One can feel anxiety about the most trivial of things, from elevators to dust. So anxiety regarding one’s health seems natural enough. But it turns out that health-related anxiety in large amounts can be unhealthy! They even have a word for it – Hypochondriasis. Some might call it health phobia. But that would be trivializing it. It is a formally classified mental disorder.
A hypochondriac worries excessively about his/her health. One would think what is deemed excessive is a subjective matter. However, the amount and intensity of fretting that a hypochondriac does over seemingly trivial health issues ought to be readily discerned as unusual behavior. Minor symptoms such as a stomach upset or back pain are identified by the hypochondriac as sign of a major illness. Most patients seek repeated affirmations from family members and medical practitioners. However, confirmations are seldom helpful as the patients doubt the doctor’s diagnosis. Most patients repeatedly seek medical opinion and help, undeterred by repeated clean chits. As one can image, the behavior can be akin to obsessive compulsive disorder.
A generalized anxiety disorder can lead to hypochondriasis, especially in individuals predisposed to worrying about mortality. Very often a precipitating factor such as a major health incident or accident is present. A death in the family or that of a closely known person can also trigger hypochondriasis.
In various studies, incidence in the general population has been estimated to be in the range of 1 to 5%. It is, however, accepted that incidence is higher in in-clinic and out-clinic population: 3 to over 10%. It is largely unrelated to age and gender.
The overall symptoms would match those of generalized anxiety. Specific medical symptoms present a tricky situation. The patient blows minor aches, pains, murmurs and niggles out of proportion or even imagines some of them. This can make narrowing down on actual symptoms difficult. Moreover, the co-existing anxiety and depression produce actual physical symptoms such as loss of appetite and insomnia. These further worsen the hypochondriac’s condition leading to a cycle that is very hard to break. The patient will check his/her body very often for signs of illness. Patients insist on frequent medical check-ups and major investigative procedures such as MRIs and CT scans.
The ideal and most likely to diagnose this condition would be a psychiatrist. How many genuine cases of hypochondriasis end up at a psychiatrist’s clinic is anyone’s guess. Most patients are likely to visit the same doctor multiple times. They may even go to different doctors for a second and third opinion. It is during repeat visits that a doctor needs to identify the condition as hypochondriasis. Many patients go on for years or even longer living with these anxieties. During this time a lot of medicines such as antacids, painkillers and others are prescribed to the patient for somewhat real and imagined illnesses. This along with expenditure for diagnostic tests represents a huge amount of avoidable expenditure.
While symptomatic treatment for the reported headaches and back aches may be required, the anxiety at the root of the issue needs to be addressed. Hypochondriasis is treated like all other psychological disorders: with anti-depressants and therapy (sessions with psychiatrists).
Patients today know more about their symptoms and possible diagnosis and treatment before visiting the doctor’s clinic. Since the patient has no other physical symptoms, this condition can be very frustrating for family and care givers. Also, unlike other phobias, it is difficult for healthy individuals to relate to this condition. It more often than not, seems like excessive fretting to the point of maliciousness.
Hypochondriasis does tend to occur along with clinical depression and or obsessive compulsive disorder (OCD). Symptoms such as acidity or fatigue that are caused by depression are perceived by hypochondriacs to be the proof of their gravely imagined illness. Anxiety is thus perpetuated in a vicious circle.
What can I do?
If reading this feature made you worry more about health, it may be time to meet a doctor. If a family member or someone you know fits the profile of a hypochondriac as we have seen in this feature, do not hesitate in suggesting so. You would be doing them a big a favor.
– Punit Pania