The Uncanny Upside of Health Anxiety

How Hypervigilance Sometimes Gets It Right 🤔

ICYMI 👉

• Do You Have Brain Fog?

• How to Manage Anxiety When the World Feels Like It’s Falling Apart

• What is Your Blood Pressure Telling You?

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This Friday’s LIVE Q&A is about cholesterol, blood pressure & preventing heart disease! Join me HERE on Friday 4/25 at 3 pm ET!

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A book recommendation! 📚

I highly recommend you read An Abundance of Caution, out today, written by my friend an investigative journalist

David Zweig

. It’s an important and fascinating critique of what happened in America during the pandemic. It is not just about COVID; it is about how our public health system operates. It will leave you a more educated person about how medical and health policies are made. Enjoy!

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A few months ago, a patient named Laura came to see me with persistent chest discomfort. She apologized repeatedly for what she thought might be just anxiety. She mentioned that her husband thought she was becoming overly concerned about her health.

As we talked, I learned Laura had been experiencing intermittent pressure in her chest for three weeks, usually during her morning walks. Her father had died of a heart attack at 62. While her initial EKG looked normal, further testing (an exercise stress test followed by a cardiac catheterization) revealed a significant coronary artery blockage requiring intervention.

Photo by Robina Weermeijer on Unsplash

Laura's body awareness had saved her life.

It’s funny—moments like these cause me to reflect on the value we place on patients’ stories. The wellness industry tends to celebrate those who "listen to their bodies,” while our rushed medical system often dismisses patients whose self-reported physical symptoms aren’t quickly measured in a test.

Many of my patients feel this contradiction: they feel pressured to track biometric data—from steps to hours of sleep—through wearable devices, yet they feel sheepish to report persistent symptoms to their doctor. But Laura’s story begs the question: What does it look like to maintain a balanced relationship with our physical sensations—alert but not alarmed?

The Evolutionary Advantage of Body Awareness

Our bodies are constantly sending us signals, and for good reason. Throughout human history, those who noticed and responded to changes in their physical state had survival advantages. This internal monitoring system didn't evolve randomly—it developed to help us identify threats, illness, and injury before they became life-threatening.

I saw this clearly with another patient, a normally stoic retired teacher in his seventies. He came in because he noticed his usual five-mile walks were becoming increasingly difficult. Nothing dramatic—just slightly more fatigue than usual. Most people would have attributed this to aging or being out of shape. But he knew his body well enough to recognize something was off. Testing revealed a significant pulmonary embolus requiring supplemental oxygen and six months of blood thinning medications. I told him he’d likely saved his own life by coming in when he did.

Modern medicine, despite its technological advances, still relies heavily on this innate capacity for self-monitoring—as it should! If I’ve learned nothing else in medicine, it is to BELIEVE PATIENTS. Many conditions are first identified not through screening tests but through a patient's recognition that something feels different.

Patients always know their bodies better than any doctor ever will.

Finding the Sweet Spot

The challenge lies in finding the optimal level of bodily awareness—what we might call "calibrated concern”—the middle ground between inattention and hypervigilance.

I think about Laura, who struggled to discern whether her chest discomfort warranted medical attention. Her father's heart attack made her more vigilant about cardiac symptoms, but she worried about being labeled anxious. Finding that middle ground—where she could listen to her body without catastrophizing—proved challenging but ultimately crucial.

Health vigilance exists on a spectrum:

• Insufficient vigilance: Ignoring potentially important symptoms, avoiding preventive care, dismissing pain signals that warrant attention. These are patients who compartmentalize their concerns or deny their significance, sometimes at a real cost to their health. Avoidance is a negative coping mechanism for anxiety, but many people say they’re just too busy to see their doctor. The problem is that the more we avoid medical care, the more things tend to pile up without us knowing. Denial is a powerful force!

• Calibrated concern: Appropriate attention to meaningful bodily changes, timely medical consultation, proportional response without excessive worry. This is the place I try to help my patients arrive at—calibrating their concern to the level of actual threat, centering data and the patient narrative and with me as their partner and guide. Arriving at this place requires a hefty dose of trust and clear communication on both sides.

• Excessive vigilance: Constant symptom monitoring, catastrophic interpretation of normal sensations, frequent medical visits despite reassurance. These are often patients who have a history of being dismissed or misdiagnosed by doctors. These also tend to be patients who have difficulty trusting doctors—sometimes with good reason!—and/or who have a generally heightened level of anxiety that, in and of itself, warrants addressing. (I've written before about managing overwhelming anxiety and how anxiety itself can be more debilitating than the disease we fear having.)

Most of us move along this spectrum depending on circumstances, personal history, and current stressors. Someone who has recently experienced health trauma may temporarily shift toward greater vigilance. A caregiver might temporarily neglect their own symptoms while focused on others.

The goal isn't to eliminate health vigilance but to develop a relationship with our bodies that allows us to notice important signals without becoming overwhelmed by them.

Destigmatizing Health Concerns

When patients feel the need to apologize for bringing up health concerns, I find myself reassuring them that body awareness is not only normal but valuable. The labels often attached to health-conscious individuals—"worried well" or "hypochondriac"—unfairly stigmatize what is fundamentally a human tendency to monitor our wellbeing.

Rather than dismissing health concerns outright or treating them as purely pathological, we can acknowledge their roots in normal human psychology. Destigmatizing health vigilance helps patients develop a more balanced relationship with their bodies. When we remove judgment from the equation, people can learn to trust their internal signals without fearing they'll be dismissed or labeled.

Practical Tips

For some patients, I recommend structured "worry time"—setting aside 15 minutes daily to check in with their body, note any concerns, and decide if action is needed. This can help contain health concerns to manageable windows rather than letting them expand to fill every moment.

For others, I suggest a "symptom journal" to track patterns over time without obsessive checking. This objective record can help distinguish between transient, benign sensations and those that warrant medical attention. It also provides valuable information to share with healthcare providers.

And sometimes, I simply validate that their concern is reasonable given their circumstances. The patient who worries about chest pain after losing a parent to heart disease isn't being irrational—they're responding to their personal risk factors and history. Acknowledging this reality doesn't reinforce anxiety; it honors the complex interplay between personal experience and physical symptoms.

For Laura, finding this balance meant establishing regular check-ins with her cardiologist, maintaining a simple symptom log, and practicing mindfulness techniques to stay present with physical sensations without immediately attaching catastrophic meanings to them. Six months later, she told me she felt more tuned into her body but less controlled by worry—a balance that serves both her physical and mental health.

This balanced vigilance allows us to benefit from our body's warning signals without being paralyzed by them. Partnering with a trusted health guide can make all the difference.

QUESTIONS FOR YOU! 🙋🏻‍♀️

• Do you worry you’ll be labeled a “hypochondriac” when bringing your symptoms to your doctor?

• Can you recall a time when paying attention to your body led to an important health discovery?

• Do you tend toward greater or lesser vigilance when it comes to your health? How does this pattern affect your medical care?

These are topics I’m covering in my book, so I am all ears!

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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.