Strength of Struggle Q&A #5: Every Pain Feels Like a Heart Attack

Q:
Hi Rabbi, I suffer from severe health anxiety. I get chest pain from stomach issues and every time it happens I am sure it is a heart attack. Even though my heart was checked and the doctor keeps reassuring me, my mind creates full scenes of an ambulance coming, me collapsing, everything.

I ask my husband and therapist for reassurance many times a day. I try redirecting the thoughts but then my mind argues back that maybe something will happen before then. I recently started medication but I still feel stuck. Is there anything else I can do?
— Sara

A:
Sara, thank you for writing. What you’re describing is incredibly draining, and it’s also something many people with health anxiety experience. You’re not crazy and you’re not imagining the fear. Your nervous system is reacting to every sensation as if it might be danger.

Health anxiety often works like this: the brain notices a normal physical sensation, and instead of saying, “this is uncomfortable but harmless,” it jumps to the worst-case scenario.

Iyov describes this emotional experience:
“כִּי פַחַד פָּחַדְתִּי וַיֶּאֱתָנֵי”
“What I feared has overtaken me.” (Iyov 3:25)

Chazal say something similar. In Yoma 75a, a person who is already anxious interprets what they feel and see through fear, not reality. Meaning: the sensation isn’t the problem. The interpretation is.

The Rambam writes:
“הַדָּבָר הַמְפַחֵד אֵינוֹ מְבִיא לַפַּחַד… אֶלָּא הַדִּמָּיוֹן.”
“It is not the thing itself that causes fear, but the imagination.” (Moreh Nevuchim 3:12)

Your mind thinks it’s protecting you by imagining danger, but the alarm keeps going off even when nothing is wrong.

A few things can help:

1. Don’t fight the thoughts.
Instead try: “I hear the thought. It’s anxiety talking, not danger.”

2. Label panic correctly.
Panic feels like a heart attack, but it is not one. Say: “This is fear, not a medical emergency.”

3. Ground the body.
Slow exhale, feet on the floor, look around the room. Safety in the body calms the mind.

4. Limit reassurance gradually.
Constant reassurance teaches the brain that there was something to fear. Reduce it slowly, not all at once.

5. Slow exposure with support.
Continue the work you’re doing with your therapist, gently and consistently.

You’re not failing. Your mind is tired and trying too hard to keep you alive. With time, tools, and support, this can get much easier.