Have you ever met someone who is constantly worried about having contracted some major disease from the mere signs of a health problem? For instance, someone who is convinced that the headache she is suffering from is because of brain tumour, or the rash is a sign of developing skin cancer. There’s a high chance that such a person is suffering from hypochondriasis.
What is hypochondriasis?
Hypochondriasis is a somatoform disorder. The common feature of somatoform disorders, according to the Diagnostic and Statistical Manual of Mental Disorders, is the presence of physical symptoms that suggest a general medical condition. In hypochondriasis, a person is most of the time preoccupied with illnesses and symptoms. She usually relates even a minor bodily symptom to grave diseases and feels extremely distressed about it.
What are the symptoms?
Hypochondriacs tend to be extremely aware of tiny bodily sensations that most people hardly notice [even if we do, we ignore them or live with them]. They have a lot of health fears, and actually spend a lot of time worrying and thinking about their symptoms. The stress that goes along with this worry can sometimes worsen the symptoms. In severe cases, it can turn into a devastating obsession and jeopardise a person’s life.
Hypochondriacs go for various tests repeatedly, but do not feel reassured by the normal reports and doctors’ advice. Concern about the feared illnesses often becomes a central feature of the individual’s self-image, a topic of social interactions and a way of life. Often, hypochondriasis interferes with relationships, chores or job performance and causes the person to miss work, parties or vacations by being under ‘treatment’ at all times.
How is it caused?
Hypochondriasis generally begins in early 20s. It sometimes comes on following the illness of a friend or family member, and it can also occur as a secondary illness to depression or a anxiety disorder. Some root causes of hypochondriacal anxieties could be:
Some people who are obsessed with illnesses have a family background where only medical conditions or physical injuries receive concern and emotional support; emotional needs are ridiculed or ignored. Such people develop symptoms of any illness when they are emotionally upset, to get desired attention.
Fear of death
If someone is too afraid of dying or preoccupied with the fear of death, each episode of illness and symptoms could bring this fear to surface, making him/her react with blown-up anxiety. On the surface such individuals appear to be over-reacting to illness and symptoms, whereas, it actually is a reaction to the fear of losing life.
Distorted perception of reality
If in childhood we saw our parents getting over-cautious about health, illness, germs, precautions, we grow up with similar restrictions making us paranoid about having contracted fatal diseases every time there is unexplained illness [fever for instance]. Some childhood experiences can also lead to such paranoia. For example, suppose a child playing doctor-set with her dolls is told by someone that the doll has fever and it might die.
This incident might form a connection between fever and death in the child’s mind. Unfortunately, if something really happens to that doll [it gets lost and adults tell the kid that it died], it could strengthen this connection, and the child could grow up into an adult believing that a person might die when s/he has fever, thereby becoming very anxious whenever there is fever.
Sometimes narcissism is not clearly manifested as an “I am the best” phenomenon. It can be present in various ‘non-narcissistic’ ways. Someone with predominant narcissistic needs may be too obsessed with themselves. Their energies are too focussed on themselves and they give high importance to the smallest thing happening to them. Thus, an abdominal pain that would go unnoticed normally by others will be noticed by them and they would want to analyse the reason for the pain and make a big deal of it. They want people around them to look at their symptoms and get concerned.
Some people harbour an unconscious sense of guilt since childhood, wherein they feel they have done something terribly wrong and they need to be punished. They are not aware of this feeling, of course. But they unconsciously put themselves in situations where they feel problems, pain and/or fears. So, when someone with predominant masochist tendencies gets over-anxious about illnesses and treatment, they are punishing themselves, more than anything else. And to these feelings, others react with apathy, amusement, irritation or boredom.
Fear of the unknown
Unfamiliarity of something can be very frightening to most of us. We have a natural tendency towards trying to know what we don’t. If this tendency is exaggeratedly present in someone, it could colour his/her perceptions and experiences to a great extent.
For example, when someone runs a fever without any apparent cause, one might find it extremely threatening to ‘stay in suspense’ and might find it easier to deal with the situation if the illness can be identified and named, no matter how grave the illness be. This could lead to preoccupation with big names like ‘malaria, jaundice, typhoid’ when there is unexplained fever for a couple of days.
Similarly, many of us are afraid of irreversibility of a situation. These people are always preoccupied with the fear of ‘permanent damage’. They may be obsessed with body parts like heart, brain, eyes, ears, which they feel are beyond repair once the damage is done. So, they want to make sure that they are fine by getting tests done even if there is a slightest suspicion.
Fear of chaos
We all would hate to be in a chaotic situation where everything goes haywire. But excessive fear of chaos is generally there in two kinds of people. One, where the person is a perfectionist—unplanned and unmanageable events are a nightmare for someone who is obsessed with orderliness and control in life.
The other kind, where the person has been through a situation where things were totally out of control and there was a real threat to life/relationships/work. Under the fear of chaos, one wants to equip himself/herself with emergency action-plans like “suppose this fever means malaria. Then I will need a medical leave from work. Who will pick up my child from school? Then I will have to plan things accordingly. It is better I get the check up done and start treatment. But suppose it is not malaria, but AIDS. Then I will have to make some major changes in my future planning.” And this goes on and on.
How is hypochondria treated?
Treatment of hypochondria is often difficult because of the following reasons:
- People with this condition commonly do not accept that their symptoms are due to mental factors. They become angry or irritated with their doctors who cannot ‘find the cause’ for their symptoms. ‘Doctor shopping’ with frustration is very common.
- People with hypochondriasis, like everyone else, do develop physical diseases in normal course of time. Every episode of a simple illness increases hypochondriacal anxiety and the sufferer wants to get many big diseases checked and ruled out. Thus, even when there is viral fever for which a simple paracetamol would suffice, in the first few appointments the doctor gets misguided into thinking that the problem is bigger than that and the unnecessary investigations create a bumpy detour to simple course of recovery. It’s only later that the doctor realises that it was a simple viral and the exaggerated complaints of the patient had created the confusion.
- Complications in health may result from repeated diagnostic procedures that carry their own side-effects and are costly. Like, repeated X-rays do more harm than good. And someone with hypochondriasis is always on the risk of developing problems due to frequent MRIs [magnetic resonance imaging], X-rays, CT scans, and blood tests. In fact, frequent visits to hospitals put them at high risk of contracting infections from the ‘real’ patients there.
- Earlier, hypochondriacs researching an illness had to read up many books and ask many doctors for the information. For hypochondriacs, the internet has now absolutely worsened things, as it encourages self-diagnosis.
What you must know
Hypochondriacs are not pretending, faking an illness or just trying to get attention—they really feel the distress they’re talking about. Absence of ‘targeted’ diagnosis brings a lot of embarrassment each time the reports come out normal and they almost end up wishing that they get the disease, to prove their point and to avoid the tease from family and friends. The best thing to do is to get medical treatment from a trustworthy doctor and rely on the doctor’s diagnosis and reassurances.
Many people who have hypochondriasis also have other mental health problems such as depression, anxiety or substance abuse. Treatment of these other mental health problems may improve the situation. If the person can be convinced that psychological factors may be causing or increasing the physical symptoms, they may accept psychotherapeutic interventions.
Psychotherapy improves the condition by helping the person understand the reasons behind symptoms, change any ‘false’ beliefs that they may have, rectify the distorted perception of reality and deal with emotions better.