Are you a hypochondriac?
Psychiatrists may delete "hypochondria" from the next edition of the Diagnostic and Statistical Manual of Mental Disorders. (The likely new term: "illness anxiety disorder.")
But even if the word gets the axe, many of us - and many of our family members - will still worry that we've got symptoms of a dreadful disease. How can we rest easy when web stories make us suspect that a little nausea is a sign of cancer or a heart attack? To find out how we can feel less anxious, Family Goes Strong talked with Catherine Belling, assistant professor of medical humanities and bioethics at Northwestern University's Feinberg School of Medicine and author of the new book, A Condition of Doubt: The Meanings of Hypochondria (Oxford University Press). Excerpts:
What's the official definition of a hypochondriac?
The current definition is the preoccupation with the fear that one has, or is about to have, a serious disease, based on the misinterpretation of symptoms.
But psychiatrists plan to change the definition in the next edition of their Diagnostic and Statistical Manual (DSM).
It looks like they're going to drop "hypochondriac" because of the pejorative nature of the word. One issue with the new DSM is whether it's going to be classified as an anxiety disorder or connected with OCD [obsessive-compulsive disorder]. At the moment it's a somatoform disorder, which is really kind of a grab bag of mental illnesses related to the body. [Here are the proposed revisions.]
Do most of us worry needlessly about being a hypochondriac?
According to one study, 85 to 90 percent of the most common symptoms, like headaches or pain, can't be explained by the doctor. What makes it hypochrondria, because it's not like pneumonia where you can identify the organic cause, is really behavioral. [One] patient says, "You can't explain my symptom, but the symptom isn't going away. I think I have cancer inside me." Another person would just say, "I'll take an aspirin." For the hypochondriac, the symptom is never just a symptom. It means there's something more sinister going on. That's why it's incredibly disconcerting when the doctor says, "I can't find anything."
What should you do if you think your kids seem like hypochondriacs?
In growing up we all go through a period of learning we can get broken or sick — the first time a child bleeds and doesn't realize the bleeding will stop or says, "I've got a tummy ache. What's causing it?" We encourage children to tell us, and then we figure it out. For some children, they see everything as medicalized. They have a parent who becomes very seriously ill or has serious symptoms, and they see that whenever you experience anything negative, you get rushed to the doctor. So everything they feel, they begin to see as something dangerous.
Should we should be low key - with our kids and with our aging parents?
Treat medical information as interesting but not as doom laden and scary. That's hard to do in our culture. Say you feel your heart beating faster. We're so pressured into, "Rule out a heart attack." If you're feeling worried, your heart will beat faster. The symptoms of anxiety mimic a great deal of other symptoms.
Often older Americans' health concerns are valid, right?
Remember the old saying, "Just because you're paranoid doesn't mean they're not following you around?" We're all going to die and most of us will, at some point, become seriously ill in that process, and as we age, the likelihood of that increases. If an elderly person is worried about their health, why on earth would we consider that hypochrondria rather than the perfectly rational recognition that as we get older, we'll develop the illness that will eventually kill us?
What can help people with true hypochondria?
In very severe hypochondriasis, antidepressants work extremely work very well — SSRI's [selective serotonin reuptake inhibitors]. I don't think that's a long-term solution. We live in a time when public health really does produce something akin to hypochrondria. Special disease awareness months and early detection and screening means that people who have no symptoms at all are being taught to think of themselves as having probably having some disease inside. Public health puts this pressure to think if you're a good public health citizen, you will go and get tested..
What about the history of hypochondriasis?
It hasn't always been defined as being scared. It's one of the oldest diseases on record. The term was introduced by Hippocrates [who lived 460 B.C. to 370 B.C.] It was an anatomical term, and it was called the hypochondrian — the space underneath your rib cage where the spleen is. The spleen in Hippocratic medicine was thought of as the source of melancholy, of black bile. Hypochondria was considered one of the forms of melancholia.
You say hypochondriacs make doctors feel less confident.
Hypochondria makes doctors suffer, too. There's a percentage of people who are right. Missed diagnoses can happen. Medicine is not infallible, and uncertainty is part of the deal. It's unfair to expect your doctor to be 100 percent certain.
What about getting second (and third and fourth) opinions?
Hypochondriacs have more faith in medicine than other patients. In theory, no individual doctor is good enough. They have this idea that if they could just find the right doctor, that doctor could identify everything that could go wrong and take care of it. For a while there was that craze of people going off and having full-body screenings. No one ever had a full-CT scan and was not found with something. Then what follows is that cascade of treating all those things or doing further testing. Once you look inside, what you find is disease even in people who are really fundamentally healthy.
So what do you think of the push to do fewer prostate-cancer screenings?
There's a move now as there's been a broader recognition that medicine is not 100 percent omniscient, and also there's a real cost to knowledge - false positives, which then are followed up by harmful biopsies, unnecessary treatment, radiation exposure. Always you have to balance that against the lives that are genuinely saved.
Who's your favorite hypochondriac from TV or the movies?
There's a wonderful story about Woody Allen, who's everybody's favorite hypochondriac. In his "Vicky Cristina Barcelona," there was the famous kiss between Penelope Cruz and Scarlett Johansson. There was all this coverage. On the day of the scene, Woody Allen wasn't there because he had a mole on his hand. It couldn't wait. Nothing was more important than having that checked. Uncertainty is unbearable. Show me the worst news rather than let me worry.
Is that so bad?
The way to be mentally healthy, I think, is to be slightly deluded. [Harvard hypochondria expert] Arthur Barsky compared the risk perception of people diagnosed with serious hypochondriasis and mentally healthy people. As you'd expect, the people with hypochondria thought they were more at risk of bad medical event. It turned out that statistically, compared to the real medical risk, both groups were optimistic. Even the hypochondriacs underestimated how at risk they were. The mentally healthy patients, their attitude is less realistic. But they're more likely to function well and be mentally healthy. It goes against this notion of the more we know, the healthier we are. We have to be somewhat in denial in order to function.
Optimistic people are happier, right?
Completely. The pessimists will go around saying, "They're crazy. They're just deluding themselves." [But] very often that attitude produces good results.
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