Almost every physician has got one – the person who repeatedly comes in with a concern about having or getting a serious illness. They obsess about health related issues and behaviours and may frequently check their body for signs of illness.
Physicians often complain these patients, with their unending problems, are a nuisance and clog the healthcare system with their unnecessary visits and tests.
Sometimes, doctors appease these patients, unwilling to stigmatize them or anger them. Even though they suspect hypochondria, some doctors simply shrug and say they aren’t certain what the problem could be.
In other cases, the modern trend of visiting walk-in clinics and only dealing with one symptom per visit may make it difficult to put the problem in perspective.
But what is hypochondria? Is it just a fancy way of describing a neurotic complainer who wants attention or, worse still, a malingerer? Although this is how many might view it, hypochondriacs really aren’t faking it. What they have is a disorder of thought rather than a disorder of the body.
Hypochondriacs are preoccupied with fears of having a serious disease based on their misinterpretation of bodily symptoms. The attention they seek is reassurance that they are well. Unfortunately, they may find it impossible to accept reassurance when it is given or only do so temporarily.
Preoccupation with physical symptoms can occur in many psychiatric disorders. For instance, anxiety and depression are almost always associated with physical symptoms. However, people with these disorders can usually accept the explanation and reassurance given by healthcare providers.
Somatic symptom disorder (formerly somatization disorder) is another disorder that is associated with preoccupation. It is characterized by a history of many physical symptoms in several body systems that cannot be fully explained by a known general medical condition. Common symptoms include chronic pain, nausea, dizziness, fatigue and weakness. This disorder is similar to hypochondriasis, but more pervasive and often with more severe symptoms. A somatic type of delusional disorder is also similar but even more resistant to rational intervention.
Illness anxiety becomes a self-reinforcing spiral as a symptom is noticed and then focused on. The more people focus on their body, the more ‘twinges’ and unexplainable pains they are likely to find. This could be on the rise today as a vast amount of medical information is easily accessible on the Internet. This is exactly what happens to many medical students early on in their careers. While learning about many different diseases, they often start to think they have them.
Cognitive behaviour therapy can be helpful for this as for other types of anxiety. These techniques help teach the individual to change patterns of thinking. To begin with, patients need to be listened to and to have their concerns understood by the therapist. A careful examination should follow with reassurance if appropriate. Even more important, patients should be given an explanation for their symptoms. If the pain is not cancer, what is it?
This in-depth examination requires a comprehensive medical history, which may not be possible in a regular five to 10 minute appointment with a doctor. For this reason, assessments such as these may be better suited to the skills of a psychiatrist than to a busy family doctor.
Along with cognitive behaviour therapy, some studies have found that a high percentage of hypochondriacal patients respond positively to serotonin reuptake inhibitor antidepressants in the same way that obsessive-compulsive or anxiety patients do.
Now that there are effective ways to deal with illness anxiety, physicians need to be ready to diagnose it and suggest options for their patients. In the end this will prevent the destructive repetition of medical appointments and investigations that tell us what we don’t have, but offer no clarity about what we do have.
Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.