Hypochondriasis: the Illness of not having an Illness

Introduction

Picture By Brian Cronin for TIME

Two weeks ago during spring break, I thought for sure I was dying. It started with a simple chest pain, which gradually became worse as the days rolled on. Like many other average Americans, when faced with the threat of illness or disease, I turn to the internet for the “answers.” What I found (and diagnosed myself with) was Costochondritis, an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone or sternum (emedicinehealth.com). I felt a little better knowing that Costochondritis goes away on its own, and that I had cracked the case on what was affecting me for the last three days.

On day four came the heart palpitations which stayed with me morning until night, and the realization that when I laid on the left side of my body,  my heart felt like it was going to explode out of my chest. Frantic and distressed, I rushed back to my computer see what these new symptoms might mean for me. And sure enough, after researching for twenty minutes on WebMD, I had found the REAL diagnosis to what was wrong with me, I have Coronary Heart Disease!

You might be asking yourself right now if this story has a point. Here it is, four days later all my symptoms had subsided into nothingness and I felt like my average self again. I never went to the doctor once during this event, and my diagnoses (real or not) had been determined based on a few lines of text. In the end, my friends and loved ones decided to diagnose me with Hypochondriasis a.k.a. Hypochondria.   While I know that I am NOT a hypochondriac, I don’t really know much about it. In this blog post, I will provide research and social analysis of Hypochondriasis, including a brief history of the illness, the attitudes and behaviors that label hypochondriacs as deviant (if any), who gains or loses from a diagnosis, both sides of the public perceptions of hypochondria, and finally the social constructions behind it.

History Review of Hypochondriasis

Before Hypochondriasis was camped in with mental illnesses or disorders, its roots could be found within the physical aspects of the body.  Originally, the word hypochondriac or hypochondria comes from the word Hypochondrium, the upper part of the abdomen dorsal to the lowest ribs of the thorax; this word derives from the Greek term hupochondros, meaning abdomen, or literally under cartilage (Avia & Ruiz, 2005). The use of Hypochondriasis to state a feeling of disease without evidence or cause reflects an ancient Greek belief that the internal organs of the hypochondrium was the seat of melancholy and the source of vapors that caused morbid feelings (Avia & Ruiz, 2005).

Research about the history of Hypochondriasis is scarce, but up until the seventeenth century, it was considered a physical condition (Noyes Jr., 2011). Over the next 150 years, the disorder was transformed from an affliction of abdominal organs to a disorder in the nervous system and brain, until it was finally considered a disorder of the mind (Noyes Jr., 2011). Two factors supposedly contributed to this change. One was a shift based on emerging medical knowledge, meaning illnesses that once involved the whole person were now diagnosed and targeted based upon the bodily organs. Because of this, Hypochondriasis became an illness without somatic (bodily) disease (Noyes Jr., 2011).  The other factor was the change in the disorder’s social significance. During the period of Enlightenment (time of reason and science) Hypochondriasis became on one hand, a distinction which conveyed ones class status; someone who was knowledgeable or well learned. On the other hand, Hypochondriasis was of social disapproval, considered something born out of ones own paranoia of disease or illness (Noyes Jr., 2011).

A Diagnosis of Hypochondriasis

Currently, the Diagnostic and Statistical Manuel of Mental Disorders (DSM-IV) states the following for Hypochondriasis:

“In Hypochondriasis patients come to believe, or at least to very strongly suspect, that they are sick with a serious, perhaps life-threatening disease. Minor symptoms or anomalies support and augment their concern. A muscle ache or perhaps an accidental bruise indicates the dreaded diagnosis. Their concerns persist despite the reassurances of their physicians. The preoccupation with illness may become all-consuming; some patients become invalids, bed-bound not by their symptoms, but by their fear of having a disabling illness. Hypochondriasis has a lifetime prevalence somewhere between 1 and 5%, and appears to be equally common in males and females” (Brown.edu).

In terms of ones process of medicalization, hypochondriacs generally visit doctors multiple times complaining of illnesses or ailments. During this time, a doctor may advise an individual that they should seek a mental health professional for a diagnosis of Hypochondriasis or some type of anxiety disorder.  Hypochondriasis may begin anywhere from adolescence to middle ages. The peak age of onset is generally in the twenties and thirties. There are no specific reasons why someone may suffer from Hypochondriasis, although some factors have been shown to have correlation with being diagnosed; witnessing someone else suffer or die of a disease seems at times to trigger Hypochondriasis, and in some cases a serious illness in the patient’s own life may act as a catalyst (Brown.edu). The most common treatment for Hypochondriasis is cognitive behavioral therapy, where patients are trained to focus their attention away from the symptoms (Brown.edu).

Hypochondriasis in Society

While the history and current diagnosis of Hypochondriasis is important, the main area of discussion revolves around the social implications, limitations, and emotions regarding this illness. Within this section I will provide a brief overview of both sides of the argument in regards to the legitimacy and social constructions of Hypochondria.

