CBT: How Checking Contributes to Mental Health Problems (Eating Disorders, Depression, Anxiety)

By Dr Alice Boyes |

Although common ‘disorders’ (e.g., eating disorders, anxiety, and depression) look different on the surface, there are some common underlying mechanisms.

One of these is checking. I’m going to go explain the role of checking in a selection of common mental health problems.

Checking in Health Anxiety

Examples:
- Person goes to the Dr for blood tests.
- Person looks at themselves in mirror to see if they look pale.
- Person frequently asks their partner if they look unwell.
- Person researches disorders online or calls healthline frequently.

What happens:
- The checking causes the person’s anxiety about possibly having a health problem to increase.
- Eventually a test may return a false positive, causing distress.
- They start to feel like they’re going crazy.
- People get mad at them.

Checking in Eating Disorders

People with eating disorders often do lots of types of checking. For example:

- Excessive weighing.
- Pinching skin on stomach to measure fat.
- Looking in the mirror to see if their thighs touch or they have a double chin.
- Obsessively reading labels or measuring food.
- If they binge and purge, eating a marker food at the start of a binge to try to ascertain if they have vomited up all they ate (not effective).
- Rigidly doing a set amount of exercise no matter what the circumstances, such as running in a blizzard.

What happens:
- Person’s obsessionality gets worse.
- Person withdraws socially.
- Natural fluctuations in weight cause great anxiety.
- Person starts not feeling satisfied with their checking and therefore does extra checking (similar to in Obsessive Compulsive Disorder)
- Person may skip opportunities such as overseas holidays if they think they won’t be able to do their checking (e.g., won’t be able to measure food, go to the gym etc).

Checking in Sleep Disorders

People with sleep disorders typically do both excessive nighttime and daytime checking.

Examples
- They might look at the clock excessively frequently at night.
- During the day, they might over monitor things they see as signs of tiredness, such as yawning or not being able to find a word.
- They might excessively monitor worry thoughts because they relate worry thoughts to not being able to sleep.

What happens
- Person’s anxiety about getting to sleep prevents getting to sleep.
- People with sleep disorders often overestimate their sleep deficit.
- They may develop counterproductive safety behaviors, such as falling asleep with the TV on to try to prevent worrying, but this increases fears of worrying.

Checking in Panic Disorder

Examples
- Checking to see where the exits are on entering a new building.
- Checking own pulse.
- Reassurance seeking to make sure other people will be there to help them if they have a panic attack.
- Checking whereabouts of partner at all times, just in case needs them in an emergency or if has a panic attack.
- The examples listed for health anxiety often also apply to people with panic disorder.

What happens
- Person becomes fearful of their own internal physical sensations (such as feeling hot or elevated heart rate).
- Person loses confidence in themselves.
- Person avoids fun things. Their opportunities to experience pleasure get restricted.
- The checking does not make the person feel safe, and over time the person avoids more and more, putting them at risk of depression.

Checking in Depression

Examples
- Person over monitors feelings of lethargy or low mood. They bail on commitments, work that needs doing, or social gatherings if feeling tired or low.
- Person starts looking for clues that their partner might be going to leave them due to their depression.
- Person feels mentally foggy and therefore over-checks their work, such as rechecking numbers multiple times.
- Person over monitors feelings of anxiety and avoids when they’re feeling anxious.

What happens

- The avoidance generates stress e.g., people get mad at them bailing.
- Person loses confidence in themselves even further.

Checking in Relationships Problems

Examples
- Asking “Do you love me?” or “Do you promise you won’t leave me?”
- Checking their partner’s phone, email, or Facebook.

What happens
- ‘Pursuing and demanding behaviors’ cause partner to attack or withdraw.
- Partner realizes they wield all the power in the relationship. Power imbalance becomes more uneven.

Checking in Obsessive Compulsive Disorder

Example = person triple checks all their electrical outlets are switched off before leaving the house because they’re worried about a fire.

What happens:
- Person starts to think they’re going crazy.
- Their family get irritated at them for taking so long to leave the house.
- Their fear of fires gets worse.
- Their excessive responsibility taking and intolerance of uncertainty gets worse.

Avoidance of Checking

People with all the above disorders often flip flop between extra checking and avoidance of checking. For example, someone with an eating disorder might go through phases of weighing themselves multiple times a day and then other phases of avoiding weighing themselves. Or, in depression, the person may avoid checking their VISA statement, because “they don’t want to know.” Avoidance coping is stress generating.

Seeing a Clinical psychology PhD

The examples above aren’t exhaustive (this post was getting long). The advantage of seeing a clinical psychology PhD is that clinical psychology PhDs are trained to understand the types of mechanisms illustrated above, which differently trained people may not understand as thoroughly.

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About The Author

is the author of an upcoming book about anxiety for PenguinRandomHouse. She writes for Psychology Today, GOOD magazine, and is the Emotions Expert for Women's Health Australia. She lives in NYC and is originally from New Zealand.

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