At the beginning of my "ordeal", if that's what we can call a complete spiral down due to perimenopause and a reaction to the typhoid vaccine, I became consumed with blood pressure.
After a few panic attacks (in hindsight), where blood pressure and heart rate spiked, the doctors alarmed me enough to where I was completely fixated on it.
The low point is when I took my blood pressure 3 times in a short duration and actually bruised by vein in my arm!
Needless to say, in my very anxious state, THAT then took on a life of its own.
This followed with multiple questions on about whether I had this or that terminal disease.
Yes, brain tumors were questioned many times.
My husband's favorite…
"Am I going to be like this forever??".
That whole story is here.
Let's just say that health anxiety is something I can speak to.
I never had it till perimenopause sent me reeling but it's definitely been a hitchhiker ever since (albeit with less intensity).
This brings up the question...is health anxiety just a manifestation of a general anxiety state?
Is it something completely different in the brain or in experience?
We're going to look at interesting research at the intersection of health anxiety and panic disorder!
See our artilce on CBD and GABA.
Maybe more importantly, what can help there and is CBD in that mix?
We're going to look at the following:
- A quick intro to health anxiety
- Past trauma and health anxiety
- Hypervigilance and health anxiety
- Negative thoughts, ruminations, and health anxiety
- Can CBD help with health anxiety
- How much CBD for health anxiety
- What's the best CBD for health anxiety
Let's see if we can get more clarity on a very common issue.
A quick intro to health anxiety
First, health anxiety is a general term used for two very different issues:
- Somatic Symptom Disorder
- Illness Anxiety Disorder (formerly, hypochondriasis)
The first deals with symptoms or feelings that do not have a root in the body.
The second deals with exaggerated worry about getting sick.
First, understand that the mind is very powerful.
When we look at studies of CBD versus anti-anxiety medications, it's always fascinating just how powerful the placebo effect can be.
If you scan the body, looking for things, you're likely to eventually find them!
That speaks to the somatic symptom disorder.
Researchers see different brain activity for somatic symptoms, no symptoms, and even faking symptoms.
We still need more research on this front.
See our article on does CBD boost GABA.
We're starting to get clues albeit strange ones.
For example, in one study, participants were shown an image of their hands being touched.
People who had a history of Medically Unexplained Symptoms (MUS or somatic symptom disorder) "felt" more from these imaginary touches.
These findings support the proposed link between MUS and disturbances in body representation and suggest that an over-reliance on top-down knowledge may interfere with current sensory inputs, contributing to symptom formation and maintenance in susceptible individuals.
That means that the brain would "fill in the gaps" for a lessened sense of feeling from the body.
Again, we need more research on this front but studies have shown there's clear communication between brain and body on various states:
Finnish researches show how subjective feelings map into five major categories: positive emotions, negative emotions, cognitive functions, somatic states, and illnesses. All these feelings were imbued with strong bodily sensations.
Keep in mind that the vagus nerve is our internal sensor. There's are ways to strenthen it.
What about the other health anxiety.
Technically...true health anxiety is a common occurrence (officially at about 4% of the population but likely closer to 12%).
The signs may be familiar (they were to me!):
They obsess over bodily functions (breathing, heartbeat), physical oddities (skin blemishes), and physical discomfort (headaches, stomach aches, lightheadedness). They might worry about a specific organ (brain, heart) or a disease they heard about on the news or at work (MS, diabetes). They are preoccupied with the belief that they have, or are in danger of contracting, a serious illness.
Interestingly, there tends to be a lot of follow up with doctors and requests for testing.
Some doctors will dismiss it and say to stop researching it online or it's all in their head.
That's actually counterproductive!
More information on a prospective disease tends to disarm it for health anxiety.
In fact, here's a list of things TO do:
- Research diseases.
- Construct and dwell on the Nightmare (at the prescribed time)
Check out that link for more information.
