Mon 17 Mar 2003
DO you worry that you’ve contracted some deadly disease? Have you begged your doctor for a third opinion, even when told there’s no need for a first?
Perhaps you experience physical symptoms like headaches, heart palpitations and stomach upsets, or find yourself gripped with anxiety that you might have cancer, multiple sclerosis, or some other serious illness? And do these worries dictate the way in which you run your life, career and relationships? If so, then you’re probably a bit of a hypochondriac.
A hypochondriac is the kind of person who would believe a mild headache to be the beginnings of a brain tumour, a bad cold to be the onset of intestinal flu, and pins and needles a worrying indication that a heart attack is in the post.
“Hypochondria is an irrational fear of being ill where the person – who sees it as a physical problem – becomes focused on the negative things about their body, even when their problem has been checked out and nothing has come up,” says Jan Lawrence, director of stress management company Equilibrium Associates Limited.
“Because people focus so much on the signs of physical problems, it can become more obvious. For instance, a person with an increased heart rate may panic, thinking it’s the start of a heart attack. And because they become more anxious about it, their heart rate will increase, thus making their heart rate increase even more.”
There’s nothing wrong in feeling slightly anxious about the possibility of our bodies malfunctioning. Who hasn’t flicked through a family medical dictionary for alarming descriptions of symptoms, and thought: “I’ve got them all”?
But while most of us can dismiss such thoughts, not everyone can be reassured by medical diagnosis or opinion. For while hypochondria – or Functional Symptoms as it’s better known in medical terminology – has long been regarded as a joke, it seems it’s not so funny after all.
With 30 per cent of patients attending consultations with unexplained disorders, some medical experts say this excessive health anxiety is just as serious as any other medical diagnosis.
“The term hypochondria has a lot of connotations, so we like to call it Functional Symptoms, because it describes what we currently believe is going on; that in some way the brain’s function is distorted,” explains Dr Alan Carson, a consultant in neurosurgery at the Royal Edinburgh Hospital. “We treat it as seriously as cancer.”
He adds: “If a patient complains of terribly serious symptoms, where it’s ruining their lives, anything that suggests that they’re doing this deliberately, or imagining it, is clearly ludicrous. Figures state that seven out of every 100,000 patients have unexplained motor conversion – the same ratio as people with multiple sclerosis.”
For some people feelings of having a disease or illness don’t pass, but dominate the way they think about themselves.
“No matter what doctors say, I’m convinced there’s something wrong and that I’m going to die,” declares Norman Holmes, a self-confessed hypochondriac of 26 years. “Once it gets into your head something’s wrong, you just can’t shake it. Lately, I’ve been thinking I’ve got diabetes because I’ve been getting up two or three times a night to go to the toilet.”
Leith-based, Norman is often told that his “tonsillitis” and “hernia” are nothing to be troubled about. He’s had several blood tests, countless consultations and visited out-patients departments on numerous occasions. Nothing has been found to be medically wrong with him, yet that does not reassure him.
“I’ve a morbid fear of tonsillitis, so when I complained of a sore throat to the doctor he just said it would go away. I wasn’t convinced, so I tried desperately to obtain some antibiotics just to make me feel better,” he says. “On two or three other occasions they looked at my stomach, because I was certain I had a hernia. All they did was prod around and say I was a bit bloated. I had numerous blood tests that said I’m okay, but I’m still convinced something’s wrong.”
The fear of having an illness has taken over Norman’s life. “I rarely leave the house these days without having some kind of indigestion tablets, or ibuprofen in my pocket. My partner gets utterly fed up with me saying I’m ill, because I’m always saying I have some kind of ailment.”
It’s not just living in constant fear that worries Norman, though. It’s the discrimination and stigma attached to hypochondria that bothers him too. “It’s unbelievable – particularly among doctors, employers and the social security,” slams Norman bitterly. “They think you’re lying and force you to make it sound worse than it actually is, which in turn makes me feel physically ill.”
