Hypochondria is an illness marked by intense health anxiety over perceived problems — and it’s very real. Joanne Silberner, co-founder of the Association of Healthcare Journalists, joins host Krys Boyd to discuss why it’s taken so long for the mental health community to take hypochondria seriously, the new ways it’s being diagnosed, and the devastating outcomes for those who don’t find help. Her Scientific American article is “Hypochondria Is a Real and Dangerous Illness, New Research Shows.”
Imagining an illness is all too real
By Madelyn Walton, Think Intern
Are you one of those people who doomscrolls on Web MD for all your medical needs and then find yourself dodging the doctor’s office to avoid having your worst feelings confirmed? If you are, the truth is you’re probably not alone. Hypochondria, or intense health anxiety, can be deadly, but there may be some new remedies for it.
Joanne Silberner is the co-founder of the Association of Healthcare Journalists. She joined host Krys Boyd to discuss the history surrounding this health anxiety, new ways to treat it, and the fear many people face when help is hard to find. Her Scientific American article is “Hypochondria Is a Real and Dangerous Illness, New Research Shows.”
“Recent medical research has shown that hypochondria is as much a real illness as depression and post-traumatic stress disorder,” she says.
The disorder dates back to the ancient Greeks, she says. Many historians had their doubts until psychologists studied the condition.
“Eventually hypochondria came to be associated with the nervous system, and in the early 20th century Sigmund Freud termed it an actual neurosis,” Silberner says.
In the past, researchers have linked hypochondria to sexual repression and obsessive-compulsive disorder (OCD), but today they split the disorder into two diagnoses: somatic symptom disorder and illness anxiety disorder.
“The two new descriptions are about actual symptoms, such as unusual thoughts and behaviors related to a person’s medical concerns,” she says.
Somatic symptom disorder is linked to side effects experienced in daily life. For example, headaches or shortness of breath. Illness anxiety disorder is related to the fears a person associates with medical diagnoses. For example, in 2020, many people worried that if they left the house, they would contract COVID-19.
“Treating any kind of hypochondria is a challenge for doctors,” she says. “They’ve got to rule out organic disease, and if they do, but the patient keeps coming back, it can be frustrating.”
Doctors say that cognitive behavior therapy, CBT, and antidepressants have been helpful in relieving patients’ symptoms. However, of course, the internet tends to interfere with the healing process.
“Cyberchondria is where your hypochondria is manifest through the internet. You are constantly going to the internet. Any symptom, any feeling,” Silberner says.
A Google search or WebMD can give you a diagnosis that you weren’t expecting, and this may be triggering for some patients.
The obsession with technology makes it difficult for people to resist searching for a result and get the answer in seconds, but now health professionals have a way to help.
- +
Transcript
Krys Boyd [00:00:00] We’ve come a long way toward reducing the stigma surrounding various forms of mental illness. Most of us understand how debilitating it can be to live with untreated depression or obsessive compulsive disorder. And we acknowledge that people who experience delusions deserve compassion and care rather than derision. But when people who are physically okay experienced pervasive anxiety about their health or what we broadly refer to as hypochondria, those folks are sometimes treated as nuisances rather than patients in need of professional care. From Kera in Dallas, this is Think. I’m Krys Boyd. That is beginning to change as scientists learn more about health anxiety, which is good because, believe it or not, people who suffer from untreated hypochondria are more likely to die within a given period of time than the general population, even if there’s nothing seriously wrong with their bodies. Joanne Silberner is co-founder of the Association of Health Care Journalists. Her article, “Hypochondria is a Real and Dangerous Illness. New research shows.” Appears in Scientific American. Joanne, welcome to Think.
Joanne Silberner [00:01:05] Great to be here. Thank you.
Krys Boyd [00:01:07] Since most of us have probably experienced at least some passing worry about some symptom that turned out to be nothing, I want to start with the very basic question of what counts as hypochondria.
