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Are you a hypochondriac?

Medical 29/10/2015
© Getty When does being vigilant about medical matters turn into an unhealthy obsession? We discuss the rise of health anxiety – and what can be done to address it...

Let me start by telling you about a very good friend of mine. We'll call her Susan. Susan is kind, intelligent and often great company – but she's also a hypochondriac. Barely a week passes without her contracting a new debilitating medical condition that prevents her from enjoying her otherwise carefree life. Each new illness or injury comes along shortly after she's read about it online, heard something on the news or met someone who's suffering from the same thing – regardless of whether or not the condition is actually contagious.

A winter sore throat that was still hanging around three days into a course of antibiotics became 'suspected oral cancer' – suspected, I should add, by nobody except Susan, who had an aunt who'd just been diagnosed with the disease. A stomach upset during a holiday to India led to a string of food intolerance tests and expensive treatments for months after she returned home. Apparently, the symptoms still reappear whenever she's had a very rich meal with alcohol. You're doubtless getting the picture by now. So it'll come as no surprise to learn that during the swine flu pandemic, Susan only rarely left the house – and made a point of running away at high speed from anyone who coughed.

Still, Susan is determined to get well so does all she can to address each issue thoroughly. She's expert in securing 'urgent' appointments with her GP and takes printouts along to the surgery to illustrate the complexities and rarities of her self-diagnosis. When she's not completely comfortable with her doctor's response, she'll seek out other experts – both mainstream and alternative – and pay to see them privately. Each suspected illness becomes a serious project until she's confident it's been properly addressed – which is normally around the time the next all-consuming medical condition comes along.

Is hypochondria a growing problem?

So why do I find myself constantly reassuring Susan about each new health issue instead of challenging her about her hypochondria? It's partly because no matter how far-fetched her symptoms – and the reasoning behind them – may appear, they're real to her. She seems genuinely distressed. I'm also concerned that the one time I opt to tell her she's being ridiculous, she really will have something seriously wrong with her.  And it's also because I recognise some of her unhelpful behaviours in myself. After all, it's hard to be a health writer without developing a tiny bit of hypochondria each time I'm listing the risk factors or possible symptoms attached to various illnesses.

Of course, the internet has made it easier than ever to be a hypochondriac. With all that medical information at our fingertips, it's fairly easy to make the leap from 'sore throat' to 'oral cancer' with just a few seconds of anxious Googling. 'Hypochondria is nothing new,' says psychotherapist Hilda Burke. 'Before we had widespread access to the internet, there were home medical books to get people in a panic. However, now that we can access online resources wherever and whenever we wish, I think the condition has become much more pervasive.'

And yes, hypochondria – or 'health anxiety', as it's also known – is a medically recognised condition, and one that does need to be addressed, often through therapy. Like every other illness you can think of, it has its own section on the NHS website. Hypochondria can be hugely debilitating and ruin people's lives. 'In most instances, it's likely that a patient suffering from health anxiety has another undiagnosed medical condition, such as depression or an anxiety disorder,' says Dr Nick Travaglia, GP at St Joseph's Hospital. 'So it's important these people are properly referred to receive the specialist help they need, rather than being labelled as a drain on resources.'

How can GPs recognise health anxiety?

The problem, of course, is that hypochondria isn't always easy for doctors to recognise – particularly when someone presents with symptoms that do theoretically need checking out. Chances are a breast lump, persistent cough or bloated stomach are absolutely nothing to worry about, but we're (rightly) encouraged to get any abnormalities seen by a medical professional 'just in case'.  Besides, faced with funding and time pressures, a GP could perhaps be forgiven for going through the motions of addressing the physical symptom being discussed, rather than delving deeper to uncover a psychological cause.

One 2013 study, carried out by researchers from the University of Oxford and the University of Southampton, found that 97 per cent of GPs admitted prescribing an 'impure placebo' at some point during their career, and 77 per cent said they did so at least once a week. These are treatments that contain active ingredients, but aren't recommended for the condition being treated – such as antibiotics for flu. Every year, 10 million unnecessary prescriptions are written for antibiotics in England alone, according to the National Institute for Health and Care Excellence.

So where does rational vigilance spill over into the irrational? 'I would always encourage someone to be vigilant about their health, as I often see people who aren't as concerned as they should be,' says Dr Travaglia. 'From time to time, as a GP, you do meet patients who constantly worry about the state of their health and it's when this preoccupation with illness starts to affect their everyday life that it becomes a problem. Symptoms of health anxiety can include needing constant reassurance from your doctor or family members, disbelief in your doctor's diagnosis or reassurances, constant self-examination and self-diagnosis, as well as regularly avoiding everyday situations which you feel will put you at risk of contracting an illness.'

What to say to a hypochondriac

While it may take time and effort for a GP to recognise health anxiety in a patient, it may take even longer for the individual themselves to acknowledge the real problem. So is there a “polite” way for friends and relatives to steer them in the right direction without causing offence? 'Most instances of hypochondria have their roots in emotional issues,' says Hilda Burke. 'The technical term is “somatisation”, which is when we feel an emotion physically in our body. The pain is real to the person who's experiencing it – so first and foremost, I would encourage them to get it checked out.

'Once it's been ascertained that there's definitely no physical problem, simply ask them how they're doing emotionally. Some won't be prepared to go there. They'll tell you curtly that they're fine, and it's the physical symptom that's the issue here. In that case, there isn't a lot you can do. It's up to the individual to either be honest with themselves or stick their heads in the sand. But for others, it may allow them to open up and talk about what's really going on – and that's the first step towards seeking help.' So Susan, if you're reading this: I think you may definitely have a health problem. Now, over to you...

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