Everything you need to know about hypochondria

The symptoms:

• A preoccupation with physical illness that persists despite a doctor’s reassurance that all is well.

• Denial that this condition, whether brief or chronic, could have emotional roots.

• Heightened sensitivity to minor aches and pains, such as feeling a pinprick as a stabbing pain.

Who is at risk?

An estimated 5 percent of Americans suffer from severe hypochondria. The condition can begin at any age, although men usually experience it beginning in their thirties and women about a decade later. One study found that firstborn children, especially women, had an increased incidence of hypochondria, possibly because their inexperienced mothers showed more concern about their physical health than that of younger brothers and sisters.

How it develops

Hypochondria, which tends to come and go, often starts with a genuine medical problem. But instead of getting well, the person continues to focus on the illness even after symptoms disappear. Often, he or she enjoys the special attention that comes with being sick. Or the illness may provide an excuse to avoid other obligations. Whatever the underlying cause, the hypochondriac becomes increasingly preoccupied with symptoms—real or imagined—and is often convinced that he or she has a serious illness that defies medical diagnosis or treatment.

Hypochondriacs often take vast quantities of medications, vitamins, and natural remedies, and many spend hours on the Internet or in libraries researching their supposed diseases. Although there are some similarities, hypochondria should not be confused with psychogenic pain, a condition in which patients experience real pain that has a psychological, rather than organic, cause.

What can you do

People with hypochondria will often try one treatment after another, from home remedies to professional care, despite the futility of such efforts. Family and friends can help if they:

• Give the person a chance to complain and feel heard, but do not provide so much attention that they create an incentive for him or her to remain sick.

• Encourage the person to focus on other things. Diplomatically note that when people have more going on in their lives, they are less likely to notice minor ailments and overestimate their medical significance.

• Reward behavior that is not related to complaints about physical ailments. The most effective way to change behavior is to reinforce people when they are doing something positive.

• Do not suggest additional tests or treatments. Instead, point out that overmedication may be to blame for the symptoms (as is often the case).

• Recommend group therapy. People with hypochondria may benefit from complaining to others.

How to treat it

Even when doctors suspect hypochondria, they will conduct a thorough physical exam and tests in order to rule out the possibility of a genuine physical cause for concern. Patients may also fill out symptom checklists that reveal whether their complaints fit a known pattern of illness or may be imaginary. If hypochondria is due to underlying anxiety or depression, a doctor may prescribe an antianxiety drug or an antidepressant medication.

Some doctors reduce their patients’ anxiety by scheduling regular appointments to review symptoms. A more effective approach, however, involves convincing the patient to see a psychotherapist. Treatment that combines patient education with behavior modification seems to work best. Many people with hypochondria, however, resist psychotherapy because they want a medical solution.

How to prevent it

Hypochondria is a complex problem with no simple means of prevention. Some experts think that prevention starts in childhood. They urge parents not to give children extra privileges when they are sick to avoid associating illness with rewards. In addition, leading a busy and fulfilling life decreases the chances that a person will focus on minor physical problems and magnify their significance.

Alternative therapies

Movement therapies
Dance therapy, t’ai chi, yoga, and other movement therapies designed to foster a sense of well-being as well as provide exercise are sometimes helpful. For example, a person who is convinced that a “bad back” precludes vigorous exercise may enjoy dance therapy or t’ai chi, and then be able to move on to other physical activities.

Pet therapy
Caring for an animal provides a hypochondriac with something other than his or her ailments to think about. Assuming responsibility for the care of another living creature also gives the hypochondriac something positive to do.