CBT (cognitive behavioral therapy) is often recommended with a follow up for SSRI's (see CBD versus SSRI's for anxiety). Those build tolerance though with time.
What about causes or associations?
Interestingly, health anxiety affects men and women equally which is different from traditional anxiety's heavier prevalence on women.
General anxiety disorder was more common in families of people who have health anxiety or hypochondriasis.
There was also an association with OCD inheritability.
The intersection of these two (general anxiety and OCD) is an interesting cross-section (anxious and worrying state combined with repetitive coping mechanism) for health anxiety.
Typically, no amount of testing or reassurance from doctors will resolve the initial fear!
Since there doesn't appear to be a gender difference, hormones likely do not factor in as strongly.
Let's first clarify that there may be three subsets of health anxiety:
- OCD and health anxiety (intrusive, repetitive and negative thoughts about health)
- Phobia and health anxiety (white coat, fear of doctors, etc)
- Depression and health anxiety (catastrophizing - assume life-threatening disease)
We'll look at aspects of each below.
Let's then focus on associated occurrences tied to health anxiety which brings it under the PTSD, panic attack, and anxiety fold.
Past trauma, worrying parents, and health anxiety
We've covered many aspects of anxiety that actually come for prior assaults.
From long ago...and even in the womb!
We looked at the genetic pieces (OCD and general anxiety disorders in family members).
Let's look at parenting style and trauma.
First, let's blame the parents (always fun).
We learn how to respond to stress and other events (including health issues) from our parents initially:
Those scoring highest on each of the three dimensions under examination remembered one or both of their parents as highly likely to call a doctor in response to childhood illness in the subjects.
We "pattern" our response after parents like training wheels.
As one researcher put it:
Psychiatrists have long thought some sort of trauma, tragedy or conflict years earlier was the main driver of health-anxious fears and behaviors
Of course, these figures strongly into anxiety in general as our reaction to stressful events is partially learned.
Then there's experience with traumatic health situations.
Take a look at some of the known risk factors:
- a stressful event or situation
- the possibility of a serious illness that turns out to not be serious
- being abused as a child
- having had a serious childhood illness or a parent with a serious illness
- having a worrying personality
- excessively checking your health on the internet
Four of those factors deal with past traumatic experiences and two of them are directly tied to childhood.
Don't worry, we'll look below at how to "unwind" past experiences in the brain!
One result of dealing with health scares is an increase in vigilance.
Let's look at that now.
Panic disorders, OCD, and health anxiety
So is health anxiety just anxiety that's expressed in one area...health?
Is the constant testing and rechecking a function of OCD?
Maybe more interestingly, is health anxiety somehow tied to panic disorder?
Let's open this question with a study that looked at brain activity between subjects with OCD, panic disorder (PD), and hypochondriasis.
See our artilce about CBD and OCD.
Interestingly, brain activity for health anxiety (hypochondriasis) mirrored panic disorder!
Patients with hypochondriasis showed a similar activation pattern to patients with PD.
If you read our review on CBD and panic attacks, this starts to make a little sense.
In the negative thoughts section below, we'll touch on two key brain areas tied to panic attacks that are the seat of doom and gloom (that tickle in my throat is probably cancer).
For panic disorder and health anxiety subjects, there's was more emotional processing of cues and less rational interpretation:
In contrast, generalized emotional interference effects were found in PD and hypochondriasis, involving ventral and widespread dorsal brain regions, reflecting not only unconscious emotional stimulus processing but also increased cognitive elaboration.
The "unconscious" piece is interesting in terms of rumination and negative thoughts.
See our review on CBD and negative thoughts on how the brain can get stuck in default mode (where we daydream and meander).
Obviously, the emotional and fear processing is tied to a major player of our anxiety circuit...the Amygdala (see CBD for anxiety here).
Another study pinpointed this effect in people with severe health anxiety (PHA - pathological health anxiety):
The attentional bias observed in patients with PHA is associated with hyperactivation in response to body symptom words in brain regions that are crucial for an arousal-related fear response (e.g., the amygdala) and for resolving emotional interference (e.g., the rostral anterior cingulate cortex).
