Hypochondriasis, Illness Anxiety Disorder, Health Anxiety
Signs and Symptoms of Hypochondria
Almost everyone worries intermittently about illness. People with hypochondria live in dread that they have a serious disease . The symptoms they worry over can manifest anywhere in the body. A headache is proof of a brain tumor. Stomach pain is a sign of pancreatic cancer. A sore muscle indicates multiple sclerosis. Hypochondriacs search for proof online or by going to doctors, often “doctor-shopping” from provider to provider.
Somewhere between 5 to 10 percent of people are thought to have hypochondria, but doctors find their practices disproportionately burdened by such patients, who may repeatedly call with every complaint and concern. More females than males have the disorder, and it generally begins in middle adulthood. In c hildren, the disorder manifests in recurrent abdominal pain or headache.
Patients with Illness Anxiety Disorder or Somatic Symptom Disorder spend a great deal of time monitoring body sensations and visiting doctors. They spend considerable time seeking health information online, feeling distressed after online health research, and then making appointments for doctor visits—a phenomenon sometimes dubbed cyberchondria. They specialize in self-diagnosis and frequently demand medical tests, even when their doctor considers such tests unnecessary. As a result, they may have medical bills 10 times the national average.
Nevertheless, they are not reassured when their doctor reports that no medical problem can be found, and they may be consistently disappointed or even angry with their physician for failing to find an illness. They are likely to consider their doctor unskilled and uncaring. They may go from doctor to doctor (“doctor-hopping”) seeking diagnosis of the illness they fear is eating away at them. Many researchers who have studied the condition believe that people with hypochondria are looking more for care and concern than for cure.
"My Distress Is Real"
Hypochondria exposes the weakness of a medical system that divides disorders by whether they are expressed in the body or the psyche, when most conditions are collaborative ventures between mind and body, only to differing degrees. The consequence is that conditions presented to the division of the healthcare system that looks only for somatic causes must, by definition, be deemed nonexistent—not real—when diagnostic search yields no objective evidence of illness. Referral to a psychiatrist is often seen by patients as a rejection of the validity of their suffering.
There is no question that the physical distress hypochondriacs experience is real, as is their emotional anguish. They want their pain and suffering to be acknowledged as real by physicians and those around them. They appear to have heightened perception of and sensitivity to the inner workings of their own bodies (interoception), so that what others experience as a little twinge for them has more power and staying power. As with other forms of anxiety, the very real physical and psychological components of the condition intensify each other.
Normal somatic sensations are thought to play a significant role in hypochondria, or health anxiety. Anxiety propels systems of awareness to go on high alert for danger. In health (or illness) anxiety, the vigilance that is a characteristic of all anxiety is focused on the body. Under extreme surveillance, given a mind on the lookout for and attuned to negative outcomes, every little twinge, no matter how benign, is mentally magnified and becomes a sign of impending medical disaster. That soreness in your chest? Must be a heart problem. Abdominal cramps? Colon cancer, no doubt.
What is more, there is evidence that those prone to anxiety are especially sensitive to body sensations—they are especially aware of and pay more attention to bodily sensations than others. The phenomenon is called interoceptive sensitivity. Further, those normal body sensations are deemed intolerable, a conduit to catastrophe ahead. That is a misinterpretation, a cognitive distortion, but it nevertheless plays a role in creating the real terror that hypochondriacs experience.
Causes of Hypochondria
Hypochondria is a baffling disorder. No one knows for sure what makes some people especially prone to express distress exclusively through physical complaints. Or why people persist in believing that they have a medical disorder after being repeatedly reassured by physicians that they are fine. But it is well-documented that many people with illness anxiety refuse referral to mental health specialists, resisting seeing their symptoms as having a psychological origin.
If the tendency to focus on somatic complaints is a prerequisite for hypochondria, then stress is often a catalyst. In particular, one identified catalyst is personal tragedy, such as the death of a loved one. Or it could be the death of a friend who has succumbed to a common, or uncommon, disease. Even news reports about a disorder have been known to trigger hypochondria. Another trigger may be the personal experience of a symptom—a memory lapse, a shooting pain in the chest—well-identified with a disorder considered a major threat to longevity. An online search for information may convert curiosity to conviction that something is wrong.
There is no gene for hypochondria, just as there is gene for general anxiety. There is, however, some evidence that hypochondria is more common in those with a parent who has the disorder. But familial transmission does not necessarily implicate genes . There are many ways families develop their own codes of behavior and pass them on to the next generation. Ways of expressing emotions in general and distress in particular are often among them. Parents who tell children such things as “they’ll be no anger [or sadness] in this house," are laying the groundwork for alternate pathways of expressing emotional distress. Parents who worry about their children’s health and take elaborate precautions to ward off every sniffle may, through their acts of overprotection, be directly demonstrating to their children how to worry about their own health.
A number of factors in addition to recent life stress have been linked to development of hypochondria. As with general anxiety, illness anxiety is linked to the personality trait of neuroticism , the tendency to respond to experience with negative affectivity—that is, distressing thoughts and worrisome feelings—and to be roiled by them. In study after study, neuroticism predicts susceptibility to both anxiety and depression and, to a lesser degree, all other mental disorders. Scientists believe that neuroticism reflects emotional reactivity that is especially attuned to threat.
Treatment of Hypochondria
Until recently, hypochondria—the conviction some people have that they are suffering a serious undiagnosed illness— was considered a disorder beyond the reach of treatment. But in the past decade or so, the components of the condition have come into clearer focus— belief in the presence of an undiagnosed disease, health-related anxiety, bodily preoccupation. The misperception of benign body sensations and the distorted thinking that magnifies and misattributes them have led researchers and clinicians to see the value of psychological treatments.
Nevertheless, physicians report that hypochondria remains a difficult disorder to treat, in part because it is difficult to orient patients to the right treatment. Patients with illness anxiety spend a great deal of time in the medical system. They overutilize medical services and remain anxious even when diagnostic procedures turn up no evidence of illness. They literally don’t take no for an answer; it does not give them reassurance. Many resist seeing their problem as inherently psychological, because they believe it means their suffering is not “real.”
The challenge for any treatment of hypochondria is to educate patients about the nature of their disorder and what triggers it. Beyond that, the treatment of choice for hypochondria, or Illness (health) Anxiety Disorder, is psychotherapy , because it specifically targets the perceptual and cognitive mechanism thought to underlie the disorder—and in particular, cognitive behavioral therapy (CBT) . There is a mountain of evidence documenting the effectiveness of CBT for generalized anxiety and other anxiety disorders. And as with other anxiety disorders, the antidepressant drug fluoxetine (Prozac) is sometimes al so used to treat health anxiety.
Research has shown that CBT successfully teaches hypochondriacs to identify what triggers their behavior and gives them coping skills to help them manage it. In one well-regarded, randomized, and controlled study, patients assigned to CBT received treatment in six 90-minute sessions at weekly intervals. At both 6-month and 12-month follow-up, CBT patients logged significant reductions in hypochondriacal thought frequency, health anxiety, and amplification of body sensations. They also were better able to participate in the normal activities of daily living.
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