Hypochondria: causes, symptoms, and clinical management

Hypochondriasis: An Overview

Description of Hypochondria

You're such a hypochondriac!" The symptoms of hypochondriasis, the formal diagnostic term for hypochondria, have entered the popular vocabulary to such a degree that the condition has become the punch line of jokes, and is not seen as a serious, diagnosable medical disorder. To some degree, the illness is both fodder for Woody Allen films as well as a formal ailment, because the degree to which someone is be excessively worried about his or her health without being 'mentally ill,' can be highly subjective. Some degree of vigilance about one's health is not only normal, but beneficial and necessary, and when such a preoccupation has become overwhelming and counterproductive rather than a part of a healthy lifestyle must be determined on a case-by-case basis.

According to the traditional definition, a hypochondriac is suffering from a "somatoform disorder," a "mental illness in which a person has symptoms of a medical illness, but the symptoms cannot be fully explained by an actual physical disorder" ("Hypochondriasis," the Cleveland Clinic, 2008).In other words, a person may be so worried about getting an illness, they may unconsciously exhibit symptoms of the illness, but unlike sufferers of Munchausen Syndrome they do not deliberately create a charade, like shaving their head to simulate going through chemotherapy. Hypochondriacs genuinely believe they are ill and do not feel they need to pretend. Sometimes they are just very worried about getting a disease, such as the person who washes his or her hands over and over again to avoid getting a cold, or they may believe they have a disease, even after medical tests indicate otherwise ("Hypochondriasis," the Cleveland Clinic, 2008). Obsessive-compulsive disorders, anxiety, and depression, as is evident from these descriptions, may be linked to hypochondria.

Hypochondriacs often misinterpret minor health problems or normal body functions as symptoms of an illness, like tiredness is seen as anemia, hypothyroid, or chronic fatigue syndrome (CFS). Another example of a hypochondriac is the person with headaches who fears he or she has a brain tumor. The disease most often manifests itself during young adulthood, and, as with many anxiety disorders, is often accompanied by a stressful event in his or her life, or a life change. A doctor may suspect his or her patient is a hypochondriac if a patient has a reputation for "doctor swapping" or when doctors refuse to confirm the patient's self-perception as an individual afflicted serious illness ("Hypochondriasis," the Cleveland Clinic, 2008). One of the difficulties in treating a hypochondriac as a physician or a therapist is the patient's conviction that it is he or she who is 'really ill' while the supposedly sane doctor is 'crazy' or unsympathetic to deny the illness.

To receive a diagnosis, the conviction on the part of the patient that he or she is ill must not be "of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder). The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning" ("Hypochondriasis," Psych Central, 2008). This inhibition of function, in the eyes of the patient is due to the illness, however, not the mental affliction, and it may be difficult to convince the patient that his or her demand to be treated for a series of physical complaints is actually counterproductive to his or her health.

Part II: Controversies

Because hypochondria is linked to a variety of disorders, its evolution can be difficult to pinpoint. "Some psychologists believe that hypochondria may be the result of an underlying depression that is causing people to evaluate their symptoms differently and experience them in different ways than people who aren't depressed...when people get depressed they withdraw and become focused on their minds and bodies and are much less responsive to external cues. A cannon could go off across the street and they wouldn't notice it. They become too wrapped up in themselves; therefore those little stomach cramps become big stomach cramps. Since they're not distracted by external things, which would turn them away from their symptoms, they experience them as being more severe than they really are"(Rierden 1989, p.2).

The availability of the Internet, many beleaguered doctors fear, will make it easier for hypochondriac patients to find new and rare illnesses to diagnose themselves with -- however, even doctors acknowledge the value of the Internet in their own work, when cases baffle them. "Web-based search engines such as Google are becoming the latest tools in clinical medicine, and doctors in training need to become proficient in their use....Using clusters of symptom-related words, they [the doctors] searched Google for a correct diagnosis and compared the internet diagnosis with those in the journals....Google searches found the correct diagnosis in 15 - or 58 per cent - of cases proving, say the authors, that the engine is a useful aid, particularly if the condition has 'unique' symptoms...But patients doing a Google search may be less likely to reach the correct diagnosis" ("GPs should Google diagnosis: study," Nine MSNBC, 2007). Again, one of the difficulties with hypochondria is that the person may be occasionally correct, that he or she is ill, which confirms every other suspicion that the patient has had about the medical establishment's lack of sympathy and competency.

Some modern diseases, such as Chronic Fatigue Syndrome, and other autoimmune disorders have often been classified as "hysterical" or typical of hypochondria in their nature and etiology, and questioning the 'reality' of certain illnesses with highly permeable categories of diagnosis, again makes it difficult to determine what is in the mind and what is real. Of course self-identified CFS sufferers vehemently deny such claims as made by Elaine Showalter of Princeton University that the outbreak of CFS is an "infectious hysterical disease" like "recovered memory syndrome, Gulf War syndrome, and multiple personality syndrome" (Swizter 1995). When even psychiatrists disagree on the reality of illness, the degree to which hypochondria is real, a symptom of depression or anxiety, or a disease in and of itself further blurs. Some see it as a symptom of depression, OCD, or anxiety disorders, while other see it as a unique somatic disease in and of itself, because of its occasional ability to produce bodily symptoms.