The Reality of Hypochondria

We love to laugh at the geeky, constantly sniffling, hand-wringing hypochondriac portrayed on TV and in movies.

Admit it: It’s fun to watch The Big Bang Theory’s Sheldon manically overreact when he’s convinced he has an untraceable disease, or Woody Allen, the undisputed king of hypochondriacs, going berserk over a buzzing noise in his ear (“I got the classic symptoms of a brain tumor!”).

But absent laugh tracks and one-liners, the disorder isn’t as amusing in real life. Hypochondria causes intense mental and physical distress, and leads to unnecessary doctor visits and tests and missed school and work. It seriously limits life.

Making matters worse, family and friends often misunderstand what’s going on, believing that their loved one is exaggerating for attention’s sake or simply faking sick.

INSIDE THE MIND

So why do some people believe they are sick, even when they’re not? People with true hypochondria are absolutely convinced that they have a serious or life-threatening health condition that hasn’t been diagnosed yet, even when there’s no clear medical evidence of a serious health problem.

Convinced of their ill health, they devote an excessive amount of time to looking for symptoms and researching health conditions. And when they’re not checking their pulses or surfing the Web, they’re seeing their doctors — again. These visits ease their minds for a time, but they are not reassured for long and frequently believe their medical care has been inadequate.

What causes this behavior is unknown, but a combination of genetics, environment and a history of trauma may all play roles in hypochondria, says Stefan Ursu, M.D., Ph.D., an assistant professor of psychiatry and behavioral sciences at The University of Texas Health Science Center at Houston (UTHealth) Medical School. He adds that hypochondria shares qualities with anxiety and obsessive compulsive disorder (OCD).

“The course of the disorder is pretty similar to OCD, waxing and waning over time depending on the levels of stress in a person’s life at the moment,” he says. “The focus of the health concern also can change over time.” Patients may fixate on a rare skin condition for a while, and then shift their attention to heart problems weeks or months later.

TREATING THE WORRIED WELL

Q&A WITH JEFFREY SPIKE, PH.D., PROFESSOR AT THE MCGOVERN CENTER FOR HUMANITIES AND ETHICS AND DIRECTOR OF THE CAMPUS-WIDE ETHICS PROGRAM AT UTHEALTH

Spike is co-author of The Brewsters, a critically acclaimed book on professional health ethics that’s required reading for all UTHealth students. The book is written in a choose-your-own-adventure novel style, in which the reader plays the roles of health care provider, scientific researcher, patient and their family. Many of the book’s storylines center around Wayne Brewster, a 50-year-old man convinced he has osteoporosis. Spike spoke to HealthLEADER about the challenges and ethical considerations involved in treating patients with hypochondria.

HealthLEADER: What makes treating these patients so challenging?

Spike: As a physician, it is very easy to be impatient with someone who has hypochondria. These patients can be “frequent fliers,” meaning that they come in for visits more often than necessary. You may feel that they have trivial complaints. The big challenge is not to become frustrated and angry and take it out on the patient.

The patient has real issues and concerns. The fact that they are turning to you for help could be a good thing. What you can do is help give them accurate information about their health. Don’t ignore the fact that they could be very anxious, and that anxiety is a medical condition in itself.

What can doctors do to decrease their feelings of irritation?

You can schedule a regular appointment for patients with hypochondria every six months, to help reduce the frequency of their visits. That doesn’t upset your schedule, and give the patients the psychological reassurance they need. And as a physician, you have some good news to give them every time they visit, when you can report that they don’t have the terrible disease they are worried about.

The Brewsters asks readers to consider whether Wayne Brewster should undergo an expensive scan even though it wasn’t medically warranted. How should doctors approach this kind of situation?

It happens quite often that a patient may worry that they have something, but a physician finds no reason for concern. The physician can then choose between having an attitude that their patient is wasting their time, or being empathic to their patient’s concerns and taking the time to explain why it is very unlikely they have that condition. If there is a test that can reassure the patient they don’t have it, and it is not dangerous, not too expensive, and it poses no risk to the patient, then there are times when ordering that test may be justified.

What else would you emphasize?

Good physicians need to be empathic; it really helps you understand your patient and what your patient needs. We probably don’t emphasize that enough in training physicians. We need to have more time to ask patients follow-up questions and address their stress. Our focus should be on treating the whole patient — patients are persons and not just diagnoses.

