the Psychological Conflict of Smoking and Health Anxiety

Contradictory psychology

Hello, Dr.
Ding.
I have been troubled by some serious issues over the past year, so I would like to consult you.
Please read carefully, thank you...

1.
I am a civil servant, and since childhood, I have been seen as the "good child" by my parents.
However, they do not know that I learned to smoke during my military service, and I have been smoking for about 12 years now.
My parents and wife are unaware of my smoking, and I have been carrying a sense of guilt about it.
2.
During a health check last year, the doctor initially suspected that I had a kidney tumor.
I researched related information online and discovered that tumors are cancerous and can be caused by smoking.
This made me feel very guilty about hiding my smoking habit from my family.
Fortunately, after undergoing a CT scan, it was confirmed that the doctor had misdiagnosed me, and I do not have a kidney tumor.
However, the anxiety about cancer has lingered in my mind.
Whenever I feel discomfort in any part of my body, I worry that it might be cancer...
3.
Yesterday, I visited a smoking cessation clinic and told the doctor that I have recently experienced itchy airways, coughing, and chest tightness, and I asked if I could have an X-ray.
After listening to my lungs, the doctor said that it was not necessary at this time and that it might be due to sensitivity to weather changes.
Is that really the case?
4.
I am actually afraid of developing lung cancer, but I cannot quit smoking (I smoke about a pack every two days and have been smoking for ten years).
My family does not know that I smoke, which makes me feel very worried and helpless.
What should I do?
5.
What kind of condition do I have? Is it anxiety disorder? Hypochondriasis? Panic disorder? I apologize for having so many questions, and I appreciate your help...

Xiao Ke, 30~39 year old female. Ask Date: 2013/11/26

Dr. Ding Shuyan reply Psychiatry

Hello, first of all, I want to encourage and commend you.
You must be a responsible person who is considerate of others and has high self-expectations.
People generally appreciate individuals like you, but the downside is that you may often feel troubled by many things.
Some of the emotions and stress come from things we don't want others to know about.
These may be perceived flaws or unspeakable secrets.
Constantly worrying about whether someone will discover these issues can lead to pressure, causing us to become withdrawn, suspicious, and easily anxious.

As for the excessive worry about developing cancer, this can be part of anxiety, compounded by an obsession with one's health.
Some individuals with health anxiety experience this as well.
However, this can be simplified into a life attitude and belief: negative thinking, worrying that our current life will change for the worse—not just regarding physical health, but in all aspects of life.
If this truly troubles you, seeking help from a psychiatrist could be beneficial.
What we can do is recognize a fact: no matter how hard we try, everything we cherish cannot remain unchanged forever; there will come a day of loss.
This applies to loved ones, our health, and our lives, all of which can change or even come to an end.
Many of these changes are beyond our knowledge and control, and worrying is futile.
It is better to face these realities with an open mind—whatever comes, comes; whatever goes, goes.

Additionally, we should not overly emphasize whether we can bear the consequences of losing what we cherish.
Throughout history, countless people have gone through similar experiences; we are not special, and we are just like everyone else.
When faced with challenges, we simply need to confront them.
Regarding the issue of quitting smoking, it is not as difficult as you might think.
Past failures in quitting can indeed diminish your confidence and increase feelings of guilt.
You should find ways to eliminate anything related to cigarettes from your environment.
Throughout your day, try not to leave too much idle time that might tempt you to smoke or create internal conflict about whether to smoke.

During the process of quitting, it is important to relax your mind, as if smoking were merely a dream experience that you forget upon waking, or a distant memory that no longer holds much connection to you.
Focus on the present moment, and this will help a bit.
Wishing you all the best,
Dr.
Ding Shuo-Yan

Reply Date: 2013/11/26

More Info

Dear friend,
Thank you for sharing your concerns with me. It sounds like you are experiencing a significant amount of psychological distress related to your smoking habit, health anxiety, and the fear of potential health issues. Let’s break down your situation and address your questions comprehensively.

Firstly, it’s important to recognize that smoking is not just a physical addiction but also a psychological one. The guilt and anxiety you feel about hiding your smoking from your family, combined with the fear of serious health consequences, can create a cycle of stress that exacerbates your smoking habit. This is a common experience among smokers, especially those who feel they must keep their habit secret. The psychological conflict you are experiencing—wanting to quit smoking but feeling compelled to continue due to anxiety and guilt—is a significant barrier to cessation.

Your experience of health anxiety, particularly after the scare regarding a potential kidney tumor, is understandable. Many individuals who smoke develop a heightened awareness of their health and often worry about serious illnesses, including cancer. This anxiety can manifest in various ways, such as hyper-focusing on bodily sensations and interpreting them as signs of serious illness. This is known as health anxiety or hypochondriasis, where individuals become excessively worried about their health, often without substantial medical evidence to support their fears.

Regarding your symptoms of cough, chest tightness, and throat irritation, these can be common among smokers, especially if you have recently quit or are experiencing withdrawal symptoms. It’s also possible that changes in weather or environmental factors could be contributing to your discomfort. However, it’s crucial to monitor these symptoms closely, as persistent respiratory issues should be evaluated by a healthcare professional.

You mentioned that you are afraid of developing lung cancer but feel trapped in your smoking habit. This fear can create a paradox where the anxiety about health issues leads to increased smoking as a coping mechanism, which in turn heightens your anxiety about health. This cycle can be difficult to break, but it is essential to address both the smoking and the underlying anxiety.

To manage your anxiety and smoking cessation, consider the following strategies:
1. Seek Professional Help: It may be beneficial to work with a mental health professional who specializes in anxiety disorders and smoking cessation. Cognitive-behavioral therapy (CBT) can be particularly effective in addressing both anxiety and smoking habits.

2. Join Support Groups: Connecting with others who are also trying to quit smoking can provide you with emotional support and practical strategies for managing cravings and anxiety.

3. Practice Mindfulness and Relaxation Techniques: Techniques such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help reduce anxiety and improve your overall mental well-being.

4. Consider Medication: If your anxiety is significantly impacting your daily life, discussing medication options with a psychiatrist or your primary care physician may be appropriate. There are medications that can help manage anxiety and support smoking cessation.

5. Educate Yourself: Understanding the effects of smoking on your health can empower you to make informed decisions about quitting. However, be cautious about excessive research that may lead to increased anxiety.

6. Set Realistic Goals: Quitting smoking is a process, and it’s essential to set achievable goals. Consider reducing your smoking gradually rather than quitting cold turkey if that feels more manageable.

7. Communicate with Your Family: While it may be difficult, consider discussing your smoking habit with your family. Their support can be invaluable in your journey to quit.

In summary, your symptoms may be indicative of anxiety, and the interplay between your smoking habit and health concerns is creating a challenging situation. It’s crucial to address both the smoking and the anxiety to find a path forward. Remember, you are not alone in this struggle, and seeking help is a strong and positive step toward improving your health and well-being.

Wishing you strength and success on your journey to quit smoking and manage your anxiety.

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