It is estimated that millions of people in the U.S. suffer from imaginary illnesses, including a rise in recent years in food intolerances. Are we really a nation of hypochondriacs?
The “worried well,” it would appear, are everywhere: An estimated one in four physician appointments is taken by a healthy person.
But while the popular view of the hypochondriac is the patient who instantly declares a cold to be flu, those who suffer from health anxiety, as it is now more sympathetically named, rarely concern themselves with such mundane conditions. For those with health anxiety every twinge can be the latest symptom of a terminal disease. Anxiety exacerbates any ache they have so that their pain becomes real and potentially debilitating.
Physicians’ reassurance can have little effect, as the individual often doubts the doctors’ conclusion that they are perfectly healthy. The disorder can become disabling, especially when it coexists with obsessive-compulsive disorder (OCD).
Thousands of people suffer from such acute health anxiety that they are unable to work. “They may be at the extreme end of the spectrum, but this is a problem for many people and it has to be seen as condition in itself,” says Prof. Paul Salkovskis, the director of the Maudsley Hospital Centre for Anxiety Disorders and Trauma, London, UK. “Their suffering is genuine, and their pain often greater than if something really was wrong with them.”
But hypochondria a Greek word meaning “beneath the breastbone cartilage” is not a modern phenomenon. Famous hypochondriacs include Tennessee Williams, whose health fears led to alcohol and drug dependence; Lord Byron, who wrote and worried about being thirsty; and Howard Hughes, who became a recluse over fear of germs. But while health anxiety sufferers formerly had limited sources to feed their paranoia, the Internet makes it more possible than ever, while media advertise for wellness checks and body scans.
This is fueling anxiety, according to general practitioner Dr. Mike Fitzpatrick. “But you can’t just blame the media and the Internet,” he says. “People are becoming ever more introverted and self-preoccupied, and consequently they do worry much more about their bodies. The advice on health awareness sometimes seems to make that worse.”
Currently there are no guidelines to deal with the condition. Patients either are repeatedly turned away by their doctor or sent for “reassurance” scans to prove to them that nothing is wrong. But such tests, it is argued, rarely provide the patient with the reassurance he or she needs, leading to further demands for more tests and examinations, or merely tiding them over until the next worry emerges.
Cognitive behavioral therapy (CBT), a form of psychotherapy which tries to understand and modify behavior, is one option. It has been found effective along with selective serotonin reuptake inhibitors (SSRIs) in recent clinical trials. Talking through the issue can help while antidepressants help reduce obsessional worry through altering neurotransmitter levels.
A team led by clinical psychologist Anja Greeven of Leiden University in the Netherlands found that CBT and the antidepressant paroxetine (sold as Paxil or Seroxat) are both “effective short-term treatment options for subjects with hypochondria.” Their study assigned 112 patients to CBT, paroxetine, or a placebo. Both therapies were “significantly superior to placebo, but did not differ significantly from each other.” After 16 weeks, CBT showed a 45 percent response rate, Paxil a 30 percent response, and 14 percent for placebo.
“Hypochondria is an underestimated problem,” Dr. Greeven said. “Patients have to cross an enormous barrier before seeking psychological help for their symptoms.” She believes it is not a straightforward task for a physician to give the right sort of care to hypochondria patients. “If you tell patients they are imagining their problem, they will immediately get up and leave,” she says. “It is important to take their complaints seriously and to help them to look at their physical symptoms differently. The danger of hypochondria is that the doctor gets tired of the patient and no longer examines him or her, even when there may be real medical reasons for doing so. Consequently, there is a risk that a real physical symptom may go unnoticed.”
Greeven A. et al. Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. The American Journal of Psychiatry, Vol. 164, January 2007, pp. 91-99.