Cyberchondria

Medical information – some reliable and some questionable – is now at everyone's fingertips. This is generally good, as patients are generally better informed, but it also encourages self-diagnosis. Deciding that you definitely have cancer because of a list of symptoms you found on a dodgy website obviously is not only inadvisable, but also dangerous.

They used to call it "medical-student syndrome". Today you learn about multiple sclerosis or liver cancer, and by tonight you're sure you have all the symptoms – and you think you have only a few days to live.

Cyberchondriacs scour the internet for hours in search of an explanation for their symptoms. And after a few hours of surfing the net, they have their answer. And it's usually not good news. Look long enough, and you're bound to find a really sinister explanation of your symptoms.

So what is hypochondria/cyberchondria?
A hypochondriac is someone who is preoccupied with their physical health in an obsessive manner. According to the Diagnostic and Statistical Manual of Mental Disorders (IV), a hypochondriac is:

• Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms.
• The preoccupation persists despite appropriate medical evaluation and reassurance.
• The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The duration of the disturbance is at least six months

For example, Mike believes his headache indicates he has a brain tumour. He goes to the doctor, who tells him he is fine. Then he goes to a neurologist, who also tells him he's fine. Then he goes to a... Enough. You get the picture. This carries on for months and finally his girlfriend can take it no more, and leaves him for a fitness instructor who doesn't even feel ill, even when he is, thereby causing Mike lots of social distress. And he gets a warning at work, because he has used up all his sick leave.

Hypochondria is equally common amongst men and women and is found in all age groups and social classes. The internet has made health information - and misinformation - really accessible. So does this mean doctors are noticing an increase in this sort of behaviour?

A doctor's viewpoint
"There is nothing wrong with being well-informed on a condition that you have," says Dr Neville Wellington, general practitioner with the Kenilworth Medicross Clinic.

Many more of his patients were using the internet to gather information, he said, and patients are generally better informed than they were a few years ago. He says that few patients come to him with printouts of articles off the internet, although he has come across a few who have come to him pretty certain that they knew what was wrong with them. And they weren't always right. It's important, he pointed out, to learn to distinguish between trustworthy websites and dodgy ones.

"People should be sceptical about every area of medicine," he added. "That includes information given to them by doctors, as well as information they gather off the net. It is always a good idea to question information you have been given, and get a second opinion."

He stressed, however, that internet-based self-diagnosis can be dangerous.

And the most radical case of cyberchondria he has ever come across?

"There was a fad a while ago about progesterone cream. Many patients thought it was a miracle cure for everything and wanted to know why we weren't prescribing it. Well, basically we ignored it because it was slammed by gynaecologists and researchers, who said the claims made by the developer were outrageous. But that didn't stop him from selling tons of the stuff. But it didn't work, so the fad died down," according to Dr Wellington.

The good news
On the upside, health websites are more reliable than one might think. According to a study by the University of Texas in the US, only 5% of the 343 websites dedicated to breast cancer offered inaccurate information. Interestingly enough, websites focusing on complementary and alternative health were 16 times more likely to have inaccurate information than mainstream sites, according to the researchers.

They did, however, warn that even websites that provided accurate facts did not necesarily give the full picture that people needed in order to help them make informed decisions with regards to their disease or condition.

What the internet is uniquely good for, is to help you to get background information on a condition that you may have. It's also great for networking with other people who have the same condition.

But the big question is: how do you recognise a dodgy website and how do you know when you can trust the information?

Separating the good from the bad
Here are a few tips on how to distinguish between reputable websites and the ones you would do better not to consult:

The dodgy ones

• These contain many spelling errors and unnecessary punctuation marks.
• It is unclear exactly where this information is coming from. No really well-known institutions are named and there are no references to reputable studies that have appeared in medical journals.
• It appears that much of the information is copied and pasted from elsewhere – and the source is not credited. This can be seen in the variety of writing styles present on the site.
• Incredible claims are made for a specific product or invention. Those singing its praises are also untraceable (for example John from New York).
• There is an attempt to sell a product to the user online.
• There are no contact details (telephone numbers or e-mail addresses) – only a page where you can give your credit card details to purchase something.
• Dodgy websites also contain articles that have not been updated for years and years.
• There are no authors or reviewers mentioned at the bottom of articles.

The good ones

• They have HONcode (Health on the Net Foundation) accreditation. This organisation monitors the quality and trustworthiness of health information on the internet. This also means that no advertorial copy will find its way into editorial space.
• Trustworthy studies from reputable institutions and medical journals are quoted.
• Medical information appears to be solid and a wide range of diseases and conditions are covered.
• The addresses of the websites end in .gov (government organisations) or in .org. (registered organisations – not fly-by-nights) or in the name of a recognisable and reputable university or hospital; or, as in the case of the website you're currently on, it is part of a well-established and reputable media group (in this case, Media24/Naspers).
• There are contact names and addresses of real organisations and people.
• The user is frequently told that information gathered from the internet cannot take the place of a face-to-face consultation with a medical practitioner.

Are you a cyberchondriac/hypochondriac?
Answer the following questions as honestly as you can and it will give you a clear indication of whether you are just health-conscious, or whether you have crossed the threshold into the world of cyberchondria:

1. Do you worry about your health more than most people do? Yes/No
2. If you've been ill and someone tells you you're looking better, do you feel annoyed? Yes/No
3. Are you bothered by many aches and pains? Yes/No
4. Do you spend an inordinate amount of time on the internet or in the library trying to find out more about your symptoms? Yes/No
5. Do your family members get visibly irritated by your complaints about your health? Yes/No
6. Do you think there is something seriously wrong with your body? Yes/No
7. Do you spend most of your time thinking about yourself and your health, rather than other people or things? Yes/No
8. Do you feel that other people are not paying enough attention to your illnesses? Yes/No
9. Do you think the doctor is lying when he/she tells you there is nothing wrong with you? Yes/No
10. If you hear about a disease, are you afraid of getting it? Yes/No
11. Do you worry often that you may have a serious illness? Yes/No
12. Do you have many different types of symptoms? Yes/No

If you have answered yes to three or more of these questions, you could be a hypochondriac. Ask your family what they think, and consider making an appointment to see a therapist to deal with your anxiety levels.

(Susan Erasmus, Health24, updated February 2009)