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Like some others I take the question "Are you okay?" as an expression of concern, that the person thinks I'm not my usual self. How I answer depends on the person asking the question. If it is someone I'm comfortable telling if I'm not okay. I tell them what's going on. For others I just say "I'm fine."
To me, "How are you?" is different. In the US it's another way of saying "hello."
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