We also covered the ACC (anterior cingulate cortex) in detail at our CBD for general anxiety disorder since it's the translator between our fear center and our rational brain.
The key is that past trauma can trigger changes in the brain (which can reverse with steps below).
There's a good review of how PTSD affects brain function here:
Another study found that health anxiety subjects shared more commonality with panic disorder people along feeling symptoms:
While panic patients had more comorbidity with agoraphobia, hypochondriasis was more closely associated with somatization
Somatization is a tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them
"feeling more" essentially.
This was one of the types of health anxiety we looked at above.
Hypervigilance, OCD, and health anxiety
A study found that people who are hypervigilant have too much activity in the "pain avoiding" section of the hippocampus.
Results showed enhanced C1 amplitudes in response to spatially directed target stimuli in spider-fearful participants only.
You can learn all about the importance (and vulnerability) of this brain area in our CBD and hippocampus neurogenesis for anxiety review.
It's critical to our ability to repair areas tied to long term anxiety.
Next, let's introduce orexin.
It's a fascinating hormone we covered in our CBD and Panic Attack articles.
It's literally the hormone of vigilance!
Too little and you have narcolepsy. Too much and you have hypervigilance and panic attacks!
New studies are also pointing to its effect on compulsive behavior.
Orexin 1 receptor antagonists in compulsive behavior and anxiety: possible therapeutic use
There's a good review of differences and similarities here between OCD and health anxiety.
The primary difference is that health anxiety focuses on one thing...health and symptoms!
Interestingly, there's a gene tied to OCD which sheds light on health anxiety as well.
It's HTR2A and involves the serotonin pathway. We'll revisit that below in more detail since it's a lever we can potentially push for health anxiety.
New studies are pointing to GABA as a key player for both OCD and our next topic, negative thoughts.
Compared with healthy controls, the GABA/W and NAA/W concentration in individuals with OCD are significantly decreased (p=0.031, t=2.193, p=0.002, t=3.223). Also, the concentration of GABA/W had a trend of decrease in the ACC.
GABA is something we can influence below as well.
Next, on to thoughts of impending (health) doom.
Negative thoughts, ruminations, and health anxiety
Especially, repetitive negative thoughts.
Now just point this "system" over to health concerns triggered by prior health scares.
First, let's touch on some brain areas from our CBD and Panic Attack review.
- dPAG - where we anticipate and react to bad things
- The habenula (seat of dread feeling)
Tell me that a feeling of impending doom doesn't smack of health anxiety.
In fact, every symptom or disease read about becomes a potential death knell.
As for the dPAG:
The results indicate that activation of the DPAG caused a short-lived, but selective, increase in defensive behaviors associated with generalized anxiety.
As we mentioned above, repetitive, negative thoughts are a function of an anxiety state with OCD behaviors.
GABA is a key player there and it's actually something we can address.
Let's get to that piece now.
Can CBD help with health anxiety
We've covered how CBD works quite a bit for anxiety.
Let's focus on health anxiety which has aspects of OCD and catastrophizing intertwined.
We'll lead with serotonin and GABA for health anxiety.
These are the levers for the two most common medications prescribed for health anxiety.
- SSRI's boost serotonin (till tolerance kicks in)
- Benzos boost GABA (till tolerance and addiction kick in...fast)
The quick takeaways for both with CBD…
Speaking of benzos...one study found CBD had the same effect as a popular benzo, diazepam:
mice treated with cannabidiol and nabilone spent a greater amount of time in the open arm of the maze, an effect similar to that produced by diazepam, the reference anxiolytic agent.
How does it have this anxiolytic (anti-anxiety) effect?
Finally, the anxiolytic effects of systemic CBD partially depended on GABAA receptor activation in the EPM model
Most importantly, it doesn't just keep boosting GABA in one direction which would lead to sedation and death (benzo overdose).
