Photo Credit: Dormstormer
August 9, 2013
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“What’s the matter?” “I have a headache,” “Maybe it’s a tumor?”
“It’s not a tumor!” In pop culture, we like to poke fun at individuals
who fuss over every little ailment with numerous TV characters based on
those who possess hypochondriac personas. However, for the sufferer,
living each day in constant fear of contracting a serious
life-threatening illness is no laughing matter.
Hypochondriasis,
as it was previously known in the medical field, is a serious mental
condition that places a major physical, emotional and financial strain
not only on the sufferer, but also on relationships, family members and
the entire health care industry. To date, there has not been
significant medical research dedicated to understanding the condition
and many doctors are unsure about how to manage patients who exhibit
symptoms. A
working definition was only formulated in the last few decades by the
American Psychiatric Association
(APA), which defined the disorder as, “the fear or belief of serious
illness that persists six months or more despite physician reassurance."
More recently in May 2013, the condition was re-termed
Illness Anxiety Disorder by the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the APA in an effort to shift the focus away from the
symptoms of the condition and instead toward the abnormal behavior and feelings evoked
by
the symptoms. This made it clear that this is primarily a mental
disorder where people worry excessively and unnecessarily about medical
problems.
In the absence of concrete medical studies it is
uncertain how many people actually suffer from illness anxiety disorder,
but according to Brian Fallon, professor of clinical psychiatry at
Columbia University and co-author of
Phantom Illness: Recognizing, Understanding and Overcoming Hypochondria,
at least 25 percent of patient visits to doctors are believed to have
no identifiable medical cause. Moreover, approximately 12 percent of
the population suffers from some form of a fear of illness.
“A
factor that contributes to illness anxiety disorder is a person’s
genetic makeup," Fallon told AlterNet. "If you have genes in your family
aiding obsessional anxiety, it is likely you will suffer from
obsessional anxiety. It is also true that if you grew up as a child
where a parent was quite ill or suddenly afflicted with serious illness
then this can create a channeled fear that you will develop a disease
and also adds to a lack of trust in the world. Others can develop the
disorder after losing a loved one to a serious illness or as a secondary
illness to depression or anxiety disorder."
Sometimes, the
condition is so extreme that individuals can actually experience
physical symptoms created through the mind. Such worry wreaks havoc on
the immune system causing a lack of sleep and severe anxiety which can
lead to further physiological conditions. As Arthur Barsky of Harvard
Medical School and author of
Worried Sick: Our Troubled Quest for Wellness told
WebMD,
the illness then becomes part of the hypochondriac’s identity and as a
result, the individual’s work, family and relationships begin to suffer.
“Contrary
to what some skeptics think, hypochondriacs are not pretending or just
trying to get attention. They're absolutely not fakers or malingerers
[…] They really feel the distress they're talking about. It's just that
their feelings don't have an obvious medical basis,” Barsky said.
So
how does one differentiate between a hypochondriac and a person merely
concerned about their health? According to Benjamin Liptzin, chair of
the department of psychiatry at Baystate Medical Center in Springfield,
the primary distinction lies in the
extent to which a person believes he or she has a serious illness. As he explained to AlterNet:
“A
certain amount of concern about one’s health is a good thing. This
gets us to visit the doctor, to watch our diet, to exercise, take
medication – healthy normal people should be concerned about their
health. What distinguishes people with the disorder is that it is
excessive – these people are not reassured by good news from the doctor
or when test results come back negative. They are just convinced there
is something their doctor is missing."
Fallon agrees.
“Hypochondriacs
live in constant or intermittent fear that they might be dying or
afflicted with a serious illness whereas people who are generally
concerned about their health are conscious about their wellbeing rather
than live in incessant apprehension of a threat to their health or
contracting a serious illness,” he said.
This inability to accept
negative test results at face value or a doctor’s assurances leads to a
rampant abuse of the healthcare system whereby hypochondriacs spend
large amounts of money on numerous and unnecessary medical appointments
and procedures like blood tests and MRIs even after results indicate
they do not have an illness.
A
study by Barsky found
that those with unexplained physical symptoms with no medical basis
accounted for 16 percent of all medical costs, with the annual cost of
hypochondria in the billions of dollars. Fallon believes this to be an
accurate figure in light of the ease and freedom with which patients in
the US can visit multiple doctors at any given time, at the expense of
the insurance companies which beart the costs.
The disorder places
a major strain on the doctor-patient relationship as doctors struggle
with having to determine to what extent they should investigate a
physical medical complaint in the absence of any substantial symptoms.
This often results in a doctor ordering excessive medical tests not out
of necessity, but merely to ease a patient’s state of mind.
