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Addicted to Illness: The Menace of Hypochondria

 

“I noticed that when I thought about my head, it ached. But when I forgot about my head, it didn’t ache. I decided not to Google ‘benzodiazepine withdrawal symptoms’. I should have known better than to dump my worries into a search engine,” recalls writer Diana Spechler. She’s talking about weaning herself off medications for anxiety, depression, and insomnia, but she echoes the experience of many who suffer from hypochondria, who nurse abnormal anxieties about their health.

Hypochondria is extremely distressing for those affected and exasperating for doctors reassuring them. CBS News Chief Medical Correspondent Dr. Jonathan LaPook assures, however: “We don’t make fun of our hypochondriac patients, contrary to popular belief.” He adds, “Doctors aren’t immune to hypochondria,” referring to the tendency of first-year medical students to develop symptoms they are studying.

What is hypochondria?

Hypochondria, aka hypochondriasis, illness anxiety disorder, or somatic symptom disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders [1], is an excessive preoccupation with one’s health externalized through worry, anxiety, and incessant discussion. Hypochondriacs live in fear of having a serious illness, despite their medical tests being normal. They have no scientific data backing their medical concerns, but they think they know more than doctors. The Journal of the American Medical Association claims hypochondria affects up to 5% of medical outpatients [2].

Severity and focus

Both depend on the patient’s age, tendency to worry, and stress level. The attention may be on one organ, like the liver, or one disease, such as cancer. Some patients fear one disease after another.

Symptoms

  • An overwhelming, persistent fear of illness lasting more than six months, compelling them to have their doctors on speed dial.
  • Overreaction to the slightest abnormality or symptom.
  • Fear of normal body functions—night sweats interpreted as pneumonia.
  • Fear of minor abnormalities—gas pains taken as heart attacks.
  • Frequent physician visits for testing or reassurance.
  • Doctor shopping—changing healthcare providers when unsatisfied with diagnoses.
  • Manic researching of symptoms of possible diseases.
  • Constant body-checking for signs of illness.
  • Avoidance of people, places, and activities that could pose health risks.
  • Self-isolation and depression as a result of the disruption in healthy emotional function.
  • Hypochondriacs derive no reassurance from negative test results. They’re convinced their existing health problems will dramatically worsen.
  • Some avoid medical practitioners for fear of finding out they do have serious illnesses.

Why is hypochondria troublesome?

The extreme preoccupation damages relationships and affects the ability to work. It impairs daily living because it completely immerses the brain with worry. Often debilitating and severe, it causes sufferers to lose focus. Even mild concerns can lead to obsessive-compulsive disorder (OCD).

Causes

Hypochondria usually starts in early adulthood. It may appear during recovery from a serious illness, or after somebody close falls ill or dies.

Experts haven’t determined hypochondria’s exact origins, but believe both genetics and environment may be responsible for its development. Those susceptible include people who experienced childhood illness, trauma or abuse, grew up with hypochondriac or chronically ill family members, or are prone to catastrophic thinking. For some, however, roots aren’t easily identifiable.

Others’ hypochondriasis could be related to legitimate health conditions. A high percentage of hypochondriacs have major depression, panic disorder, OCD, or generalized anxiety disorder.

Other factors include massive stress or learning about a disease with increased media exposure, like COVID-19. Some worry excessively about their health as they approach the age when a parent died, especially if the death was premature. Contributors to hypochondria include mass media advertising and the Internet. Psychiatrist Dr. William Fisher compares the last to “a doctor who’s available 24/7 and never kicks you out of his office.”

Duration

Hypochondriacs are said to have a lower pain threshold, so they notice sensations earlier than others do. They can spend months or years worrying about illness, but may also spend long periods in between without obsessing. Those with personality disorders may find it harder to recover. Some with transient conditions are less likely to have psychiatric problems or severe anxiety disorder, and more likely to have medical issues. Recovery is more common in the higher socioeconomic strata and in those with depression or anxiety who respond well to treatment.

Since most hypochondriacs approach their family doctors about diseases they fear rather than seeing a mental health specialist, they may never receive a proper diagnosis.

Analogous disorders

Hypochondria and Munchausen syndrome (aka factitious disorder) are similar in that both conditions involve illnesses that aren’t real. But hypochondriacs really think they’re sick. Munchausen syndrome patients deliberately falsify signs and symptoms for a diagnosis to get attention.

Hypochondriacs become almost addicted to looking up information, examining themselves, and soliciting reassurance from doctors. Their Internet use has spawned the term, cyberchondria [3].

Strategies for overcoming hypochondria

Determine how the condition started. Don’t look up symptoms online because hypochondriacs always target the worst-case scenario. Leave diagnoses to medical professionals. Distinguish real symptoms from those which the mind creates.

Treatment options

Cognitive behaviour therapy (CBT)—isolates false beliefs and subjects them to rational thinking.

Biofeedback—a mind-body technique that uses audiovisual feedback to control involuntary bodily functions.

Mapping—a neurolinguistic programming (NLP) technique that helps patients be comfortable with anxiety and irrational thought patterns.

Medications—antidepressants, anti-anxiety medications, or selective serotonin reuptake inhibitors help combat stimuli and reduce anxiety levels.

Herbal medicine for reducing anxiety include St. John’s Wort, kava kava, and bacopa. Patients should consult physicians before using these, because some may react with medications.

Mindfulness meditation—mental training practice for alleviating stress

Psychodynamic therapy—interpretation of mental and emotional processes to relieve tension

12-Step programs—offer guiding principles for recovery

Dual diagnosis treatment—considered the gold standard when hypochondria co-occurs with addiction. Holistic and experiential therapies teach patients to make emotional, cognitive, and behavioural changes to address health anxiety and addiction while explaining the overlap between the two. They help redefine patients’ relationships with their bodies.

Exposure therapy—teaches patients how to react appropriately to anxiety triggers. It’s like facing fear head-on.

The link between hypochondria and addiction

  • Hypochondriasis can lead to OCD, which can lead to addictive behaviour.
  • Hypochondriasis is a symptom of benzodiazepine withdrawal.
  • Many hypochondriacs turn to drugs and/or alcohol for solace, relief, and coping with anxiety. While substance use may give a reprieve from the health obsession, it usually leads to addiction.
  • Some medications used to treat hypochondriac anxiety can be habit-forming. Antidepressants, however, aren’t addictive in the same way substances like alcohol and heroin are.
  • Addiction can aggravate psychological suffering and escalate anxiety and depression. Individuals with depression are more likely to abuse other drugs.

We are more than our anxiety

Therapists say we are born with two kinds of fear: that of falling and loud noises. Everything else is learned, including illness anxiety. To eliminate it, we have to go through it. Anxiety isn’t necessarily negative. Ruminating thoughts are signals that our subconscious is asking us for direction.

Healing involves disrupting deeply held beliefs and thought patterns, so it requires specialized therapeutic interventions. When hypochondriacs undergo these, they learn skill sets and techniques to develop a positive mindset for growth. When they overcome fear, they become like newborns. They shed old identities. That’s when healing begins.

Sources

[1] In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the term hypochondriasis was replaced with somatic symptom disorder. American Psychiatric Association. 2013.
[2] Barsky and Ahern. “Cognitive behavior therapy for hypochondriasis: A randomized controlled trial”. Journal of the American Medical Association. 2004.
[3] Dr. Fallon, Brian. “Phantom Illness: Recognizing, Understanding and Overcoming Hypochondria”. 1996.

Image by Alterio Felines from Pixabay