Joanne Silberner [00:01:18] That’s a great question, because in doing this story, I was thinking, wait a minute, you know, that’s happened to me, but it’s happened to me just for a little bit of time, you know, maybe an hour or two and, you know, just episodically. But when you’re persistently concerned about an illness and it’s over time and the key here is if it’s like limiting so that you’re not doing things with your family because you’re busy on the computer checking something out for days and days, it’s perfectly normal to check things out. You know, when you’ve heard something from your doctor or when you experience a symptom, but when you don’t leave your computer to be with your family or to eat or to go outside or anything else, if it’s life limiting and that you can’t focus on your work, you can’t focus on anything else. That’s when it becomes hypochondria.
Krys Boyd [00:02:05] Is hypochondria and official diagnosis in the DSM.
Joanne Silberner [00:02:09] It was it was up until a few years ago when they changed, they actually dropped the term entirely and they picked up two new terms. And one of them is illness anxiety disorder. And that’s where you are anxious without symptoms. The other is called somatic symptom disorder, which is where you actually do have symptoms. You know, all this concern, all of those things are they can cause heart palpitations. You’re breathing heavily. Maybe your heart is racing. Your blood pressure is up. With those people, they have concerns. They have symptoms. They may even actually have illnesses. But when they are just so focused on it that they can’t focus on anything else. Their concerns are extraordinary. Then that’s somatic symptom disorder.
Krys Boyd [00:02:55] And that’s rough because, you know, if their anxiety is causing those physiological symptoms, it seems like a self-reinforcing feedback loop.
Joanne Silberner [00:03:03] Certainly is. It certainly is. And, you know, how many times can you run to the doctor? And that’s a problem these days. One of the things that struck me in looking into the story is there’s more active research going on in Europe. And I think the issue there is people are suffering and you got to do something about it because it’s not only, you know, it’s hurting them. It’s hurting their interactions with the medical system, which, you know, in our medical system is not really set up to deal with this very well because doctors only have, you know, a lot of them have 10 or 15 minutes with you. And it takes a lot longer than that to encounter and deal with hypochondria.
Krys Boyd [00:03:43] What do you know about why the editors of the DSM made that change to the clinical definitions around hypochondria, removed hypochondria as a blanket term and created these two more specific illnesses?
Joanne Silberner [00:03:55] I think part of it was the stigma. You know, they recognized that doctors don’t even like to give the diagnosis because, well, partly because it’s almost feels like a it can feel to them like a failure on their part. And partly because it looks like they haven’t adequately treated the patient. But there’s a big stigma against the word hypochondria or hypochondriasis. And also because it’s as it’s being increasingly understood, I think, you know, there’s science behind it. They wanted to tell not just the psychiatrist who rely on the DSM, but other health care providers as well. Hey, we’re understanding more about this. This is these are two real illnesses. And if we give them a name, you know, there’s just going to be more attention and more, you know, they’re hoping more of an effort to understand what any particular patient has and then how to go about treating them.
Krys Boyd [00:04:50] There is this other problem which is not in the DSM as a diagnosis, at least not yet. What is cyberchondria?
Joanne Silberner [00:04:59] Yeah. I don’t know why that hasn’t made it yet, because it’s really common. Cyberchondria is where your hypochondria is manifest through the internet. You are constantly going to the internet. Any symptom, any feeling, and eviewing medical results. And again if you go to the doctor and they tell you you have something, you know, who doesn’t go home and look at it. But when you don’t look at anything else, when that’s all you’re looking at, you’re obsessed with it. And it’s really increasing. It’s it’s become very common.
Krys Boyd [00:05:35] And presumably it’s possible for some people to experience multiple forms of these health anxieties at the same time.
Joanne Silberner [00:05:42] Sure. Yeah, absolutely.
Krys Boyd [00:05:45] So if illness anxiety disorder is a preoccupation with the general idea of symptoms, does it manifest in behaviors designed to prevent illness?