Such
measures serve as a double-edged sword whereby exploring phantom
illnesses only heighten the insecurities of the hypochondriac patient
who already believes he/she has some rare disease. Many doctors feel
pressured to succumb to a patient’s irrational demands to avoid a
malpractice action based on misdiagnosis.
Physician Rahul Parikh describes the lack of faith between doctor and patient in his article, “
The real reason hypochondriacs drive doctors crazy." He wrote:
“Today’s
medical system encourages the approach of hurrying difficult patients
out the door. Doctors, unlike lawyers or consultants, don’t bill for
their hours. Most of us get reimbursed by insurance companies for tests,
and procedures, and prescriptions, often regardless of whether they’re
necessary. A hypochondriac on our schedule is a time and money sink. The
ugly truth is that modern medicine doesn’t reward those physicians,
like primary care doctors, whose main work is to listen to and think
deeply about patients and their ailments, whether they are physical or
psychological."
It doesn’t help that we live in a
society of medical paranoia where self-help books are encouraged and
when we turn on the TV we are confronted with public health messages
stressing the benefits of early detection in the absence of symptoms.
Even 30-second drug advertisements manage to provide every possible
life-threatening side-effect of taking medication.
The plight of
the hypochondriac is amplified by the Internet. Historically, those
interested in investigating their physical symptoms had to trek to a
library to borrow a book in order to research an illness. Today, one
only needs to Google a symptom of an illness and instantaneously
thousands of serious medical conditions appear, often displaying a
worst-case diagnosis that happens to match the seeker’s problem.
As Fallon explains,
“cyber-chondria”
is the addiction to researching medical conditions online whereby the
more access a person has to learn about an illness, the more the person
thinks he/she has it. He said:
“There is a tremendous
temptation for people with illness anxiety to type in their symptoms on
the Internet to see if they can find a diagnosis to explain their
symptoms. The problem with that is that the web is filled with
information which is both accurate and inaccurate, as well as other
patients trying to give people advice and warnings against horrible
doctors. This only causes people to feel worse. My recommendation is
that if you have a pre-existing illness anxiety, stay away from the
Internet!”
So how should a doctor proceed when
treating a patient who is exhibiting hypochondriac traits? Liptzin says
that when a doctor is faced with a person suffering from an obvious
illness anxiety disorder, it is better not to submit to patient
pressure.
“Doctors should only do what is necessary and if they
are confident that they have ruled out a series of illnesses, they
should explain that to the patient and say, Let’s see how you do over
the next six months,” he said.
Fallon believes the key for doctors is to differentiate between illness and obsessional anxiety disorders.
“It
is hard for doctors at an initial consultation to diagnose
hypochondriasis because of the limited amount of time they have with
their patients," he said. "However, if a patient returns after medical
tests come back negative, and the doctor has the opportunity to get to
know the patient, it is important for the doctor to show compassion and
kindness and explain carefully that the cause of the problem may be an
underlying anxiety disorder and encourage treatment for anxiety or
depression."
Whether such measures by physicians actually curb
erratic patient behavior is debatable, considering that many patients
who are unhappy with a diagnosis are likely to continue doctor shopping
in search of a validation of their illness. Fallon acknowledges that
those who believe they are hypochondriacs can take matters into their
own hands to help alleviate the problem.
“People suffering from
illness anxiety disorder can do things to help themselves by reducing
the focus on physical symptoms and enhancing interpersonal physical
relationships," he said. "Psychotherapy has also proven effective by
concentrating on positive behavioral strategies. If the illness anxiety
is severe, it is important to see a mental health professional or at the
very least learn about the disorder."
Liptzin believes that while
attending clinics with group sessions for those who suffer from the
illness may be helpful, it can have the opposite effect.
“Sometimes
these clinical sessions only reinforce the disorder as sufferers end up
supporting each other’s irrational thought patterns," he said. "There
is not much evidence that medication helps either. Rather, any type of
relaxation technique or meditation or mindfulness is recommended to help
reduce the anxiety of the person. What you really need to do is to take
your mind off the symptoms and anything that is upsetting you."
People who believe they may be suffering from illness anxiety disorder can take the
Whitley Index Test, which has been developed to help identify hypochondriacs. The
Mayo Clinic
recommends sticking with one doctor, no self-checks or self-diagnosis
and attending group therapy sessions. In severe cases, medications like
Prozac can be prescribed to treat anxiety disorders with mixed results
of success.
It is important to remember that even hypochondriacs
do get sick at times. Therefore, it is important to always listen to
your body and seek medical assistance when it comes to general health
concerns.
