By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
What is catastrophizing?
Catastrophizing is a way of looking at life, always searching for the “worst-case” possibilities. In recovery circles, this can be described as having a “magical magnify mind.” There are times when considering the worst possible alternative can protect you from bad life outcomes, other times it can make you miserable. Adopting catastrophizing as your default way of thinking has been tied to pessimism and many mental illnesses.
Wikipedia defines catastrophizing as “Giving greater weight to the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable.”
Catastrophizing and mental health.
Ellis (1962) created the term ‘‘catastrophizing’’ to describe a tendency to magnify a perceived threat and overestimate the seriousness of its potential consequences.
Beck in his work on cognitive behavioral therapy created a list of “cognitive distortions,” which are factors in creating and maintaining some mental illnesses. Recently cognitive therapists, have begun referring to these thinking patterns as “unhelpful thoughts.”
One of these unhelpful thoughts is magnification, a cognitive process in which people who are depressed create exaggerated beliefs which bias their thinking in a negative direction (Beck 1963, 1964.)
When you don’t know what causes bad events, the consequences are magnified. Catastrophizing is an unhelpful way some people use to try to find the causes of bad events in their life and to try to prevent future unpleasant consequences.
Other definitions of catastrophizing.
Catastrophizing involves focusing on the difficulty and negative aspects of a stressor. Catastrophizing is envisaging the worst results of a negative event.
Catastrophizing is an automatic “what if” questioning style, causing an individual to iterate about a particular problem and perceive possible outcomes as threatening (Kendall & Ingram, 1987; Vasey & Borkovec, 1992).
Mental illnesses are connected to catastrophizing.
Many of the things we call mental illnesses lies on a continuum from mild to severe. It’s quite common for people with one mental illness to also show symptoms of other mental illnesses. How a specific mental illness will affect you is also the result of the interaction between that illness and you. Your life experiences, your genetics, your personality, and how you go about thinking about the world, all play roles in your risk for having a particular mental illness and your path towards recovery from that illness. Below is a brief review of some of the research about the connections between catastrophizing and mental illnesses.
Chronic pain is made worse by Catastrophizing.
Many studies have found a connection between catastrophizing and disability from chronic pain. Catastrophic thinking in the pain field was deﬁned as ‘‘an exaggerated negative orientation toward pain stimuli and pain experience’’ (Spevak and Buckenmaier 2011.) Focusing on your pain seems to magnify it. Catastrophizing about your pain, imagining all the possible connections between your pain and serious illness, increases the pain’s impact on your life
Stanford Pain Management Center conducted a pilot program that involved a 2-hour class on pain and pain catastrophizing. The class significantly reduced patients catastrophizing about pain. I have to wonder if more information about mental and physical issues wouldn’t reduce people’s worry and result in significantly less catastrophizing.
The connection between chronic pain and catastrophizing is especially strong in the research on fibromyalgia. “Several factors of pain appraisal contribute to the pain experience. The most outstanding ones are pain catastrophizing, fear of pain, and vigilance to pain. In FM patients, pain catastrophizing has been associated with pain intensity and impairment” (Mart´ınez, S´anchez, Mir´o, Medina, & Lami,2011.)
“Among the most widely researched psychological factors in recent years, pain catastrophizing has shown consistent and robust associations with acute and chronic clinical pain as well as experimental pain responses” (Fillingim.)
Panic disorder is fueled by catastrophizing.
“People with panic disorder misinterpret their physical symptoms as catastrophic and indicative of imminent danger, leading to panic attacks” (Ottaviani and Beck 1987.)
Phobias may be created and maintained by catastrophizing.
The pattern of jumping to the most negative consequences, catastrophizing, is common in social phobia, agoraphobia, and specific phobia. In social phobia, people expect to be judged negatively and are on the alert for clues of rejection. This can result in being socially awkward and creating the social rejection they fear. Agoraphobia, the fear of the marketplace, or the fear of being out in public, is characterized by a fear that something bad will happen and the person will not be able to escape or get help. Specific phobias frequently involve overestimating the chances the thing that scares you will be present or will harm you.