Joanne Silberner [00:05:58] That’s a great question. And are you asking, you know, do people go to the doctor more or change their life to accommodate their concerns?
Krys Boyd [00:06:08] Well, I guess I’m asking, you know, it sounds in some ways similar to what we understand about obsessive compulsive disorder. You know, a lot of hand-washing, a lot of, you know, preventive measures. But these are distinct diagnoses, right? OCD is not the same thing as illness anxiety disorder.
Joanne Silberner [00:06:25] Well, a lot of doctors consider this a subset or certainly close to it because it’s obsessive and compulsive. So I think that some people feel it’s a subset and they they may be right. And in terms of what people do about it, you know, some people go to the doctor more and some people avoid doctors completely. They think, well, I’ve learned all this. Clearly that rapid heartbeat is because I have a tumor in my heart and I don’t want anyone to know. I don’t want the doctor to tell me. I don’t want to have to have surgery. They over interpret a symptom and then they get so afraid that they avoid doctors. So some people go to the doctor for more and some people go less.
Krys Boyd [00:07:10] The headline of your story asserts that hypochondria is a real illness, which of course, suggests not everybody believes that. What sort of stigma exists around hypochondria?
Joanne Silberner [00:07:22] Well, I have to ask myself that. I confess that when I started this story, I decided to look into this. When I saw a study in the journal called Jama Psychiatry that was that found a higher death rate among people with hypochondria. It was a really remarkable study. And if you want to hear more about that, I’m happy to tell you. But when I first looked at that study, I was really thinking, you know, everybody knows. I think I certainly do know a few people with hypochondria or people have gone in and out of it. And I come from New Jersey and I have to tell you that the state emotion there is annoyance, which is very easily annoyed. And then I just found I found that people annoying, you know, and I certainly don’t find people with depression annoying and I don’t find people with any of the other mental illnesses annoying. And so, you know, I stopped and I read the study and I thought, my gosh, this is a real illness. You know, if you can associated with an increased risk of death, the you know what? We’re talking a mental illness. We’re talking about sympathy being needed. So I think that there’s a lot of stigma out there. I certainly had it before. Again, I’m embarrassed to admit this and I apologize to everyone I’ve ever known with hypochondria. But, you know, I just found it, you know, until I understood it better, I just thought, you know, it’s a personality disorder. It’s a weakness. No, it’s not.
Krys Boyd [00:08:48] Yeah. And I guess when and you’re not alone, I don’t think, in stigmatizing this previously. But if we think of hypochondria as a quirk or a character flaw, we’re overlooking the real suffering associated with it.
Joanne Silberner [00:09:02] Exactly. And I talked to a number of people who have either written in actually, they had all written about their own hypochondria, which is how I found it. And, you know, they’re just as much sort of disappointed and they in having those symptoms and they initially we just were just as they were self stigmatizing. You know, it takes a lot for people with hypochondria to or some people with I shouldn’t make broad generalizations but an awful lot of them don’t want to admit it. They and, you know, many of them are absolutely convinced that they are sick. You know, it’s that that tombstone, the joke you know, the tombstone says, I told you I was sick. You know, it’s hard for some of them to understand that it is you know, it’s not a real symptom and that they’re not really sick. And actually, in some cases, it is real symptoms. The problem is that they are just they are completely obsessed with them.
Krys Boyd [00:10:07] You know, I get that self stigmatizing. I don’t think I come anywhere close to a diagnosis of any form of hypochondria. But when you go to the doctor and the doctor says, yes, this thing really is wrong with you, here’s treatment that you might try that’s somehow validating. And if the doctor tells you it should be the opposite of the doctor tells you, you’re basically fine. This is just a thing that happens. It’s almost embarrassing.
