Scientists warn of the lethal dangers of hypochondria
New research suggests anxiety about the disease may be a self-fulfilling prophecy. Fortunately, there are effective treatment methods.
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Irish comedian Spike Milligan's tombstone in an English cemetery bears a warning message for those who knew him: “I told you I was sick.” As The Guardian writes, we can all share Milligan's concerns. Who hasn't panicked and researched suspected symptoms, fearing the worst? His joke speaks to our fear that legitimate health concerns will be dismissed as nothing to worry about — “Oh, it's just hypochondria.”
But constant fear of an undiagnosed disease can lead to endless visits to the doctor or , on the contrary, to complete evasion of medical care. What if we don't take hypochondria itself seriously enough?
That's the finding of a recent Swedish study, which found that people with so-called illness-related anxiety disorder may die earlier than others, The Guardian writes. It's an alarming discovery that makes the disorder sound like a self-fulfilling prophecy. As one worried observer put it: “It's not enough to just have worries—now you have to worry about your worries.”
But this does not mean that people with this disorder should despair, notes The Guardian. The study contains an important and ultimately encouraging finding. “This is a serious mental disorder. This is not a feature or something to be ridiculed,” says study lead author David Mataix-Kols from Sweden's Karolinska Institutet. The deaths recorded in the study were largely preventable, the researchers noted. Their results highlight the need for diagnosis and treatment, and the good news is that the treatment is very effective.
The study, published in JAMA Psychiatry, looked at the records of about 45,000 people, comparing mortality rates among those diagnosed with hypochondriacal syndrome (about 4,000 people) and those without it (about 41,000 demographically similar people). . They found that people with the disorder were 84% more likely to die during the study period, and that they died on average five years younger than those without a diagnosis, at ages 70 versus 75.
All this may seem counterintuitive: surely the people who care most about their health would take good care of it? But “like all anxiety disorders and chronic stress, we've known for years, decades, that it's bad for your health,” Mataix-Cols says, although she stresses that the study doesn't explore the reasons behind this discrepancy.< /p>
Patients with this disorder were more likely to die from both natural and unnatural causes, with the majority of unnatural deaths being the result of suicide. This may be particularly surprising among people who are thought to have a strong fear of death. But people with illness-related anxiety disorder can experience “a lot of distress and hopelessness,” Mataix-Cols says, including feeling like others don't understand them. In terms of natural causes, the researchers noted that anxiety is associated with cardiovascular disease, and Mataix-Cols says some subjects with the condition also struggled with chronic stress as well as drugs and alcohol. (He also points out that while the inequality may seem grim, the absolute risk of death among people with health concerns remained low.)
And then there is the lack of access to treatment. The “biggest surprise” for the scientist was how few people were actually diagnosed with the disorder compared to the number known to be living with it. Research has shown that about 3-5% of people suffer from “what we call pathological health anxiety,” says Mataix-Cols. “According to these figures, we should have found between 100,000 and 200,000 people [in Sweden] with this diagnosis in 20 years. And we only found 4,000,” which means the disorder is “severely underestimated” and therefore undertreated.
Diagnosing an anxiety disorder requires sensitivity, especially in a world in which patients' actual physical ailments—such as women's pain—can be mistakenly ignored. Ideally, doctors do not advise patients to console themselves with the thought that “it’s all in your head.” Instead, they view mental health problems as part of the big picture.
When doctors see a patient in need of what appears to be excessive care, they may decide to refer the patient to a psychotherapist.
Dr. Jessie Borelli, a clinical psychologist and professor at the University of California, Irvine, notes that she receives this type of advice “frequently.” She had heard some “horror stories” about the program, but she had also seen doctors approach it with caution. “I think they deal with this best by talking about the stress of their health problems or health concerns—how much stress and difficulty it causes, and the need for more support in managing it,” Borelli says. “People are usually receptive to that kind of talk.”
Fortunately, experts say that treatments for this disorder are very effective, especially cognitive behavioral therapy. Therapists and patients can, for example, work together to identify patterns of behavior that are rooted in anxiety and work with them by gradually introducing them to the situations that bother them.
If a patient wants to undergo additional medical testing, Dr. Nora Brier says “we discuss it together” to determine whether it is necessary or whether the decision is based on concern. If it's the latter, «then the risk would be to not make an appointment, not to Google and not to double-check, but to endure that anxiety and just sit at home and think, 'maybe I should have taken that appointment,'» Brier says. , psychologist and associate professor of clinical psychiatry at the University of Pennsylvania.
Patients experiencing anxiety about their illness may continue to seek medical help, but this may be done in conjunction with therapy. And not everyone comes to therapy through their doctor — for example, patients may seek therapy themselves if they are too afraid of the diagnosis to see a doctor and realize they need help overcoming this anxiety, writes The Guardian.
All of this underlies anxiety in a broader sense: the struggle to live with not knowing. “Hypochondria is, in some ways, a challenge to medicine's need for certainty,” says Dr. Katherine Belling, assistant professor of medical education at Northwestern University. The best doctor in the world cannot be 100% sure that everything is physically fine with the patient. Not only the patient, but also the doctor has to endure this.
It requires the doctor to say: “Well, I don’t know. We must watch, wait and see, but in the meantime we could do something about your concerns,” Belling adds. In fact, doctors themselves are familiar with these problems: in their first years, medical students have been known to suddenly realize that they have every disorder described in the book.
One big threat to people with health concerns right now: spending hours on the Internet. One of the key elements of illness-related anxiety is the search for reassurance, says Mataix-Cols, and with Google, we're all self-diagnosing medical students. There's even a term for it: cyberchondria.
The pandemic has also brought health concerns to the forefront (though Bryer says it's too early to know for sure that it has increased the prevalence of the disorder itself). A 2021 study warned of a growing risk of excessive health anxiety amid Covid as we constantly think about the very real illness, and an Iranian study published last year pointed to higher health anxiety among people whose relatives had the disease Covid.
Mataix-Cols hopes his research, which has received international press attention, will attract more patients to treatment through improved diagnosis and communication between doctors and psychotherapists.
Dr Borelli also sees there is some hope in this. “In the case of something like illness anxiety, where it is quite clear that there is no underlying serious illness, it is also a case where severe anxiety about one's health can actually cause serious health problems, as seen in this study,” she says. – We know that we really need to take stress and anxiety very seriously. And the way we take this seriously is by shining a light on it.”