Think you're sick, but the doctors say you're not?


Hypochondriacs usually don’t have the illness they think they do, but they are unwell from a mental perspective. — dpa

“It's all in your head!” “Malingerer!” “Hypochondriac!”

People who constantly worry that they are – or may become – seriously ill are often an object of scorn.

But truth be told, while they typically don’t have what they think they do, in many cases, they really aren’t healthy.

Hypochondria, now usually called health anxiety or illness anxiety disorder, is a mental disorder that can severely disrupt your life.

Unfortunately for those who suffer from it, the term “hypochondriac” has become a pejorative label, notes Timo Slotta, a psychological psychotherapist at the University of Cologne’s special outpatient clinic for illness anxiety in Germany.

All that it usually takes to be branded one is to express worry about, or describe symptoms of, an illness that a medical examination doesn’t confirm.

A clinical diagnosis of illness anxiety disorder requires more than that, however.

“The persons affected are excessively preoccupied with the idea they have a serious illness,” he explains.

“It’s typically an illness that can be fatal in months or years.”

They frequently go to the doctor, brood about their health, read up on their suspected illness and engage in “body checking”.

For example, they may inspect their skin for suspicious-looking spots, palpate themselves until it hurts, test their balance, or continually take their blood pressure or measure the oxygen level in their blood.

Occasionally becoming alarmed by supposed symptoms of an illness isn’t the problem, Slotta says.

But the behaviour is pathological if the person is so insistent their suspicion be cleared up that they have trouble functioning in their daily life.

“Affected persons develop an avoidance behaviour: They stop going to the gym or to work,” says psychiatrist and psychotherapist Dr Sabine Koehler.

A doctor can diagnose illness anxiety disorder if the patient’s fear about having a serious illness lasts six months or longer, even after tests show they’re not ill.

But “the patients refuse to accept the freedom of diagnosis and keep pushing for more examinations”, says the chairwoman of the Professional Association of German Neurologists (BVDN).

Why some people develop illness anxiety isn’t completely understood; there are several theories though.

Genetic factors could play a role, as could the manner of upbringing and early experiences with illness.

An insecure bond with one’s parents during the first year of life may also lead to illness anxiety.

Another risk factor, points out Slotta, is a rash of serious illnesses in one’s family or social circle.

Certain ways of thinking can play a role as well: Many people with illness anxiety fear that their thoughts or behaviour trigger ill-ness.

Although there are specific criteria for a diagnosis of illness anxiety disorder, it’s not an easy one to make.

“It’s a very slippery disorder,” says Dr Koehler, “because while the affected persons insist on a diagnosis, they also insist they have a physical illness.

“Many don’t want to hear that they have a mental disorder.”

General practitioners (GPs) can help here, she says.

A patient without any clear impairment who, each quarter year, needs five different referrals for examinations from various medical specialists might be better served by a referral for a psychosomatic assessment and benefit from psychotherapy, she says.

“Illness anxiety is well treatable,” remarks Slotta, who says between two-thirds and four-fifths of affected persons benefit from psychotherapy, and about half from medications.

“Psychotherapy is stressful and strenuous, no question about it,” he says.

But therapy with medications, he adds, only works as long as you take them, “which isn’t the case with psychotherapy”. – dpa

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Mental health , hypochondria


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