Hypochondriasis is as covert and confounding as ever. Regarded as a mental disorder in the Diagnostic and Statistical Manual (DSM) it is defined as “preoccupation with fears of having, or the idea that one has, a serious disease, based on a misinterpretation of bodily symptoms or to put it simply, you know how you google a symptom you’ve been experiencing and suddenly everything leads to cancer?; a constant, uncontrollable paranoia of it is what hypochondria is.
Jeff Pearlman, a revered American sports writer accounted his experiences with hypochondria in his article for Psychology Today. Here is an excerpt of it:
“ I know I am dying, because, well, I just know. I’m certain of it. I can feel it.
That pain on the left side of my stomach still hasn’t gone away. It’s been there for eight or nine months now. The ultrasound came up negative. So did the CT scan, the MRI and the colonoscopy.
“It’s probably nothing,” said one doctor.
“You likely pulled a muscle,” said another.
“I’d ignore it,” advised a third.
They are wrong. I know they are wrong. So, with nowhere else to turn, I seek out reassurance. “What do you think my stomach pain is?” I ask. “Do you think I’m OK?”
Eyes roll. “You’re fine,” my father says. “You’re fine,” my mother says. “You’re fine,” my sister-in-law says.
“You’re 37 years old. You run marathons. You play basketball every Monday. You’ve never even broken a bone,” my wife says. “You’re fine.”
I don’t believe them. I can’t believe them. I refuse to believe them. I wish I could believe them.
This is what it is to be a hypochondriac—what it is to live a life too often based upon the raw, carnal fear of inevitable, forthcoming, around-the-bend death. Though I was only recently diagnosed with the disorder, it has plagued me for more than a decade. Over the past 10 years, I have been convinced that I am dying of (in no particular order): brain cancer, stomach cancer, pancreatic cancer, testicular cancer, lung cancer, neck cancer, Lyme disease. When one ailment is dismissed by doctors, I inevitably rush to the Internet to learn why they are wrong. What? I don’t have colon cancer? Then it must be….”
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In general most of us are concerned with our health. Any small injury or physical pain becomes a source for our discomfort. With the rise of information availability on the internet, many of us have started the trend of self-diagnosing ourselves. “Self-diagnosing” is an increasing phenomenon wherein any small physical symptom will lead us to believe that we have a major health issue. However what sets hypochondria apart, is the constant fear of having or the idea that one has a disease. Hypochondriacs face clinically significant distress and may often feel a lack in social, occupational or other areas of functioning. Despite medical reassurances and multiple clinical diagnosis, such people continue be preoccupied with the disbelief of suffering from a serious illness.
Hypochondriasis is a serious condition which has more of a psychological basis than a physical one. Hypochondria can take a huge toll on an individual’s well-being and mental health as a preoccupation with the idea that one’s physical health is on the verge of constant deterioration can prove to be a major source of stress and anxiety.
“The brain is so powerful that it really can convince itself of illness,” says Caroline Goldmacher-Kern, a New York-based psychotherapist who specializes in anxiety disorders. “You know something is wrong because you believe what you’re thinking, and what you’re thinking is what you perceive to be feeling. So you can have five people tell you it’s all in your mind and that’s not good enough.”
The basis for the symptoms of hypochondriasis lie mainly in the preoccupation with one’s health, primarily physical. Incidents like reading an article or hearing about a particular disease can lead to misinterpretation and cause hypochondriacal thoughts. The state with these symptoms is considered as a disorder when the concern of being healthy causes distress and overt clinical disorder.
According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-4), some of the criteria for hypochondriasis are as follows:
- Preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms.
- The preoccupation persists despite appropriate medical evaluation and reassurance.
- The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The duration of the disturbance is at least 6 months.
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Under the new 5th edition of DSM (DSM-5), hypochondriasis has been redefined as ‘Illness Anxiety Disorder’ which falls under the disorder class of ‘somatic symptoms and other related disorders’. Somatic symptom and related disorders are mental health disorders characterized by an intense focus on physical (somatic) symptoms that cause significant distress and/or interferes with daily functioning. Individuals with this condition may or may not have diagnosed medical conditions, but no serious disease is present in most cases. If a medical condition is present, the person displays anxiety around the illness that is clearly excessive. This new definition drops the idea of the fear of having a physical illness. It is rather the preoccupation with having or acquiring a serious illness.
The new definition focuses more on the anxiety surrounding the illness rather than the fear of it. People with illness anxiety disorder usually do not have physical symptoms, or if symptoms are present, they are mild. However, these mild symptoms may cause a great deal of anxiety. A doctor’s reassurance and even a complete medical evaluation often will not calm the person’s fears. Or, if it does calm them, other worries may emerge later.
To simplify the idea, illness anxiety disorder is similar to obsessive-compulsive disorder(OCD) to some extent, wherein the centre of obsessive behaviour is the idea or a thought of illness which causes people to compulsively do things to reduce the anxiety they feel due to this obsession. These activities include browsing for medical information, regularly visiting the doctor and so on.
The symptoms as per DSM-5 for illness anxiety disorder include:
- Preoccupation with having or developing a serious illness
- Absence of physical symptoms or, if present, symptoms are mild
- Behaviour indicating health anxiety, such as checking for signs of illness
- Easy alarm about medical problems; persistent fear despite medical reassurance
- Overuse or underuse medical care.
- Clinical distress or functional impairment
- The patient has been preoccupied with illness for ≥ 6 months, although the specific illness feared may change during that time period.
Individuals with hypochondriasis and illness anxiety disorder are usually apprehensive of approaching a psychologist as they fear that people view the medical symptoms as “all in your head.” Nonetheless, a combination of support and care from the primary care doctor along with psychotherapy (when it is acceptable to the patient can be helpful. Another helpful procedure can be stress management. Learning how to cope with the stress of your health can result in significant benefits. Cognitive Behaviour Therapy(CBT), which is one of the most common form of therapies can help individuals realize what triggers their anxieties or fears with regards to their health and how it can be reduced through meaningful procedures. Nonetheless, hypochondriasis and illness anxiety disorder are still not considered to be serious mental health issues. Many people spend their entire lives not knowing they had such mental health problems. They fear that “it’s all in your head” would be frequently used to ignore their concerns. Awareness and changes in the perception towards such illness can prove to be beneficial to the well-being of all.
If you do think you are experiencing any of these symptoms, then do not hesitate in reaching out for help. There are solutions available and you are not alone in facing this and rightly shouldn’t be.
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To know more about Illness Anxiety Disorder and its treatment, read the following articles:
To know more about Hypochondria, read the following articles:
 Pearlman, J. (2010, January 1). Hypochondria: The Impossible Illness. Psychology Today. Retrieved May 9, 2019, from https://www.psychologytoday.com/us/articles/201001/hypochondria-the-impossible-illness
Harvard Health Publishing. (2019, March). Illness Anxiety Disorder. Retrieved May 9, 2019, from https://www.health.harvard.edu/a_to_z/illness-anxiety-disorder-a-to-z
Bidaki, R., Mahmoudi, M., Khalili, B., Abedi, M., Golabbakhsh, A., Haghshenas, A., … Mirhosseini, S. M. (2015). Mismanagement of a hypochondriacal patient. Advanced biomedical research, 4, 24. Retrieved May 9, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333438/