I always think I have cancer. Am I just paranoid?

If you’re prone to worrying about your health, you’re not alone. Everyone experiences health anxieties from time to time. For many, these concerns are mild background noise—the thoughts seem to fade as quickly as they come. But for others, worry is all-consuming. It might even center around a specific medical condition such as cancer.  

If you’re looking for the answer to “Why do I always think I have cancer?”, the truth is that there are a number of possible explanations. One cause for cancer-related worries is illness anxiety disorder (IAD), which is defined as a persistent fear of having a serious medical illness despite few or no symptoms. Another is Cancer OCD—or, more broadly, Health Concern OCD, a type of obsessive-compulsive disorder characterized by intrusive thoughts around illness.

The good news is that you don’t have to continue living in a constant state of fear of cancer—many people with this specific health anxiety have recovered. Understanding whether you meet the criteria for one of these mental health conditions is the first step to getting help. 

Is fear of cancer causing you distress? One of our trained therapists can help. Book a free call to get started.

Is my cancer anxiety a sign of IAD?

First, if you think IAD sounds a lot like being a “hypochondriac,” you’re right. The term hypochondriasis—which had a lot of stigma attached to it—was replaced with IAD in the Diagnostic and Statistical Manual of Mental Disorders in 2013, as it better reflects a true mental disorder involving excessive worry and fear related to health.

To meet the criteria needed for a diagnosis of IAD, your fears of having cancer must persist even when you’re reassured by professionals that you’re healthy.

Top signs you might have IAD

• Having anxiety that is heightened, despite no indications that you’re actually ill
• Being hyper vigilant about cancer, which may include looking all over your body for possible signs
• Constantly researching cancer online 
• Seeking medical care excessively for reassurance that you don’t have cancer (care-seeking IAD)
• Avoiding medical professionals out of fear that you do have cancer (care-avoidant IAD)
• Having cancer-related fears that last for six months or more and affect your quality of life or interfere with your relationships

Is my cancer anxiety a sign of Health Concern OCD? 

OCD is a mental health disorder characterized by obsessions—which are unwanted and intrusive thoughts that cause distress, and compulsions, or behaviors done in an attempt to feel better or avoid a feared outcome. In the case of Health Concern OCD, the fear is getting cancer (or having it and not knowing). 

Importantly, meeting the criteria for OCD requires that your obsessions or compulsions are time-consuming (take more than an hour per day) and significantly impact your life. But make no mistake, despite the fact that OCD frequently goes undiagnosed (often the result of not seeing the right specialist), it’s quite common, impacting roughly 1 in 40 people in the U.S.

Common obsessions of cancer-related Health Concern OCD

• I’m going to get cancer, and I’m not going to be able to handle it.
• What if I die from cancer and ruin my family’s life? 
• What if I’m wasting precious time by not going to the doctor? 
• What if I have cancer, but the test failed to detect it?
• What if I think about cancer too much, and manifest the illness?

Common compulsions of cancer-related Health Concern OCD

• Spending an inordinate amount of time researching cancer online
• Constantly scanning your body for pain or discomfort that could signal cancer
• Giving yourself a breast exam multiple times a day
• Strict avoidance of any conversation or media that mentions cancer
• Seeking reassurance from loved ones that you don’t have cancer
• Requesting repeat medical tests for cancer screening

IAD vs. OCD: Tell-tale differences

IAD and OCD certainly share some similarities, which can make it difficult to tease them apart. But an OCD specialist can help discern the differences.

Taylor Newendorp, MA, LCPC, a therapist at NOCD, notes that more often than not, those experiencing IAD actually are experiencing some kind of symptom that they fear is a sign of cancer. For example, someone who has frequent headaches may worry they have a malignant brain tumor. Someone with OCD, on the other hand, tends to be more worried about a hypothetical future. That’s not always the case, but it is a common pattern. 

And while people with either condition may engage in certain behaviors like repeat doctors appointments (known as “safety behaviors” in the case of IAD and “compulsions” in OCD) to try to relieve anxiety, there’s a nuance here. In the case of an OCD compulsion, once is never enough. Any relief that compulsions provide is short-lived, simply reinforcing the original obsession and need to carry out the compulsion—this is the OCD cycle in action. Getting repeatedly tested for cancer, for example, may make you feel better momentarily, but the obsession will always return. 