Someone who understands what Norman’s going through is 37-year-old Marty Sutherland. Ten years after a bad road crash left him in excruciating pain, he says that doctors still can’t find any evidence of anything physically wrong with him. But Marty maintains that the health service’s failure to acknowledge the agonising pain in his upper body has left him sounding like a hypochondriac.
“I’ve had chest, spine, and neck pain for a decade now – and had my fair share of doctors accuse me of ‘putting it on’ – so I know how people feel when they’re accused of groaning about something that’s not there,” says the musician from Corstorphine.
“The doctors said nothing ever came up on their X-rays, but I’m often in constant agony. They’ll give me painkillers, but rarely bother try and help me. In the end you lose faith.”
Hypochondriacs want a certainty that they are 100 per cent well, but there’s no doctor on earth that can ever be completely certain about a patient’s health.
“We don’t actually know why these symptoms occur, but one has to be neutral about what the cause is,” says Dr Carson. “We start with the symptom, then start thinking after that, what does that indicate? What other psychological factors are there? What can we find out about the physical factors?”
All of which begs the question: why do people get it, and how can it be treated?
“Common reasons are if they had a similar illness in the past and have a fear it might happen again, a family history, or had a recent trauma,” says Jan Lawrence. “The way to treat it is to understand your own body. Learning to relax can help. Get an image of yourself as a healthy person, and challenge your thoughts.”
Dr Carson adds: “Because people don’t get the answers they’re looking for, or the treatment they deserve, they’ll keep on going to different specialists, which sets off a snowballing effect. We use cognitive-behavioural treatment, sometimes combined with medication. Treatments aren’t fantastic, but at least they are clinically shown as being effective.”
And as long as people have unexplained symptoms, Norman feels we should be more sympathetic to such complaints.
“I believe that hypochondria will always be a funny joke, but it’s gravely serious, and, heaven knows, it’s mucked up my life.”
Are you suffering from hypochondria?
One way to find out whether or not you’re a hypochondriac is to try the Whiteley Index, a widely-used test to diagnose hypochondria. Answer this list of questions about your health. For each one, circle the number indicating how much this is true for you.
1 = Not at all, 2 = A little bit, 3 = Moderately, 4 = Quite a bit, 5
= A great deal.
|Do you worry a lot about your health?||1||2||3||4||5|
|Do you think there is something seriously wrong with your body?||1||2||3||4||5|
|Is it hard for you to forget about yourself and think about all sorts of other things?||1||2||3||4||5|
|If you feel ill and someone tells you that you are looking better, do you become annoyed?||1||2||3||4||5|
|Do you find that you are often aware of various things happening in your body?||1||2||3||4||5|
|Are you bothered by many aches and pains?||1||2||3||4||5|
|Are you afraid of illness?||1||2||3||4||5|
|Do you worry about your health more than most people?||1||2||3||4||5|
|Do you get the feeling that people are not taking your illnesses seriously enough?||1||2||3||4||5|
|Is it hard for you to believe the doctor when he/she tells you there is nothing for you to worry about?||1||2||3||4||5|
|Do you often worry about the possibility that you have a serious illness?||1||2||3||4||5|
|If a disease is brought to your attention (through the radio, TV, newspapers or someone you know), do you worry about getting it yourself?||1||2||3||4||5|
|Do you find that you are bothered by many different symptoms?||1||2||3||4||5|
|Do you often have the symptoms of a very serious disease?||1||2||3||4||5|
The Whiteley Index score is found by summing the responses to each question.
The higher the score, the more hypochondriacal you are likely to be. There
is no set cut-off score, but healthy people without health anxiety generally
have a score of 21 +/- 7 (14 to 28). Patients with hypochondria are found
to have a score of 44 +/- 11 (33 to 55). Results must be treated cautiously
as these numbers are merely indications to help you find out if you have
hypochondria. If your score is high, we suggest you talk to your doctor.
© Copyright 2003, Scotsman.com