Hypochondriacs: Do Have a Higher Risk of Illness?
Hypochondriasis is the diagnosis is given to people who seem fearful about being or becoming ill, without a clear basis for that concern. Psychiatry also calls it illness anxiety disorder. Swedish researchers have now published a study in the scientific journal JAMA Psychiatry which found that people who have been diagnosed with hypochondriasis are much more likely to die of a wide variety of seemingly unrelated medical conditions such as heart and lung disease. They are also more likely to take their own lives.
Hypochondriasis, is a fairly common psychiatric disorder1 given to an individual who manifests persistent preoccupations about having serious medical conditions for which there is no objective reason for being particularly concerned.2
Along with the preoccupation of a perceived risk of illness, persons manifest their worry by having catastrophic interpretations of seemingly minor bodily signs or symptoms, and act upon a sense of hypervigilance about their health resulting in consistently and repetitively checking themselves and seeking reassurance from others- family and health professionals. By objective standards the concern is disproportionate to their actual symptoms causing significant emotional distress .3 https://jamanetwork.com/
Hypochondriasis, or illness anxiety disorder is underdiagnosed because in part it is not taken seriously by health professionals, and there is a negative connotation associated with a person being diagnosed, and labeled a hypochondriac.4,5
Hypochondriasis may also be associated with a substantial overuse of health care resources.1,4 The person suffering from an illness anxiety disorder will have numerous medical consultations as a result, and undergo a number of laboratory and other testing procedures, which may be unnecessary from a medical perspective and even include diagnostic procedures which have real health risks related to performance of the procedure.This regimen of overtesting is also counterproductive psychologically. 9 Although one might hope that this testing might lead to early detection and timely treatment of a serious medical condition, it appears that this outcome very unlikely. This hypervigilance in testing does not result in any medical benefit and does result in instances of iatrogenic illness from an unnecessary treatment that might be tried. Another concern is that rather than overtesting with their health care provider, some severe hypochondriacs may have so much anxiety over their perceived condition that they do the opposite, avoiding contact with medical personnel and in some cases actually delaying or not receiving a timely diagnosis of an actual medical need which should be evluated.7,10,11
Chronic anxiety and depression may accompany illness anxiety disorder, and these are by themselves known to be associated with adverse health consequences, such as cardiovascular disorders and premature death.12–14 A Norwegian study of over 7000 subjects found that people who reported having health anxiety which they themselves recognized as a symptom out of balance with having a realistic health concern, were 73% more likely to develop heart disease over the 12-year study period compared with those who had low health anxiety scores.15
In the Swedish study published in JAMA Psychiatry they analyzed mortality from any cause occurring among 268 persons with illness anxiety disorder compared to 1,761 persons who do not exhibit this condition. Their results showed that individuals with hypochondriasis had an 84% higher risk of all-cause mortality during the follow-up period compared with individuals without hypochondriasis. They had higher death rates for both natural and unnatural causes of death. Interestingly although there were more deaths for most common natural causes of death such as heart disease, they did not see an increased rate of cancer death, ironically a disorder which may be of major concern to some hypochondriacs who wind up engaging in the pattern of overutilization of medical consultations and testing procedures to rule out cancer.
The increased health risk associated with hypochondriasis was generally the same when women and men were compared.
In the journal article’s discusssion section it was emphasized that persons with a diagnosis of hypochondriasis had a 4-fold higher risk of death by suicide compared to the general population. They alert physicians and other health care providers that people with illness anxiety disorder are at risk of death by suicide, particularly if they have a lifetime history of depression and anxiety. Dismissing the symptoms reported by these individuals as simply anxiety based may result in a missed diagnosis of a true and potentially life altering diagnosis. They advocate for reducing the stigma associated with hypochondriasis in order to improve detection, diagnosis, and treatment of illness which may naturally arise in these individuals.
Treatment options for hypochondriasis do exist31 https://www.
According to a Cleveland Clinic review, a form of psychotherapy called CBT – cognitive behavioral therapy – has been found to be effective for treating anxiety illness disorder. CBT emphasizes learning coping mechanisms to manage the anxiety regarding fear of illness and avoiding unnecessary medical testing or treatments.
In Cognitive Behavioral Therapy a person is asked to identify fears and beliefs about the possibility of having a medical condition. This therapy works to help a person change unhelpful notions about having an underlying illness and instead become aware of how these fears and worries themselves affect the sufferer.
CBT attempts to change the way a person responds to sensations they may feel in their body, and learn to cope with the associated anxiety with them. One is taught to try and reduce their avoidance of activities one may fear to engage in because of their anxiety. CBT attempts to reduce the person’s propensity to be hypervigilant about their body’s symptoms through constant rechecking and the seeking of reassurance that nothing is really wrong. Hopefully these coping skills improve a person’s daily functioning which is otherwise impaired by their anxiety illness disorder. It is also important to address what may be associated mental health problems such as depression and have them appropriately evaluated and treated as needed
The overall goal of course, is to reduce illness and mortality for these individuals.