Fear is one of the most potent emotions. It can render powerful people powerless and sap them of their strength. Rational fear can save our lives; irrational fear can ruin it. One way irrational fear manifests is fear of illness. The fear is common; fortunately, traditional Chinese medicine offers a theory and pathway toward alleviating patient distress.
Those with fear of illness are in fact less capable of determining their true health status than those who are more normative. They will rate their health more poorly, spend more time searching the internet for answers about their perceived symptoms, and have a tendency toward exaggerating the danger of anything in their bodies that feels out of whack. A heavy meal that sits poorly is rarely perceived as a dire physical threat by a "regular" person.
Illness Anxiety Disorder
The same is not true for people who suffer with illness anxiety disorder (IAD). It is indeed suffering that they experience, as enjoyment of life is hard to come by when one feels constantly on the verge of a health catastrophe.
Illness anxiety is a psychological disorder defined in the DSM-V, the Bible for psychiatrists and other mental health practitioners. Although the DSM has been challenged on occasion, with modern versions reflecting changed thinking about such issues as gender and sexuality, there is little to doubt when it comes to IAD.
According to the DSM-V, a person with IAD will likely be anxious about the state of their health despite showing either none or mild symptoms of any disorder; consistently upset about their health; and either avoidant of visiting their health practitioner or a "frequent flier" visitor to doctors and other medical professionals, even if their health does not warrant so much visitation.
Psychologically, there are three primary things potentially going on with these patients. First, there is tendency toward so-called disease conviction. Disease conviction is the firmly held belief that by the patient of being seriously ill, even if the diagnostic data and doctor's examination contraindicates the existence of illness. A negative test for someone with disease conviction means (in their mind) that the test did not pick up the illness, not that the illness does not exist.
A second possibility is disease fear. This is deep concern about the potential for serious illness, generally unjustified. Finally, there is body preoccupation, which means overly acute attunement with one's physicality. It is body awareness taken to the nth degree, noting or accentuating any odd discomforts or deviations from perceived normal. It is driven by abject fear of illness.
Interestingly, self-awareness of IAD varies. Some patients are blithe to their maladaptive behaviors, while others see it, but cannot harness it.
The TCM Perspective
According to TCM, emotions have a deleterious effect on the function of various internal organs, with the emotion of fear associated with kidney function. TCM considers the functions and health of the kidney as being related to the neuroendocrine system of the body.
Some investigators suggest patients can present with an overall deficiency of the kidneys that is really connected not to the health of those organs, but to changes in the hypothalamus-pituitary-adrenal axis. Those changes are far-reaching in the body, affecting other aspects of health, but with particular challenges for kidney qi and essence.
The longer a patient suffers with IAD, the greater the stress on this axis, and the greater the likelihood there will be kidney qi and kidney essence negative involvement in their health.
Both Eastern and Western scientists have become attuned to other effects of prolonged fear, such as immune function issues. There are studies that indicate a relationship between suboptimal kidney health and erythrocyte immune response and its complementary CRA functioning, whereby poor kidney health diminishes both. These studies have been both with animals and people, giving scientists greater confidence about their findings. In short, when a patient has a kidney deficiency, it's logical to look for immune dysfunction at the same time.
There are other effects of IAD from the perspective of TCM. Yin and yang find it hard to maintain balance under the hormonal wash of fear and panic, as the body is triggered to fight, flight or freeze. There is a greater chance of both the recurrence of disease thought vanquished, and the patient complaining of new and wide-ranging symptoms.
The yin and yang disruption will also have psychological effects on the patient, particular if IAD persists. Depression and anxiety could join hypochondria and other negative emotions.
Doctors in Chinese hospitals have found a prevalence of fear and stress among patients during the worst of the Covid-19 outbreak there. Since the immune system is how the body copes with and responds to any pathogen, long-term fear can make it more likely for a patient to be susceptible to any virus, as their immune systems become depressed. This is why studies of patients with Covid-19 have found many suffer from lymphocytopenia; and immunological disorders place patients in high-risk categories for just about all bacteria and viruses.
Treating ICD: Clinical Pearls
Fortunately, TCM offers patients a helpful approach that can spare them extended psychological intervention. The most effective TCM interventions will focus on principles such as bodily integration and reunification of person with nature. A holistic approach is advisable; incorporate TCM, tuina, acupuncture, and TCM-based behavioral or emotional therapy.
For acupuncture, the helpful points to support kidney essence are sishencong (EX-HN 1), zhishi (BL 25), ximen (PC 4), shenting (DU 24), xinshu (BL 15), danshu (BL 19), and shenshu (BL 23).
Additionally, TCM five-tonal therapy, or the guiding method, may also be effective for patients. TCM practitioners may also consider employing what we know of relaxation therapy and cognitive-behavioral interventions.
- Arnaez S, et al. Illness-related intrusive thoughts and illness anxiety disorder. Psychol Psychother, 2020 Mar;94(1):63-80.
- Furer P, et al. Treating Health Anxiety and Fear of Death: A Practitioner's Guide. New York: Springer, 2011.
- Liu Q, et al. Analysis of the influence of the psychology changes of fear induced by the COVID-19 epidemic on the body. World J Acupunct Moxibustion, 2020 Jul 15 (epub ahead of print).
- Rugg S, et al. Traditional acupuncture for people with medically unexplained symptoms: a longitudinal qualitative study of patients' experiences. Br J Gen Pract, 2011 Jun;61(587):e306-15.
- Scarella TM, et al. Illness anxiety disorder: psychopathology, epidemiology, clinical characteristics, and treatment. Psychosomatic Med, June 2019;81(5):398-407.
- Starcevic V. Hypochondriasis and health anxiety: conceptual challenges: Brit J Psychiatry, 2013 Jan;202(1):7-8.
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