Neurological conditions and health anxiety

Health anxiety is especially common in neurology patients – one in four has the condition, a higher proportion than in other medical clinics (Tyrer et al, 2011a). Patients may just be offered a single appointment to exclude a more serious problem but they often have frequent investigations and when tests come back negative for underlying pathology, they tend not to be offered help for their anxiety.

Some of the most commonly feared conditions in health-anxious individuals are neurological illnesses such as brain tumours and multiple sclerosis (MS). Headaches are common in all people but frequently considered by the health-anxious patient to be evidence of a primary brain tumour or cerebral secondary deposits. Multiple sclerosis is often feared as it too is relatively common and the presenting symptoms are varied, tend to come and go (although not as frequently as health-anxious patients tend to believe) and accurate diagnosis is difficult. The symptoms of headache, perceived memory loss, clumsiness, twitching, involuntary movements, blurred vision, depersonalisation (the feeling of being unreal), dizziness and feeling faint, tingling in the extremities and trembling, are all common symptoms of anxiety but can also be part of neurological disease. They are frequently difficult to evaluate, and in many cases patients are overinvestigated for possible conditions such as Parkinson's disease.

Epilepsy is also a common condition and, as seizures can take many forms, sometimes this may be considered in anxious patients who experience depersonalisation – a distressing phenomenon where the patient feels as if they are detached from their surroundings, often accompanied by derealisation, the feeling that the surroundings too are strange. If this occurs frequently or is powerful enough, it may lead the clinician to suspect epilepsy.

Clarifying past medical communications

Multiple sclerosis is often considered as a differential diagnosis for non-specific neurological symptoms, and mentioning it in passing as a possible diagnosis can be extraordinarily worrying for patients, especially as in the early stages it can be difficult to confirm or refute. Patients worried by this can interpret every bodily sensation or change as evidence confirming the diagnosis. They frequently search on the internet for clues, and as the condition is so varied, they can easily find things to fit with their presumed pathology (Case example 14.1).