Everyone worries about their health at times, but for some people, fears of being ill are so strong, even when they are in good health, that they find it hard to cope with their everyday life.
Worrying about health can be a debilitating condition in itself.
Someone who lives in fear of having a serious illness, despite medical tests never find anything wrong, may have a condition called illness anxiety disorder, more commonly known as hypochondria, or hypochondriasis.
Contents of this article:
What is hypochondria?
A study published in JAMA has defined health anxiety disorder as "a persistent fear or belief that one has a serious, undiagnosed medical illness." The authors note that it affects up to 5% of medical outpatients.
The Mayo Clinic describes the disorder as a mental health condition in which a person worries excessively that they are sick, to the point where the anxiety itself is debilitating. Worry about health becomes an illness.
Health anxiety is a chronic condition. How severe it is can depend on age, a person's tendency to worry, and how much stress they are facing.
How does hypochondria feel?
For a person with hypochondria, normal bodily functions as heart beats, sweating, and bowel movements can seem like symptoms of a serious illness or condition, and minor abnormalities, such as a runny nose, slightly swollen lymph nodes, and a small sore, can feel like serious problems.
The person's attention may focus on one particular organ, such as the lungs, or just one disease, such as cancer, or they may fear one disease after another.
Health anxiety may cause people to talk excessively about their health, and they may make frequent visits to their physician. They may spend a lot of time searching the internet for symptoms of possible illnesses.
If tests come back negative, the person may find no relief. A negative result can make things even worse, as the patient's fears grow that no-one believes them, and that problem may never be successfully diagnosed and treated.
Some individuals with the disorder may avoid medical attention, through fear of finding out that they have a serious illness. They may avoid people, places, and activities that they believe could pose a health risk.
An overwhelming fear of disease that lasts for more than 6 months may be a sign of health anxiety disorder.
What causes health anxiety disorder?
It is not clear how many people suffer from hypochondria, but in 2013, the American Psychiatric Association (APA) estimated that in the United States, the prevalence over a period of up to 2 years ranged from 1.3 percent to 10 percent. The prevalence of the disorder is similar in males and females.
Other psychiatric disorders have been linked to health anxiety. Over 60% of patients with hypochondria also have major depression, panic disorder, obsessive-compulsive disorder, or generalized anxiety disorder.
Research published in the British Journal of Psychiatry points out that, like obsessive-compulsive disorder (OCD), health anxiety involves a need for continuous checking, as the person seeks reassurance.
These "safety behaviors," say the authors, aim "to restore a sense of wellbeing and a degree of certainty about the future."
However, they can end up worsening the problems they are supposed to reduce.
Through keeping anxiety levels high and preventing fears from being dissolved, these behaviors keep the person's attention focused on some dreaded potential disaster.
Since most patients tend to approach their family doctor about the health conditions they fear, rather than seeing a mental health specialist, they may never receive a diagnosis of hypochondria.
How long does hypochondria last?
A person with hypochondria may spend months or years, worrying about being ill, but they may also spend long periods in between not thinking about it.
In 2013, the APA estimated that approximately 30% of patients with hypochondria eventually see a significant reduction in their anxiety. For between 33 percent and 50 percent of people with illness anxiety, the condition is temporary.
Patients whose disorder is transient are less likely to have psychiatric problems or severe anxiety disorder, and more likely to have medical issues.
Recovery is more common among people with a higher socio-economic status. If a patient has depression or anxiety, and these respond well to treatment, they, too, are more likely to see a good outcome.
There is evidence that people with a personality disorder may find it harder to recover, but more research is needed to confirm this.
Since illness anxiety is a relatively new disorder, few statistics are available.
When does hypochondria start?
Health anxiety usually starts in early adulthood. It may appear during recovery from a serious illness, or after a loved one or close friend becomes ill or dies.
An underlying medical condition can trigger health anxiety. A patient who has a heart condition, for example, may assume the worst each time they experience something that could potentially be related to heart disease.
Other factors include increased stress or a greater exposure to information about a disease in the media.
Sometimes a person starts worrying excessively about their health as they approach the age at which one of their parents died, especially if the parent's death was premature.
Psychologists note that people with the condition are often self-critical or perfectionist, or both. They may perceive "health" to mean a complete absence of pain or discomfort, whereas some aches and pains are normal for most people.
It has been suggested that people with hypochondria may have a low threshold for pain, and that they may notice internal sensations earlier than other people do.
Is there any treatment for hypochondria?
Research published in JAMA has indicated that cognitive behavioral therapy (CBT) and the use of selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and paroxetine, can be helpful in treating hypochondria.
CBT can help the patient to rationalize his or her fears, and SSRIs can reduce the level of anxiety through medication.
The University of Maryland Medical Center (UMM) suggests a number of alternative therapies that might relieve symptoms, while cautioning that these are not yet supported by research.
They include avoiding stimulants such as coffee, alcohol, and tobacco, practicing mindfulness meditation, and eating healthily.
Herbs known to reduce anxiety include St. John's Wort, kava kava, and bacopa. UMM warn however, that patients should speak to a physician before using herbs, because some herbal remedies may react with medications or have other side effects.