People who obsessively worry about their health have often been dismissed as hypochondriacs. But for some, coronavirus has fuelled a rise in a debilitating mental health condition known as health anxiety. As Andrew Kersley explores, it can lead to job losses and even suicidal thoughts.
In March 2020, Ben quit his job as a bus driver. Whenever he was off shift he couldn't stop thinking about how one of his passengers must have had Covid-19 and infected him. Even though he was young and healthy and his chances of serious illness were low, he was fixated on the idea he would become infected and die.
Within a fortnight, Ben had moved out of his family home in Birmingham and into in an empty student house that his friends had left. "I kept thinking about being in a place where no-one was going in or out," he says.
Despite leaving home and quitting his job, his anxiety about getting infected still dominated his thoughts. "I would wake up and check to see if my body was okay," he says.
"I gave myself symptoms all the time - if I was tired I'd be completely convinced I had it. I was scared to go to the shops. I just avoided going out and seeing any people at all. It's all about the 'what if' rather than the reality… and no-one can ever tell you that you'll be fine."
Ben was experiencing health anxiety.
'It almost took my life'
While we all sometimes worry about our health, or google symptoms, health anxiety is recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) - known as the bible of psychiatry - as a condition in which obsessive fears about health become excessive.
It is defined by compulsively checking for symptoms, researching diseases, obsessing over normal bodily sensations or avoiding anything that could potentially lead to you being exposed to disease.
This little-known, yet widespread condition, has hit more people this year in the wake of the pandemic.
Many have been unable to leave their house or even open windows for fear of infection. Some, like Ben, have quit jobs. Others bleach their house for hours a day. Almost all have been plagued by uncontrollable thoughts about dying from Covid.
"When people say it's just light anxiety - it almost took my life," says Cherelle Farrugia, from Cardiff, who runs a YouTube channel about living with health anxiety.
She first developed it three-and-half years ago after finding a small bump and convincing herself she had lymphoma. Once that was ruled out she spiralled through breast cancer, brain tumours and more. She wasn't just worried about being sick, but certain she was dying and no-one was listening.
"I'm a relatively logical and intelligent person but health anxiety took all logic away from me," she explains. The constant fixation got so bad she repeatedly ended up at her local mental health crisis centre as it increasingly left her unable to function.
"I became suicidal, which is strange because I was trying to avoid death," she says. "But it got so bad that I couldn't live with the thought process anymore. Nothing I did would calm me down." And the pandemic made things worse.
My partner would do the food shopping and I would sit there on the floor for an hour washing it. There was a real ritual over it
"When we first got told about this virus, it was just my worst nightmare," the 28-year-old says. "I know everybody was inside but I couldn't even open my window. My partner would do the food shopping and I would sit there on the floor for an hour washing it. There was a real ritual over it.
"It makes you feel like an attention-seeker," says Cherelle. "It really destroyed my life and I feel very lucky just to be here."
Cherelle says her anxiety eased over the year because Covid started to feel more "real" and visible to her than the hypothetical illnesses she had previously convinced herself of having, but many others can't say the same.
'Enemy you can't see'
Health anxiety generally covers two areas - fear that you are already sick or fear that you could become sick. During the pandemic, the latter impacted everyone. But like most mental illness, it is a spectrum.
While some people rarely think about it, for others it is all they think about. Yet the number of those experiencing health anxiety has skyrocketed.
Dr Rob Willson, a London-based cognitive behavioural therapist and health anxiety expert, says he has "never had more enquiries" about health anxiety. Another specialist told the BBC he was fully booked for the next few months.
But seeking medical attention doesn't always ease the anxiety. "Reassurance never reassures, that's what we always say," explains clinical psychologist Dr Marianne Trent, who runs a private mental health practice in Coventry. "Their world gets very small, but their distress is still very high."
When you're dealing with an enemy that you can't see it's hard to turn that threat radar down
Coronavirus in particular poses problems for those with health anxiety.
Symptoms like shortness of breath can be symptomatic of both anxiety and Covid, and the two can create a vicious cycle. The more anxious you become the more "evidence" you have that you are sick.
Plus there's the uncertainty over infection. "When you're dealing with an enemy that you can't see it's hard to turn that threat radar down," says Dr Trent.
For Myra Ali, in north London, the past 12 months have felt very long. "I haven't really been out the house for a year," she says. "All we've heard is how easily you can catch Covid, so it's embedded in your mind."
The 33-year-old is low risk, but an intense fear about getting hospitalised with Covid controlled her thoughts. She even put off surgery for a chronic condition as a result.
Just ordering a takeaway one night was enough to trigger an episode. "The next day I had to phone a doctor because I kept thinking 'what if I'm getting symptoms?'."
The way we talk about health anxiety in society only makes it worse. Terms like hypochondriac can dismiss those who worry too much about their health, and few people are aware that health anxiety is a genuine condition.
That attitude even filters into the medical community and Dr Willson says it can be difficult to get help from doctors due to their own negative perception of it. The condition was previously called hypochondriasis, but the stigma drove professionals to call it health anxiety instead.
Dr Willson, who co-authored a book on the condition, says there is a shortage of doctors specialising in it even though the condition can have a life-changing impact. Two of his patients have taken their own lives and he says it dominates the lives of many others.
- WHAT DOES HEALTH ANXIETY FEEL LIKE?: More from Cherelle on what it's like to live with the condition
But he, along with Dr Trent, agreed health anxiety could be managed through cognitive behavioural therapy (CBT), a talking therapy which helps change the way you think and behave as well as exposure therapy, where, with professional support, people slowly expose themselves to the things making them anxious - like going outside - in small doses.
Dr Trent says she appreciates the detrimental impact it can have. "It's real life and death stuff. It can definitely be as debilitating as any other mental health condition."
As society opens up, life may resume for many, but for those with health anxiety a full return to normality is unlikely. It is thought the number of health anxiety patients will continue to rise long after the pandemic ends.
Dr Willson says: "It has been long enough for them to develop habits of checking for symptoms, googling and obsessing. The brain is not quick to give up those kind of habits."