"Oh no, it's him (or her) again!" probably goes through many a doctor's mind when a patient is soon back in the examining room with more mysterious symptoms. A week earlier they may have been intense chest pains from a suspected heart attack, and now a headache that could be signalling a brain tumour.
Just because nothing is physically wrong with the patient does not mean that the symptoms are feigned, though. They are not. And the patient truly does have a serious problem, namely hypochondria, or severe health anxiety.
While health worries can be essential for survival, hypochondriacs tend to interpret normal bodily sensations or discomforts as signs of a terrible illness. They "catastrophise" them, said Ute Habel, a member of the German Association for Psychiatry, Psychotherapy and Neurology.
As Maria Gropalis, psychologist at the Psychological Institute of the University of Mainz, put it, hypochondriacs' interpretation of their symptoms goes off in the wrong direction.
Doctor visits bring reassurance, but only briefly. Then the patients begin to doubt that nothing is really wrong with them, fresh symptoms trigger fresh fears and more doctor visits follow.
"(The visits) become addictive," remarked Thomas Gaertner, chief physician at the Schoen Clinic for Psychosomatic Medicine in Bad Arolsen.
Hypochondria is a kind of somatic disorder in which physical symptoms cannot be fully explained by any underlying physical disorder. Particularly at risk are people with a heightened sense of perception and "body vigilance," Gaertner said. Past illnesses, including those of loved ones, often play a role as well.
As Gropalis explained, hypochondriacs have difficulty coping with negative emotions and "sometimes their fears stem from heavy stress." For those who have entered psychotherapy, it is often important to be assured that they are "not crazy," Gaertner said.
Constant anxiety over one's health is a very oppressive condition, Gropalis pointed out. "Normally hypochondriacs are actually ashamed of their problems," she said, which is one of the reason that they visit several different doctors. Habel calls the practice "doctor hopping."
Years often pass before hypochondriacs receive the right therapy. By that time they have undertaken an odyssey of doctor visits and sometimes undergone painful diagnostic procedures. To overcome their fears, they first must recognise that they have a psychological disorder.
The disorder is treated with cognitive behavioural therapy (CBT), in which "cognitive restructuring" plays an important part. Patients must come to realise that it is perfectly normal for the body to react to things, Habel said. For example, stress can trigger a sudden feeling of weakness, and joy can cause an irregular heart rhythm.
CBT patients are also trained to keep their fears in check and to relativise. One method used by Gropalis is to have patients compile a list of pros and cons for their suspicions: "What evidence is there that I'm ill? What evidence is there that I'm not?" This is aimed at determining which evidence has been given too much, or too little, weight.
"Heredity is probably less of a factor in hypochondria than in other disorders," said Gaertner with respect to possible causes. External factors therefore play an even greater role and can include traumatic experiences such as a loved one's death, medical misdiagnoses or having parents who were fearful, overly careful and always suspected the worst, Habel said.
Relapses are possible after therapy and are not seldom either, Habel noted. But someone whose hypochondria has been treated has learned strategies to get a grip on his or her health anxiety and avoid falling back into the old vicious cycle.
(Sapa, November 2010)