Therapy may prevent hypochondria
April 20, 2004
HEALTH SCARES turn out to be groundless most of the time. We go for a check-up, are declared OK, and life goes on as normal.
But for 5 per cent of the population the matter doesn’t stop there. Hypochondriacs — officially defined by the American Psychiatric Association as “patients whose fears that they have a serious disease persist for at least six months and continue even after doctors have reassured them that they are healthy” — have to contend with high levels of anxiety about their health all the time, as well as their feelings of not being taken seriously.
Doctors sometimes refer to these as “heartsink” patients and may regard them as an untreatable nuisance. A new report, however, just published in the Journal of the American Medical Association, shows that cognitive behaviour therapy (CBT) can help some of these patients.
In a study conducted by Harvard Medical School and Brigham and Women’s Hospital, in Boston, hypochondriacs were given six sessions of CBT, a form of psychotherapy that aims to change patients’ beliefs about their disease. More than half of them showed “significant improvement”. “This could save billions of pounds,” says Dr Arthur Barsky, of Brigham and Women’s Hospital, the psychiatrist involved. “Treating hypochondriacs accounts for between 10 and 20 per cent of the annual American healthcare bill.” The UK figures are, if anything, even higher — 25 per cent of all consultations with GPs relate to psychosomatic or unexplained symptoms, according to figures from the Royal College of General Practitioners.
The internet may have made things worse by fuelling hypochondriacs’ fears — researching your symptoms on the internet will produce a host of terrifying diseases, leading to a new malady dubbed cyberchondria. But 200 years ago it was known as the English Disease and had its celebrities. The author James Boswell wrote a weekly magazine column entitled “The Hypochondriack”, describing his obsessions with his personal health, while Charles Darwin regularly worried over unexplained “palpitations, fatigue and trembling in his fingers” which flared up when he had to discuss evolution.
Today, psychiatrists characterise hypochondriacs as “neurotic, self-critical and introverted”. “Their nervous system seems to be like a radio whose volume has been turned up so high that the background static becomes intolerable,” says Barsky. Professor Brian Fallon, a psychiatrist at Columbia University, New York, specialises in hypochondria and believes that many sufferers have a version of OCD (obsessive compulsive disorder) or depression. He claims success in treating them with both antidepressants and CBT.
The assumption behind offering CBT is that the patients wrongly believe that they are physically ill. However, the relationship between mental and physical states may be more complex than that. Last year the Royal College of General Practitioners organised a series of seminars on how to handle patients who had no apparent cause for their symptoms. One speaker, Dr David Beales, believes that many are overbreathing — a condition known as breathing pattern disorder (BPD). “We all breathe faster when under stress or feeling strong negative emotions,” he says. “But if you keep doing it, the body chemistry changes.”
A number of studies, such as one published in October last year in the journal Behaviour Modification, have found that BPD changes the acid/alkaline balance in the blood, which in turn produces a range of physiological and psychological effects. You perform worse on cognitive tests and it can make brain cells behave in a more excited way. Some susceptible people may even have an epileptic fit.
“I’ve had patients who have done the rounds of doctors and other practitioners without anything specific being found, who showed up having BPD,” says Beales. “Some had bowel problems; some had an imbalance in the immune system. Others were producing too much of the stress hormone cortisol.”
And there are always going to be “hypochondriacs” who are actually physically
ill. After all, both Parkinson’s disease and multiple sclerosis were regarded
as psychosomatic only 50 years ago. Indeed, this is not an academic point
for the 200,000 or more people in the UK who have had ME/CFS diagnosed.
For them the official treatment is CBT. A vociferous lobby of patients,
however, points to solid evidence suggesting that CFS/ME is a disorder
of the immune system. They accuse the medical community of ignoring this
Copyright © 2004, The Times