A desire to be healthy and hydrated is completely normal, but what happens when this intention becomes an obsession?

Do you know how much water you’ve had today? Are you getting your recommended daily intake? For some people, this is a casual question. It’s something we’re all aware we should be doing, but it’s not front of mind all the time. Yet for others, not drinking enough consumes their thoughts, and they can drink excessive amounts, or experience severe anxiety at the thought of not staying hydrated.

When you Google dehydration anxiety, you’ll find an abundance of results relating to how a lack of hydration feeds anxiety. And while that may be true, it’s not what I’m looking for. The specific fear of failing to nourish our bodies with enough water to prevent illness is dehydration anxiety: a common anxiety disorder you may not know you have.

I’ve grown up around addicts – hydration addicts. And I’m no different. I am obsessed with, addicted even, to my water bottle. Litre water bottles now linger on desks around me, and board rooms are crowded with staff clutching their own bottles. If you’ve ever panicked about how little you’re drinking, you’re not alone. Emails fill our inbox with subject lines ‘Signs you aren’t drinking enough water,’ or ‘Do you really know how much fluid you should be drinking?’ The answer is probably, and understandably, no.

Over the years, with all this mixed information, are some of us taking this too far? Is there such a thing as being too obsessed with drinking water? And at what point does the balance tip from a healthy habit, to an unhealthy obsession?

What is dehydration anxiety?

Anxiety can have many causes, but when it’s specifically linked to how much, or how little, water you drink, it’s called dehydration anxiety. It’s a constant fear that you aren’t hydrating your body adequately, and given you can’t actually see the benefits of hydration, often the anxiety can escalate, and induce panic attacks. In the same breath as orthorexia – an obsession with ‘clean’ foods – we could actually be doing more harm than good with our excessive water intake.

As a millenial, I have been, and still am, surrounded by masses of conflicting information at my disposal about what I should and shouldn't be nourishing my body with. And the media often plays a part in fuelling this health anxiety. Water, like oxygen and food, is essential for life. But can you have too much? Linked in the past to flooding the brain, overhydration can also impact your blood quality and sodium levels.

Nutritional therapist Karen Alexander explains: “The eight glasses a day advice, that is often given, is surprisingly not supported by evidence, but can be used as a general guide – especially if you don’t get the usual thirst signals.”

Considering the general guide of water intake is approximately two litres, for those with dehydration anxiety, it’s likely that they are consuming significantly higher volumes.

I spoke with friend and colleague, Alice Greedus, who also experiences dehydration anxiety. For Alice, five litres of water each day is closer to her average, with her fear of headaches and urinary tract infections (UTIs) prompting her anxiety.

Everyone is different, and one size doesn’t fit all. You can achieve a balance that’s right for you

“When I went to buy a new water bottle, I had to check every one to find the largest available,” Alice says. “I’m aware that I can feel thirst, but now I’m not sure if it’s psychological or real. If I go to London, I’m constantly thinking, ‘Can I get water?’, and ‘Is there a toilet?’ It’s a vicious circle.”

Counsellor Sophie Robinson-Matthews explains that this is a form of obsessive compulsive disorder (OCD). “Anxiety relating to health is often linked with the need to control something, usually when there has been a prolonged period of feeling a lack of control or autonomy within the person’s life, and in some people, a fear of their own mortality or physical vulnerability. Most OCDs like this develop as an attempt to soothe some uncomfortable feelings, but often we fear those uncomfortable feelings so much, we attempt to prevent them all the time. Thus making engagement with the OCD behaviours increasingly common.”

How to manage dehydration anxiety

Sophie suggests keeping a log of evidence that includes times when someone didn’t drink as much as they usually would, and they were in fact, OK. “By keeping an evidence log, you are weakening the part of your mind that believes something harmful will occur if you do not drink two litres of water a day, or become thirsty. In other words, it’s strengthening the rational part that can cope with uncomfortable feelings.”

When dehydration anxiety strikes in the moment, Sophie recommends ‘box breathing’: “Close your eyes and breathe in for four counts, imagining drawing the top side of a square. Hold the breath for four counts, and visualise drawing the vertical down side of the square. Next, breathe out for four and draw the bottom of your square. Lastly, hold your empty lung space for four counts and draw the final side of the square to meet back where you started. Repeat until you feel calm again.

“By then you should feel utterly relaxed. This allows the rational mind to decide on the next course of action, otherwise you’re operating from an irrational state caused by fear and panic.”

How much should we be drinking?

Nutritional therapist Karen says: “There is no doubt that sufficient hydration is vital for your health, but the amount needed varies from person to person. A number of factors influence this, such as age, gender, diet, exercise, caffeine or alcohol consumption, and the presence of disease. Other than listening to your thirst, another way to judge your water needs is via urine colour. Ideally you want pale yellow urine – be aware that if you are taking Riboflavin (vitamin B2) this can make urine bright yellow.”

She also notes that many vegetables also contain a high water content, and can be counted towards your daily intake, including most fruit, cucumber, celery, lettuce, courgette, tomato, potato, cabbage, and even foods like salmon and eggs, if not over-cooked.

The connection between a healthy mind and a healthy body is intrinsically linked, and the key to keeping these both working in harmony, is balance. Listen to your body and reconnect with what thirst actually feels like – starting with the eight glasses a day guide. Keep a log to identify how much you actually drink, and work through your anxiety with a trained therapist, or practise mindful meditation to strengthen your rational mind. We may be hyper aware of our health and the recommended dos and don’ts of healthy living, but everyone is different, and one size doesn’t fit all. You can achieve a balance that’s right for you.

You can find more information about nutrition and hydration on nutritionist-resource.org.uk