Catastrophizing: What You Need to Know to Stop Worrying

Catastrophizing involves believing that you’re in a worse situation than you really are or exaggerating your difficulties. It can be a symptom of anxiety or depression.

For example, someone might worry that they’ll fail an exam. From there, they might assume that failing an exam means they’re a bad student and bound to never pass, get a degree, or find a job. They might conclude that this means they’ll never be financially stable.

Many successful people have failed exams, and failing an exam isn’t proof that you won’t be able to find a job. A person who is catastrophizing might not be able to acknowledge that.

It’s easy to dismiss catastrophizing as over-exaggeration, but it’s often not intentional or that simple. People who do it often don’t realize they’re doing it. They may feel they have no control over their worries, and it can even impact their health. Fortunately, effective treatments exist.

It’s unclear what exactly causes catastrophizing. It could be a coping mechanism learned from family or other important people in a person’s life. It could be a result of an experience, or could be related to brain chemistry.

Research involving people who catastrophize and who also have chronic pain suggest they may have alterations in the thalamus and prefrontal cortex, as well as increased activity in the parts of the brain that register emotions associated with pain.

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People who have other conditions such as depression and anxiety, and people who are often fatigued may also be more likely to catastrophize.

Chronic pain

The combination of chronic pain and catastrophizing happens often and is widely studied.

Because someone with chronic pain is used to constantly being in pain, they might conclude that they’ll never get better and will always feel discomfort. This fear may lead them to behave certain ways, such as avoiding physical activity, which rather than protecting them, can ultimately make their symptoms worse.

Multiple studies have found that patients who catastrophize report an increase in the severity of their pain, worse post-op outcomes, and needing to use healthcare services more often.

Another 2023 study indicates that some patients feel the term “catastrophizing” invokes stigma from healthcare providers who may not empathize with patients because of gendered notions of “hysteria.”

However, this does not mean that chronic pain should not be taken seriously. Catastrophizing isn’t the same as exaggerating about pain.

Older research on chronic pain and catastrophizing has already confirmed that catastrophizing is more than just psychological — it affects the physiology of the brain. As such, it should be taken very seriously.

Anxiety and depressive disorders

Catastrophizing is associated with depression as well as anxiety disorders such as generalized anxiety disorder (GAD), PTSD, and OCD.

A 2018 study looked at 2,401 female twins and found a strong genetic association between pain catastrophizing and anxiety. The researchers concluded that people with anxiety have a genetic predisposition to developing catastrophizing tendencies (and vice-versa); rather than personality and upbringing being the only factors.

A 2019 study found that catastrophizing was linked to both anxious and depressive disorders in children and adolescents. Controlling for anxiety, it showed that there was a strong relationship between depression and catastrophizing.

The authors concluded that this was because assuming that the worst will always happen leads to feelings of hopelessness. Constantly feeling hopeless can lead to depression.

Fatigue

A 2022 study found a link between fatigue and catastrophizing. As the researchers point out, despite fatigue being a disabling symptom, especially in patients with fibromyalgia, few studies have focused solely on fatigue.

The findings highlight the importance of taking both catastrophizing and fatigue into account when forming a treatment plan for chronic pain patients.

A combination of cognitive-behavioral therapy and walking may prove effective, even though patients frequently report feeling more pain and fatigue, at least in the beginning, when starting a walking protocol.