"It calms me down"

Sometimes it does. You search, and you find a page that says it's nothing, and you feel your shoulders drop. That relief is real, and it's the reward that keeps the habit going. I've called it the dip. It lasts a short time, and the worry that follows it is often worse than before.

There's a careful study of the same thing happening in a hospital. Lucock and colleagues followed sixty patients who'd had a camera examination of the stomach and been told by the consultant that there was nothing seriously wrong. Everyone's worry fell sharply straight afterwards. The researchers then checked back after a day, a week, a month and a year. The patients who'd scored low on a measure of health anxiety hadn't been very worried to begin with, and stayed that way. Those in the middle were reassured and mostly remained so. In the patients who'd scored high, the worry and the belief that they were ill had come back significantly within twenty-four hours, and it stayed back for the whole year. That was after a specialist had looked inside their stomachs and found nothing, and the relief lasted them about a day.

If that kind of evidence only calms someone for a day, a web page won't do better. Starcevic and Berle describe repeated symptom searching as a form of reassurance seeking. The Doherty-Torstrick study in chapter 2 found that the more anxious a person was about illness, the worse they recalled feeling after a search, where less anxious people recalled relief.

Here's how I understand what's happening. What follows is interpretation, though it's close to how clinicians who treat health anxiety describe it. When you find a reassuring page, your anxiety drops. Your mind notes what made it drop, which was searching. The next time anxiety rises, the urge to search is a little stronger, because last time it worked.

But the relief doesn't last, because the reassuring page can't examine you either, and you know that. Within hours a doubt arrives. The page might have been about a different kind of twitch, or yours might be the exception. So the anxiety comes back, and what your mind now reaches for is another search.

Over weeks, each dip gets shorter, and it takes more reading to get one. There's evidence that the two things feed each other. Fam te Poel and colleagues in Amsterdam surveyed more than five thousand people four times over. People who were more anxious about their health searched more, which you'd expect. But among people who started out with ordinary levels of health anxiety, there were also signs of the reverse. More searching was followed by more health anxiety, which was followed by more searching. The authors call this initial evidence, and I'd treat it the same way.

None of this means you should never feel reassured about your health. When a doctor examines your leg and says it's fine, that's information about you. The dip you get from a web page at midnight isn't information about you, and it wears off, and you go looking for it again.