In some cases anxiety produces real, physical symptoms like muscle and joint pain, headaches, heartburn, other digestive problems and even chest pain and heart palpitations.

“Many times patients are told that what they are experiencing is ‘all in their head,’ and in some ways that’s true,” says Erica Bruce, L.C.S.W., a licensed clinical social worker for UT Physicians who treats many patients referred by cardiologists and gastrointestinal specialists. “But that doesn’t mean the physiological symptoms they may be feeling aren’t real. Our mental and physical health are inextricably linked.”

CHANGE IN DIAGNOSIS

In an attempt to better address the complex mind-body relationship that defines hypochondria, the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V) splits the disorder (also called hypochondriasis)into two diagnoses: Illness Anxiety Disorder and Somatic Symptom Disorder.

Illness Anxiety Disorder describes patients who have exaggerated health concerns and heightened bodily sensations without any significant bodily symptoms — for example, they may think they have the latest headline-making disease after reading about it.

Somatic symptom disorder describes patients who have exaggerated concerns about chronic physical symptoms they have, like Allen’s movie character believing the buzzing in his ear meant he had a brain tumor.

The change in diagnosis also dropped the former requirement that a patient’s exaggerated concerns had to persist “despite appropriate medical evaluation and reassurance.” Now, patients can be diagnosed with either disorder, even if they have not seen a physician for treatment.

Some mental health professionals laud the change for it inclusiveness and for covering people missed by the earlier criteria. Others, Ursu says, are concerned that it will end up diagnosing too many medically ill patients with mental health disorders.

TOOLS FOR TREATMENT

Despite the change in diagnosis, many mental health professionals continue to recommend a holistic approach to treat both of the disorders formerly known as hypochondria — employing a variety of tools including medication, cognitive behavioral therapy and lifestyle interventions for the best effect.

In particular, selective serotonin reuptake inhibitors (SSRIs), which are often used for treatment of anxiety and OCD symptoms, have been found to provide relief in some cases.

Mental health professionals also work to help patients identify irrational or distorted thoughts, and stressors that trigger their health obsessions. Exercise and relaxation are key coping strategies. Yoga and meditation help relax muscle tension, which in turn prevents pain, injury and anxiety that fuel the cycle of hypochondria.

“If we don’t take those 15 to 20 minutes a day to decompress, it definitely affects us,” Bruce says. “Our daily stress level is like a balloon. Throughout the day, it fills with our experiences. If our stress balloon is full at the end of the day and we start the next day with a full balloon, it can explode or implode in the form of depression, intense anxiety or panic attacks, or manifest into hypochondria.”

TOO MUCH INFORMATION 24/7

Constantly surfing the Web for health information pumps up that stress balloon, Bruce adds. Web searches instantly yield thousands (or millions) of hits and graphic images of worst case health scenarios:

• A bug bite — deadly MRSA
• Stuffy nose — bird flu
• Stomach pain — the big C: Cancer

“I tell my patients that when you are looking all this information up, it’s like you are trying to be your own medical doctor,” Bruce says. “Leave the diagnosis to your doctor. They have training we don’t have. The Internet gives us a lot of information, but it doesn’t have the ability to assess that information.”

Our 24/7 news cycle only fuels hypochondria further, constantly alerting us to new diseases with pandemic potential. People with hypochondria respond with hyper vigilance in an effort to control the unknown. Bruce says she works with patients to help them focus on what they can control and let go of what they can’t.

GETTING HELP

Think your behavior borders on hypochondria, and that the disorder is negatively affecting your life? Then take a step back and try to achieve some balance, Bruce advises. If that’s not working, seek mental health treatment that emphasizes a holistic approach to therapy. If a family member suffers from hypochondria, make an effort to encourage coping skills by doing healthy activities together. Broach the issue of treatment with sensitivity and empathy if your loved one needs extra help. Many people with hypochondria may feel defensive, because family and friends have dismissed their feelings and symptoms for years.

“It’s important when you’re talking to family and friends with hypochondria to be supportive and to listen without judgment,” Bruce says.

 

This site is intended to provide general information only and is not intended to substitute for or be used as medical advice regarding any individual or treatment for any specific disease or condition. If you have questions regarding your or anyone else’s health, medical care, or the diagnosis or treatment of a specific disease or condition, please consult with your personal health care provider.