As for serotonin…
Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain.
Goodness...CBD supports serotonin to reduce system wide pain and anxiety following injury. With no tolerance!
Seven days of treatment with CBD reduced mechanical allodynia, decreased anxiety-like behavior, and normalized 5-HT activity.
"Modulate" and "Normalize" are the keywords.
Not boost (like SSRI). That's where SSRI's can have nasty side effects.
Remember up above that, hypervigilance (key to health anxiety) was tied to the hippocampus brain area?
This area is extremely vulnerable to both chronic stress and acute stress (trauma!!).
In fact, research is showing that the way serotonin actually helps for anxiety and depression is by repairing brain areas under attack:
The anxiolytic effect of cannabidiol on chronically stressed mice depends on hippocampal neurogenesis: involvement of the endocannabinoid system.
People...this is the key to repairing and rewinding past trauma.
Trauma leaves an imprint on the brain.
Neurogenesis is the eraser!
Of course, these figures into anxiety, PTSD, panic disorder, and...health anxiety.
Remember that seat of dread in the brain...the dPAG?
Can CBD have any effect in a specific brain area like that?
In another test on rats, there's was a clear effect from CBD administered after stimulating the Dpag:
Intra-dorsal periaqueductal gray administration of cannabidiol blocks panic-like response by activating 5-HT1A receptors.
5HT1A is just the serotonin pathway!
We've really approached this from the "anxiety" perception of our health.
There's a whole other article to be written on the positive health benefits of CBD alone!
Check out a list of benefits for CBD here.
Everything from sleep, mitochondria function (key to aging and age-related diseases), immune function, weight, and energy, auto-immune (80% of the ads you see and worry about on TV).
Let's also bring up the big one.
Remember, CBD boosts our endocannabinoid system which is tasked with balancing:
- Nervous system
- Immune system
- Endocrine system
One of our favorites (since I've been there in the health anxiety membership) is glutathione!
It's just our primary tool to get rid of toxins, oxidants, and poisons!
Check out CBD and glutathione.
The first step though is to reduce our anxiety "lens" for health-related issues.
How much CBD for that aim?
How much CBD for health anxiety
First, let's establish a top range.
Research shows that the neurogenesis (brain repair) tends to go down after 300 mg of CBD.
For that reason, we probably don't want to go any higher than that other than for extreme panic responses.
Studies actually used 600-800 mg for more serious issues (check out CBD and public speaking as an example).
It's best to start around 25-30 mg to test your response.
Most people see a helpful response from 40 - 160 mg (the latter being where sleep improved... the key to health).
Again, everyone is different so make sure to test for yourself.
What's the best CBD for health anxiety
We crafted IndigoNaturals to be as clean as possible (again, I have reactions to almost everything due to histamines...especially after perimenopause).
It's 2 ingredients:
- CBD Isolate
- MCT oil (extract from coconut)
We follow the mandatory steps:
- Organically grown in the US
- CO2 processed (much cleaner)
- 3rd party tested:
- No THC
- No Pesticides
- No Heavy metals
- No Bacteria
- No Mold
Like we mentioned, we came from a health anxiety bent and our whole family takes this.
We're very serious about quality.
There's also the question about histamines.
We purposely picked CBD Isolate for two reasons:
- All the research is based on isolate (not full spectrum)
- 40-60% of the population will have histamine responses to all the plant material in full spectrum
Of course, everyone's pushing full spectrum on the market and that's why we constantly get people who report side effects.
Check out why CBD isolate versus full spectrum here.
This is especially true for anxiety!
Histamine eats up GABA and is excitatory in the brain.
On one hand, health anxiety was a curse.
On the other hand, it caused us to research CBD for 1000's of hours and may have saved my life (see that story here).
Let's see if we can find a middle ground for everyone else.
Always work with a doctor or naturopath with any supplement!
The information provided here is not intended to treat an illness or substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.