Somatic Symptoms and Related Disorders are connected to catastrophizing.
In the past, this was often called Health Anxiety Disorder. Recently this was reorganized and is now considered a group of disorders. Somatic Symptoms Disorder (300.82) involves a focus on one or two symptoms that the patient comes to believe indicate they have a serious undiagnosed medical illness. Illness Anxiety Disorder (300.7) is a constant preoccupation and worry that you will contract a serious illness. Catastrophic thinking plays a role both in creating and in maintaining all the health-related anxiety disorders. This group of disorders frequently involves intrusive, distressing images of being sick or dying.
Obsessive-Compulsive Disorder involves catastrophizing.
OCD has two main components, intrusive thoughts, and the need to perform rituals to prevent those imagined consequences. These intrusive thoughts are primarily catastrophic in nature. When you continue to imagine worst-case, dire consequences which can only be prevented by your performing some ritual, it becomes hard to resist the impulses.
Posttraumatic Stress Disorder is connected to catastrophic thinking.
Catastrophic thinking appears to contribute to the creation and worsening of all the trauma and stressor-related disorders. Having experienced a traumatic event, you are more likely to imagine similar events occurring again. Constantly checking your environment for potential danger and then catastrophizing about what you see appears to contribute to the maintenance of PTSD.
Not everyone who experiences a traumatic event develops PTSD. People who habitually practice catastrophic thinking are at increased risk of developing PTSD should they experience a trauma (Bryant, Guthrie, 2005.)
Some studies have reported a connection between catastrophizing and fatigue.
Catastrophizing is often observed in anxiety.
“Chronic worry is known to be a feature associated with most of the anxiety disorders and most specifically with generalized anxiety disorder (GAD)” (Brown, Antony, &Barlow,1992).
According to the most recent diagnostic categorization, the cardinal diagnostic feature of GAD is “excessive anxiety and worry (apprehensive expectation) … which the individual ﬁnds difﬁcult to control” (APA, 2000, p. 476).
Catastrophizing creates Hopelessness Depression.
Hopeless depression is not a specific diagnosis. Counselors see a great many people who have lost hope. Hopelessness and a sense that the future will never be any better are common symptoms reported by people suffering from depression. Even before it reaches the level of clinical depression, a lack of hope and catastrophizing greatly increase the risk that today’s problems will become tomorrow’s depression.
“Catastrophizing (consistently inferring catastrophic consequences resulting from a negative event), has been posited as a speciﬁc risk factor for depression” (Abramson et al. 1989).
Paranoia and catastrophizing.
The emotional regulation strategies “blaming others and catastrophizing were positively correlated with paranoia and anxiety” (Westermann, et al., 2013.)
“Worry is a signiﬁcant concern for patients with paranoia. Worry in paranoia is likely to be caused by similar mechanisms as worry in emotional disorders. The results support the recent trial ﬁndings that standard techniques for treating worry in anxiety, suitably modiﬁed, are applicable for patients with paranoia” (Startup, et al., 2016.)
Poor sleep is caused by Catastrophizing.
Many research studies have shown direct connections between rumination, catastrophizing, and impaired sleep. Here are a couple of quotes from the research literature.
“Poor sleep quality, including difficulties falling asleep and waking during the night, commonly occur in early adolescence” (Carskadon, 2010).
“Up to 40% of adolescents experience some form of sleep difficulties at some point during adolescence” (Meltzer & Mindell, 2006)
Rumination magnifies your problems.
If your thinking style involves catastrophizing, looking for the worst-case scenarios, try to limit the time you spend considering alternatives. Unfortunately, people who catastrophize also tend to ruminate, going over and over the same material finding ever-increasing awful consequences. If catastrophize and ruminating are destroying your mental health, consider professional help before the problems of daily living become a serious mental illness.
More information about this topic and related subjects is found under Psychology
David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.) Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.
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