What’s more,“with OCD, you’ll see very ritualistic kinds of behaviors. People may have to do something exactly the same way or check it a certain number of times or something like that,” says Dr. Patrick McGrath, psychologist and Chief Clinical Officer at NOCD. “In illness anxiety disorder, they might just run to the bathroom and check quickly to see if that spot of concern has got any bigger. They’re not taking any kind of ritualized approach to doing something about it.”

Finally, Newendorp says you shouldn’t stress too much about knowing for sure whether it’s IAD or OCD—the important thing is to recognize when the worry has become its own kind of problem. “At the end of the day, you would use exposure and response prevention (ERP) therapy either way, and it’s highly effective for treating both,” he says.

Do I have cancer or am I just paranoid?

Cancer is real, and no health professional would encourage you to ignore a hunch that something is wrong; listening to your gut can be life-saving. However, there’s a big difference between a true intuition and brain wiring that has gone awry. 

“Real health concerns typically present with clear, consistent symptoms that persist and often get worse over time if untreated. For instance, a persistent cough or unexplained weight loss warrants a visit to the doctor,” says Evan Vida, PsyD, a psychologist at the Center for Anxiety & Behavioral Therapy. “Anxiety, on the other hand, often amplifies minor or normal bodily sensations, creating a disproportionate fear of serious illness and is accompanied by a significant amount of ‘what if’ thinking.” 

Possible signs of cancer that you should see your doctor about:

• Unexplained weight loss or weight gain of 10 pounds or more
• Blood in your urine or stools
• Lump or firmness in your breast or armpit
• Cough or hoarseness that doesn’t go away
• Vision or hearing changes
• A new mole or an existing one that changes color or shape 

You can find other legitimate indicators of cancer on this list, from University of Utah’s Huntsman Cancer Institute. Keep in mind: If scanning the list brings you significant distress, and even prompts you to wrack your brain for times you’ve experienced any of these symptoms, that’s a good sign that you’re experiencing anxiety or OCD. 

How to manage cancer-related anxiety: A 4-step plan

1. Find a doctor you trust. This is a medical professional who can assess you accurately, advise you when something is of actual concern, and let you know when it’s not. 

2. Check your testing tendencies. Follow the recommended guidelines for things like screening and cancer-prevention. If you find yourself consistently wanting to go above and beyond, without the symptoms to justify it, that’s likely a sign of health anxiety.

3. Evaluate your relationship with Dr. Google. There’s a fine line between being an informed healthcare consumer and falling down the rabbit hole of self-diagnosis and excessive worry.

4. Know when it’s time to seek out professional help. If your anxiety about cancer is getting in the way of your life, it’s likely time to seek help from a licensed mental health professional. While anxiety is a normal human emotion, it crosses a threshold if it’s hindering your ability to function at work, school, or home, interfering with your social life, consistently affecting your mood, or taking time away from doing things you love. 

Treating OCD and IAD with ERP

As mentioned earlier, the gold-standard treatment for OCD and IAD is exposure and response prevention (ERP) therapy. The evidence-based therapy is considered specialized treatment for these conditions. If you rely on traditional talk therapy or general CBT—without practicing ERP specifically—it’s very likely that your anxiety about cancer will get worse, not better.

ERP works by gradually exposing you to what triggers your fear of getting cancer, and teaching you response prevention strategies to cope with your distress—things that don’t involve engaging in safety behaviors or compulsions. For example, a first exposure might involve looking at a photo of a person in a hospital bed, or just looking at the word “cancer.” You will never be forced into anything before you’re ready, but you will be encouraged to take steps that move you toward recovery.

Through the ERP process, you learn to realize that your fears are often unfounded, or that you can handle your worst-case-scenarios better than you thought you could. Over time, ERP “makes individuals more comfortable with uncertainty, ultimately leading to a significant reduction in anxiety and compulsive behaviors,” says Vida.

NOCD member Tricia D., whose OCD thoughts centered around the fear of getting cancer, has seen ERP at work in her own life: “I tell my brain, ‘That might happen. Or it might not’ and I refuse to seek out a definitive answer.”