Joanne Silberner [00:10:31] I’ve had experience too. I was having night sweats right in the beginning of Aids. This is back in the early 80s. I wasn’t in any of the risk groups for Aids, and I was having night sweats. And then my doctor and I said, I have it. And he checked me and he said, Actually, you don’t. And it was in the middle of the summer in Washington, D.C., and my air conditioning wasn’t working so well. And he suggested that that really might be the cause of my night sweats. And that was, you know, again, I’m saying that hypochondria can come and go in some people, and it certainly came and went. I thought that was the last time I had that sort of experience. But yeah, it can you can think that you’ve got something when you do and it’s a very easy thing to do.
Krys Boyd [00:11:18] So you mentioned you were motivated to do this story when you read a piece in a medical journal that took you by surprise. What was the research in that article?
Joanne Silberner [00:11:26] It was really amazing research and it’s research that could only be done in Sweden. And that’s because in Sweden they have complete medical records on people and they hypochondria is considered an official diagnosis. And actually they still use hypochondria. They haven’t gone to the split. It’s a it’s an official diagnosis and it gets recorded. And I think there may be a little less stigma there. So what they did was they looked at medical records going back. It was from like 23 years starting in 1997 and the medical records for the entire country for the next 23 years. And they pulled out the people who had gotten an official diagnosis from a specialist that they had hypochondria. So they ended up with more than 4000 people who fit that definition and each it for each of those people, they went they pulled records on ten other people who lived in this, who lived near them, who were the same sex and age. And presumably, you know, we’re more average, let’s say. And what they found was that over those 23 years, when they looked at the death rate, they found that people who had had a diagnosis of hypochondria were 70 to 80% higher, had a higher risk of death of 70 to 80%. And that’s even when they adjusted for, you know, all sorts of socioeconomic differences like income. And that’s total deaths. That’s both natural deaths and quote unquote, natural deaths like from heart disease or lung disease and also what they call unnatural deaths, which was accidents and suicide. And what they found was that in the so overall, 70 to 80% higher chance of death, suicide was also. Now, one of the researchers, when he didn’t want to talk to me at all and I, you know, finally got him on the phone and he said, I just don’t want people to overinterpret this. He said, you know, the suicide rate was still very low, but he wanted people to do with these numbers, was to take them seriously in that understand that hypochondria has serious effects and that you need to deal with it, that you need to go to a therapist. Either, you know, start with your primary care doctor or start with a professional psychiatrist or psychologist, social worker, somebody who can help you work through this and not ignore it. So, as he said, it’s this really a lot of suffering there and it doesn’t have to be there. And then also, I have to say, a lot of humorous a number of comedians have made their their they’ve made their whole shtick on their own hypochondria. And you laugh, but then you talk to other people for whom it’s really not so funny.
Krys Boyd [00:14:10] Joanne, were any of the deaths associated with hypochondria in Sweden, excessive deaths associated with people getting unnecessary treatment or exploratory procedures, that sort of thing?
Joanne Silberner [00:14:24] That’s a great question. And they did not look at that. You know, I’m not sure that’s part of their medical records or that they could tell from the medical records they had. But that’s a very interesting question because as we know, you know, a lot of investigative procedures have risks and it’s a reasonable hypothesis. But I don’t know that there’s any data to answer the question.
Krys Boyd [00:14:45] On the other side of the coin, you know, you mentioned and we all know them, there are people who avoid medical treatments, avoid the health care system, even if they have the resources to pay for it. Is is that any kind of diagnosis in the DSM?
Joanne Silberner [00:15:00] Nothing I know of. That’s an interesting. What would you call it?
Krys Boyd [00:15:03] I don’t know. I mean, at the risk of sounding very sexist, we always hear that men are less likely to seek health care. I really don’t know what I would call it, but it does seem like that can also it’s a form of anxiety, Right? That you worry that you’re going to find something out that you don’t want to know.
Joanne Silberner [00:15:22] Yeah, And it is certainly common among people with hypochondria, so it would be an interesting subset. Maybe I should go back and read the full DSM description and see if they’ve got anything in, see if they refer to that.
