Real but Not Reliable: Navigating the Physical Reality of Health Anxiety

As specialists who work with health anxiety every day, one of the most frequent and painful questions we hear is: “But what if I’m not imagining it? What if this symptom is real?”

There is a common misconception that health anxiety is "all in your head" or that you are simply "making up" your symptoms. We want to be very clear from the start: The physical sensations you feel are 100% real. The racing heart, the tingling in your limbs, and the tension in your chest are actual physiological events occurring in your body.

In our work, we teach a crucial distinction that changes everything: Your symptoms are always real, but they are not always reliable.

The Sensation is Real, The Story is an Assumption

When you feel a sharp pain or a sudden bout of dizziness, your body is providing you with information. That information (the sensation itself) is an objective experience. However, health anxiety immediately takes that information and writes a catastrophic story around it.

Think of your body’s alarm system like a smoke detector. In health anxiety, that detector is overactive. It’s screaming "fire!" because it detected a piece of burnt toast. The smoke is real, but the house isn't burning down. Validation is about acknowledging the smoke without automatically calling the fire department.

Why the Mind Misinterprets the Body

When we focus intensely on a specific part of the body (AKA hypervigilance), we will inevitably find something that feels "off."

• The Spotlight Effect: If you focus on your heartbeat for long enough, it will start to feel stronger or faster simply because you are paying attention to it.

• The Stress Response: When you are anxious, your body releases adrenaline. This causes very real physical shifts like muscle tension, digestive upset, and lightheadedness.

• The Narrative Trap: Our minds are "storytelling machines." The moment a real sensation (like a twitch) occurs, the mind attaches a scary story to it ("This must be a neurological issue").

The goal isn't to stop the sensations from happening, it’s to stop treating these "noisy" sensations as news alerts that require immediate action.

Common "Real but Unreliable" Symptoms

We often help people re-label these common physical sensations that feel like medical crises:

• Chest Tightness: Usually caused by tight muscles between the ribs due to shallow breathing.

• Tingling or Numbness: Frequently a result of the body diverting blood to major muscle groups during a "fight or flight" response.

• "Brain Fog" or Dizziness: The result of a nervous system that is simply exhausted from being on high alert.

• Muscle Twitches: Usually a sign of benign fatigue or high nervous system arousal.

Why Validation is the Key to Recovery

We emphasize validation because resistance creates more tension. When you try to "think" your way out of a symptom or tell yourself you "shouldn't" be feeling it, your nervous system stays on high alert.

By validating that the symptom is real, you can stop the internal war. You no longer have to prove to yourself that you’re "actually" feeling something; you can simply observe it. This allows you to practice compassion toward your body. Instead of being angry at it for "tricking" you, you can recognize that it is simply trying to protect you, even if its methods are a bit misguided.

Dropping the Rope: Choosing Presence over Certainty

One of the hardest but most freeing shifts you can make is stepping out of the "certainty trap." Your brain is looking for a 100% guarantee that you are perfectly safe, but trying to argue with your mind is like a game of tug-of-war where the only way to win is to drop the rope.

Rather than fighting for a perfect answer that doesn't exist, we look at the information we actually have in this moment: I am here, I am breathing, and this sensation (while scary) is familiar. By standing on the solid ground of what we know to be true right now, we create the space to make a different choice. We can recognize the urge to check or research for what it is (a reaction to uncertainty) and decide that we have enough information to stay present instead of getting lost in a ritual.

Living With the Noise

Recovery isn't about reaching a state where you never feel an odd sensation again. It’s about reaching a state where you can feel a "real" sensation, acknowledge it with kindness, and realize it doesn't represent the "danger" you fear. By stopping the fight against your physical sensations, you free up the energy to actually live your life to be a present parent, a focused employee, and a connected partner.

Remember: Everyday you have a chance to live with fear, not in fear!