Hypochondria: what if it really is something serious?
The mole is definitely cancerous, the headaches are clearly a sign of a brain tumour: hypochondria is a spiral of anxiety that is very hard to escape without professional support. But friends and family can also help – if the fear of illness is taken seriously.
The nurse on the ward says: “The hypochondriac in cubicle 5 has died”. The doctor replies: “Now he’s gone too far...”.
Ok, so it’s not a great joke. But perhaps jokes like these can never really be funny, because they’re based too heavily on prejudices and misunderstandings.
The constant fear of falling ill severely restricts life. If those affected are dismissed as “neurotic” or “worrywarts”, the situation can quickly get out of hand. To help people who are constantly worried about their health, it’s important to understand the factors that cause and promote hypochondria.
5 factors that promote hypochondria
Hypochondria doesn’t mean that a person always exaggerates and likes to complain constantly about supposed trivial health problems such as a scratchy throat or sore joints. It’s more a matter of deeply rooted fears leading to constant preoccupation with the perception of their own body and searching for the cause of the problem. And they fear that this is almost certainly due to a serious illness. Hypochondriacs constantly check their state of health and examine their body, keep records of their blood pressure, pulse rate or mood. But it doesn’t make them feel better.
Better: Don’t be too quick to label people as hypochondriacs. In many instances, this is not the case. And it’s certainly not about whining and self-pity. It’s true that in the vast majority of cases, those affected don’t have the disease they fear they do, but they aren’t healthy either. Hypochondria in itself can lead to – physical – illness.
Even though talking about minor aches and pains and ramping up trivial health concerns to catastrophic levels may seem repetitive or exaggerated, the fears behind these thoughts are real. Hypochondriacs are convinced they are sick even if there is no medical evidence backing their concerns.
Better: Be ready to listen, but don’t get trapped into joining in with their lamenting and doom mongering. Remind them that you’re not a doctor or a psychotherapist. How to start the conversation: “I’ve noticed that you’ve not been feeling well recently. Is there anything I can do to help?”.
Many people with hypochondria have experienced stories of serious illness and death among friends or family. Both were always a big issue, a threat. Coupled with a predisposition to anxiety, hypochondria can spiral out of control. Take heart palpitations, for example. When you do sport, your heart beats faster. This can seem scary. An anxious person may therefore take precautionary measures, with the result that they do less sport, so they feel their heart race even when they climb stairs. This in turn means they rest even more and avoid activity wherever possible. But this doesn’t reduce the symptoms. Quite the opposite.
Better: Instead of avoiding threatening situations, people with fear of illness should face up to their fears. Run around the block, take a longer route through the forest, run up the hill. Ideally, they will soon no longer misinterpret a racing heart as a threat. Friends and family can help by going with them and encouraging them.
Non-stop visits to the doctor
Although doctors in Switzerland have a relatively large amount of time (16 to 17 minutes per patient) compared to other European countries, even if they show a hypochondriac an MRT image with no pathological findings and reassure them that they are in fine physical health, this reassurance only lasts for a limited time. As soon as they leave the practice, the doubts quickly set in again: doubts about the diagnosis, the doctor’s qualifications or whether the equipment is working properly.
Better: Further examinations won’t help patients with a fear of illness – they need to see a psychotherapist. Cognitive behavioural therapy in particular achieves good results. But taking the first step can be a big hurdle for hypochondriacs. Friends or relatives can help by accompanying them to the therapy session.
Health and sickness are two of the most searched-for topics online. If you start looking for the cause of acute joint pain or headaches, after a few clicks you could diagnose yourself with a life-threatening illness, because the algorithm behind Dr Google is quick to assume the worst. A bit like a hypochondriac!
Better: Although the sources of information are almost endless, reading on often leads to uncertainty instead of clarity. But it’s not hard to find sound and reliable sources.
How psychotherapy helps with fear of illness
Treatment for hypochondria focuses on changing thought patterns and regaining quality of life. Dr Steffi Weidt explains how it works.
The line between a person who is meticulous about their health and a person with a pronounced fear of illness is often blurred. How do you diagnose hypochondria?
When a person suffers, their suffering is very real. It doesn’t matter whether that person is medically right or wrong. Often, fear of illness and worries revolve around an unpleasant physical sensation that the patient misinterprets. But the perception itself is correct. As a doctor, I have to take these concerns seriously.
How do you gain the trust of patients suffering from hypochondria when that’s precisely what they’re lacking?
I do so by taking a close look at their medical history, going over previous examination findings and considering the improbable. Even if a person has been examined a hundred times, perhaps the right thing hasn’t been considered yet. Only once all the t’s have been crossed and the i’s dotted, can psychotherapy begin.
Some patients have a vague sense of discomfort, while others have a more specific fear. They try to regulate these unpleasant emotions by being examined by a doctor or researching online. And that can work in the short term, but over time the brain realises it needs another examination to feel better and more secure.
How can you tell that psychotherapy is helping?
When patients are better able to withstand this uncertainty – without examinations or internet research. The brain can also break down established, internalised patterns and relearn them, thus helping to banish old insecurities. Patients have to understand that their discomfort is justified, even if for other causes than initially assumed. That can help them feel better.
As a next step, I help the patient write a letter to their doctor asking them not to perform certain examinations if, from a medical perspective, they are not acutely useful – no matter how much the patient urges them to. This helps them reclaim their life and become more tolerant of physical symptoms by not immediately interpreting them as the end of the world.
How can relatives help?
By making sure they don’t fall into the role of co-therapist, because they aren’t equipped for this position. If their partner wants to go to the doctor or read something in the internet, they should let them. For relatives, it’s important to understand the mechanisms behind the illness and how to deal with it.
Sometimes it’s simply a matter of seeking careful reassurance from family members instead of the doctor: “You don’t think it’s a heart attack either, do you?” Such questions can also go unanswered sometimes.
About the expert
Dr Steffi Weidt is a lecturer and chief consultant at the Psychiatric University Hospital Zurich and an expert in the treatment of hypochondria.