating when your anxiety and fear is being shared by the world,” says clinical psychologist Tabasom Vahidi, who practices in Los Angeles.
Then again, Vahidi notes that “being inactive can intensify anxiety.” And, of course, there’s the specter of actually getting infected by the coronavirus – a very real possibility in a pandemic.
Tom Anderson and his wife, Cristine, chose to self-quarantine in Baton Rouge for a month, possibly longer. “I feel existentially threatened in a way I’ve never felt before,” said Anderson, who worked in disaster relief management and volunteered at Ground Zero after 9/11 and in New Orleans in the wake of Hurricane Katrina. He suffers from post-traumatic stress disorder.
“I got nervous back in December. I was really concerned we weren’t doing anything,” he said. By “we” he means America.
Now, he worries about his health (he’s 62) and that of his wife (age 72, lung issues). “I get very exhausted, very emotional and weepy. My body is vibrating,” he says. “It’s hard to catch your breath sometimes, and then it steamrolls.”
Meditation helps. Music, too. They do leave the house. Nature is a tonic. Nature feels safe, free of germs, when little else does. “The mother ship is the car,” Anderson said. “We’re going to swamps and birding. Avoiding all crowds.”
Rosen, the South Florida psychologist, and his colleagues are consulting patients via FaceTime and Skype.
“We’ll get out of this,” Rosen says. “Look at history. Human beings adapt. We’re hard-wired to adapt.”
These days, many people are adapting by doing as germaphobes have always done. Rosen says he’s received a deluge of calls and emails “from all over the world, including doctors who are feeling overstressed and threatened themselves. There’s hardly anybody who isn’t getting affected,” he said.
“It’s crazy for me to use the word crazy but,” Rosen said, “it’s crazy.”