Health Anxiety Is A Gendered Battle — & Women Are Losing

I'm someone who religiously drinks four litres of water a day (at least). While I'm often met with impressed oohs and aahs, my own reaction is quite the opposite. Why am I thirsty all the time? I think. Is this normal? I think I have diabetes. Oh god, I have diabetes, don't I?

Most of us have become acquainted with Dr. Google, as we briefly catastrophise our symptoms before coming to our senses. Most of us will realise that a headache is simply the result of going out clubbing until 3am. But for some of us, it's much harder to simply turn the switch off. That headache could be the sign of something more sinister, we tell ourselves. It's a brain tumour. A sign of an impending aneurysm, surely.

While it's normal to worry about our health occasionally, for those of us with health anxiety — or hypochondria — concerns about our health are constantly at the forefront of our minds. We're almost certain that each pain or weird lump is a sign that we're seriously ill — or about to become seriously ill. Sufferers will see healthcare professionals regularly (or avoid them entirely), incessantly study their symptoms online, worry that their loved ones might be ill, and excessively body check and monitor themselves (check, check and check). It's hard to understate how debilitating this can be.

Anna, 30, always considered herself to be a "worrier", but it wasn't until recently that she considered just how much health concerns consumed her. She worries about trying new foods or medications in case she might go into anaphylactic shock, despite no history of such allergies. Every time she eats noodles, she has a fear of choking. Her anxiety also means that she regularly gets heart palpitations, which, due to her mum's history of having an irregular heartbeat, automatically makes her feel like she's dying.

"I'm afraid of dying and I'm aware that my body is delicate and can stop working at any time," Anna tells Refinery29 Australia. "If I get any sort of symptom, my brain goes straight into 'what if' mode."

But Anna's relationship with health anxiety and the term 'hypochondriac' has been fraught. While she's received treatment for generalised anxiety disorder, her health anxiety still hasn't been addressed. "It's scary getting a diagnosis for health anxiety because you are basically accepting that you're a hypochondriac," Anna says. "That word has such negative connotations. People tend to take you less seriously even though your symptoms are real."

Those suffering from hypochondria know the stigmatisation of the word all too well. Throwaway comments often make the word hypochondriac synonymous with 'dramatic'. They've been referred to as 'a pain' and 'shameless liars'. The hypochondriac is perceived as "figure of fun, comical, derided, suspected of malingering, and resented for inappropriately demanding attention and resources," says Catherine Belling, Associate Professor of Medical Education at Northwestern Medicine. In the medical world, we're the laughing stock.

But for people experiencing health anxiety, it's not a joke. For women and people of colour in particular, medical gaslighting is unfortunately a rather common experience. You're just being dramatic. Calm down. Did you know that stress can be a contributing factor?

For Madeleine, 32, that's exactly what happened. After dealing with a persistent cough for months, she knew that something didn't feel right. But after visiting seven different doctors, she still didn't have any answers. It was only after she finally visited a female GP that they finally conducted some tests. What they found validated her instincts that something wasn't right — she had stage II Hodgkin's lymphoma, or cancer of the lymphatic system.

"It felt validating to know that the warning instincts that I had experienced were right; that actually there was some truth to the reality I was living," Madeleine tells Refinery29 Australia.

But even almost ten years after her initial diagnosis, Madeleine is still angry at how she was treated by health professionals. "I can see different realities where things could have been so much easier if I had really been listened to the first (or second or third) time around."

"At various points, both myself and my mother (who was rightly very concerned) were negated, chastised for being overreactive, and advised to stop worrying so much," she says.

"Given that I started chemotherapy within weeks of my initial diagnosis, I am still extremely pissed off about the way things went."

The statistics around women's medical treatment (or lack thereof) are alarming, but ring true for any woman who has gone into a doctor's room and been told that it's all in her head. One study found that women who went to the emergency room with severe stomach pain had to wait almost 33% longer than men with the same symptoms. Another showed that women had to make twice as many visits to the doctor as men in order to be referred to a specialist for suspected bladder and renal cancer. Yet another study revealed that female patients were diagnosed with cancer far later than their male counterparts — something Madeleine is proof of.

While she's thankfully in remission now, the combination of her diagnosis, delayed treatment, and medical gaslighting still impacts Madeleine today. She still gets shaky and dissociative during routine doctor's appointments, with anxiety causing her heart rate to shoot up.

Experiencing health anxiety after a significant illness isn't unusual. In fact, according to psychologist Ash King, it's one of the key reasons why someone might develop health anxiety in the first place. "We might have had exposure to a friend or family member who was battling an illness or died, or we may have battled a serious illness in the past," she tells Refinery29 Australia. "Or we might have had a negative experience with a health practitioner that resulted in a loss of faith in clearly understanding and managing aspects related to our health and wellbeing."

When we consider the intersection between health anxiety and medical gaslighting, it becomes clear that this is a gendered issue. Studies show that hypochondriasis is much more common in females than in males. But is this just because of how women are treated in the medical system?

For Madeleine, having been sick (and being disregarded by doctors) for such a long time prior to actually getting a diagnosis meant that she was filled with a confusing blend of hyperawareness (her initial panicked emotional response) and the desire not to overreact (her attempted cognitive response). Even now, she deals with these conflicting emotions as she battles with chronic pain — something which she says is the cause of a lot of her health anxiety now.

"It's difficult to disconnect from the anger and frustration that my body repeatedly causes me," she says. "The chronic stuff is now the source of a lot of anxiety because between that and the (til recently) undiagnosed ADHD. I have an overwhelming fear that my quality of life is going to just keep diminishing and I won't be able to stop it."

The tension between real and imagined is perhaps one of the most perplexing parts of health anxiety. How can you tell what's real, legitimate pain, versus a trauma or anxiety response? When is a cough no longer just a cough?

"This is the deeper quest for most anxiety sufferers in general: The quest for certainty and control," says King. "Neither of which is totally guaranteed when it comes to our health." Throw in chronic pain, a history of illness or health anxiety into the mix and it makes for a very confusing reality, as your mind and body are constantly battling each other for supremacy, whilst simultaneously discrediting each other.

While there are ways for us to manage our health anxiety (King says that recognising our own patterns of thinking and behaviour can help here, so you can become aware of when you're falling into anxiety-induced reactivity), there is a bigger conversation that still needs to be had around women feeling comfortable enough to advocate for themselves, despite having our illnesses statistically taken less seriously.

While I’m absolutely not negating the real and debilitating symptoms of health anxiety, I wonder if this is too simple of a term to explain what women and people of colour experience every day in doctor's rooms. As women, it’s hard enough to advocate for ourselves and our health, especially when it feels like you aren’t being taken seriously. I’m not sure that I’m ready to flippantly apply the moniker of health anxiety to women who are simply seeking proper medical treatment, demanding tests, wanting answers, and asking for their health to be taken seriously. 

Perhaps it's time we start interrogating the systems and constructs in place that retire women's health to a realm of hypotheses. Perhaps it's time we stop calling our 'dramatic' friends hypochondriacs, with the knowledge that anxiety is a women's battle — and we're losing. Perhaps it's time we start demanding scans or medication or attention when we know we're ill, without being labelled a hypochondriac. Perhaps it's time we start overreacting.