If you are diagnosed or perceived to suffer from Hypochondriasis, there are a number of things to expect when living and dealing with this condition. For starters, be prepared to be ridiculed, or seen as deviant by society in general. Many individuals living with Hypochondriasis discuss the difficulties of dealing with the illness, along with trying to carry on with their normal lives and be seen as normal. Often, our imaginations take us to the far end of the spectrum, and we find ourselves thinking that hypochondriacs are individuals walking around with surgical masks on, a pair of latex gloves, and are constantly wishing to be sick. This Scrubs clip below (while funny) is an example of how some people may view hypochondria in their minds:

In fact, we as a society generally want to do anything BUT take responsibility and care for these individuals, specifically, because we believe that they do not need to be cared for in the first place. Some health care providers will cover treatment programs for individuals (the exact number or percentage I could not nail down.) Perhaps most surprising, is that many doctors and medical professionals also have a somewhat hostile attitude towards individuals with Hypochondriasis. An article in TIME Magazine titled How to Heal a Hypochondriac stated, “Most physicians tend to think of hypochondriacs as nuisances – patients they are just as happy to lose” (TIME, 2003). The stigma that follows individuals living with Hypochondriasis is similar to the stigmas people have about other mental illnesses such as depression and anxiety disorders. Despite Deeper Understanding Of Mental Illness, Stigma Lingers

As stated previously, many individuals with Hypochondriasis are involved in the conversation. They have created blogs and youtube videos in an attempt to tell their stories, and to help others who have been diagnose to cope and live normal lives. The Happy Hypochondriac, Hypochondriac's Relief Blog, Random Confessions of a Former Self-Proclaimed Hypochondriac

A case has been made, not against Hypochondriasis, but against the individuals who often are diagnosed (or self-diagnosed) as hypochondriacs. Part of this case revolves around the cost that comes with this illness. The same TIME magazine article states, “Hypochondriacs don't harm just themselves; they clog the whole health-care system. Although they account for only about 6% of the patients who visit doctors every year, they tend to burden their physicians with frequent visits that take up inordinate amounts of time. According to one estimate, hypochondria racks up some $20 billion in wasted medical resources in the U.S. alone” (TIME, 2003). The other area people can be unsympathetic is with (stated previously) the over-diagnoses or self diagnosis of Hypochondriasis. The following clip is of comedian Dennis Miller giving a rant about Hypochondria. While viewing it, try and count the number of sympathetic comments Miller makes, against the number of insults or jokes that poke fun at a hypochondriac’s condition:

Discussion and Conclusion

In society, we tend to carry two different attitudes when we think about disease and illness. When it comes to somatic diseases or illnesses, we are often sympathetic towards the individual, and sometimes we put forth an extra effort to include them in all areas of society. On the other hand, individuals who suffer from mental issues such as anxiety disorders, depression, and Hypochondriasis, are not always met with the same love or compassion. In fact, they are often seen as deviant, and often labeled as simply “crazy.”

Yet, the evidence is clear that these are in fact real illness, and many individuals truly do suffer with such illnesses. So what is it about our culture that makes individuals with Hypochondriasis seem deviant? Is there an over-diagnosis of hypochondria? Are more people truly self-diagnosing themselves? And if this is so, is it there fault, or someone else’s?

When we look at the Scrubs clip from above, we see how hypochondriacs are represented in the media. They are seen as people who want to be sick, hope they are sick, and are nothing more than a waste of a doctor’s time and a waste of a hospital bed. Because of these media depictions, when we encounter a hypochondriac in the real world, we can be quick to think that they are crazy and label them as deviant minded individuals. We must remember that if someone is diagnosed with Hypochondriasis, then their illness should be viewed as the same as someone diagnosed with depression or autism.

That being said, do I believe that individuals self-diagnose themselves, you bet I do. Do I think that individuals are being diagnosed with Hypochondriasis at a growing rate, absolutely. Do I think that individuals are specifically the ones to blame for this, no. I believe that this growing number of self-diagnoses and paranoia can be linked to two things, the internet and pharmaceutical companies.

The internet has given people the miracle of knowledge, providing us with an almost limitless amount of information at a rate we have never experienced in history. However, it has also opened up the door for individuals who are worried that their cough is the first sign of the lung cancer growing inside of them. ““They go on the Web,” says Dr. Arthur Barsky, a psychiatrist at Harvard Medical School and Brigham and Women's Hospital in Boston, “and learn about new diseases and new presentations of old diseases that they never even knew about before.” Doctors have taken to calling this phenomenon cyberchondria” (TIME, 2003). This new wave of information has caused an uproar of over-diagnoses and self-diagnosis in a number of mental health illness; The Autism Information Epidemic 

discusses a number of the same issues in its article.

Because media has such a direct affect on our lives, it is no surprise that pharmaceutical companies have taken a very strong interest in it. Every day we are bombarded with commercials, posters, and other advertisements that sell a very simple, very effective message: if you have these symptoms, you NEED this pill. In We're All Mad Here: Pharmaceutical Advertising and Messaging About Mental Illness 

we see how companies will shell out over a billion dollars, to advertise their products to you, and get you to think that there is something wrong with you that needs to be fixed or corrected. It is no surprise that when all is said and done, most doctors recommend cognitive therapy as the best medicine for dealing with Hypochondriasis.

I’m sure throughout the course of our lives we have truly thought we had a bad virus or disease, when really we had a pulled muscle or the flu. To be scared is to be human. But Hypochondriasis is a real illness, it affects people on a daily basis. What is important to remember is that the person who can best answer your medical questions is not WebMD, or the Prozac commercial, or even yourself. The best person who can diagnose you is a doctor or medical professional. If you are overly concerned about your medical condition, schedule an appointment or call a toll free nurses hotline. If you think you suffer from Hypochondriasis, schedule an appointment with a mental health professional, because if you truly think your sick, you can take the steps towards getting better.

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http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/Hypochondriasis.pdf

http://www.time.com/time/magazine/article/0,9171,490690,00.html

http://shm.oxfordjournals.org/content/24/2/281.abstract

http://en.wikipedia.org/wiki/Hypochondriasis

http://www.emedicinehealth.com/costochondritis/article_em.htm