Krys Boyd [00:15:37] So forms of hypochondria can pose particular challenges for physicians and others in the health care system, not least of which is knowing which unexplainable symptoms might actually have a physiological cause and which might be attributable to somatic symptom disorder. We’ve all heard stories, I’m sure you’ve reported stories in your career, Joanne, about people who had been long dismissed by doctors who didn’t believe they were truly sick, only to ultimately find a verifiable diagnosis.
Joanne Silberner [00:16:09] Right. And, you know, we’ve seen a number of new diagnoses arise in the last 20 years that really illustrate what you’re saying. You know, people with chronic fatigue syndrome, which I think has a different name now, who, you know, they knew something was wrong with them and doctors would run tests and they didn’t have the tests to determine that. So that is definitely an issue out there. And people having symptoms knowing that they’re sick and not, you know, not having there’s no test for whatever it is they have yet. And yet at the same time, you know, I really pity doctors who are faced with this because they have other patients who have diffused symptoms. You know, maybe they have rapid heartbeat, the high blood pressure, whatever else, convinced that they’re sick and they’re not, you know, and they the doctors can’t tell the difference. And I think one of the reasons for sort of avoidance of stigma among some doctors is that this is frustrating. You know, you have a patient come in and you want to help them and you run them through every test. And, you know, the more confident I’ve talked to a number of primary care doctors about what, you know, what did they do about this? And the more confident and experienced among them are, I think, quicker to be able to determine that this person has hypochondria and this person might have an illness that is hard to find. You know, maybe they’ll eventually find it or maybe they won’t. So, you know, what is the I, I came out of this experience just feeling really sorry for doctors.
Krys Boyd [00:17:41] Yeah. I mean, it’s this is unlike many other mental illnesses in that the first step I would imagine, in diagnosing forms of hypochondria is eliminating the possibility that patients symptoms or reported symptoms are caused by some physical function malfunctioning.
Joanne Silberner [00:17:58] Exactly. And that’s really an important point that you’re making before you decide or are told, yes, you have hypochondria, it is important to, you know, make sure that you don’t have something real because you may. But when you’ve been to a doctor repeatedly or several doctors over time and it’s going on and on and nobody is finding anything and it doesn’t fit a pattern of symptoms that other people have had. And when they’ve tested for everything that they can and it doesn’t fit again, anything like the chronic fatigue definition or some of the other newer illnesses, then it’s time to think about dealing with it as hypochondria. In fact, some some bigger clinics I’ve talked to actually, they have mental health workers on board. So if you see your doctor and you go through this, the doctor might say, you know what, we’ve got somebody down the hall who can talk to you about this and, you know, they can get therapy and that’s a really good way of going about it.
Krys Boyd [00:19:00] It’s frustrating for patients who keep experiencing symptoms their doctors can’t explain. Surely, as you mentioned, it’s also frustrating for health care workers. Are physicians trained to know the difference between patients whose illnesses might just require more testing and a deeper search for the physical cause of the reported symptoms and those who might benefit from mental health help for their suffering.
Joanne Silberner [00:19:23] You know, I asked around about that, too. And nobody the older doctors I talked to said that they had picked it up in in their clinical training where they were paired with a physician, you know, with a an experienced physician or during their hospital training where it’s just sort of, you know, you hear it from other older doctors or you I didn’t find anybody who said, yeah, I had a unit in medical school where they sat down and talked to us about that. I don’t know that it’s that straightforward. But in Europe, actually, there’s a lot of interesting research in training physicians. So they’ve got some of the people who did that epidemiological study looking at the higher rate of death. Some of them are working on how do you train physicians? They’re also there’s a lot of research going on into using telehealth, using computers. One program I looked at, they have a series of modules that the people who’ve been diagnosed with hypochondria can look at, and then they check in with a therapist so that it’s, you know, 80% of the time of their treatment is spent self-learning, you know, going through these modules. And then 20%, you bounce off of a real person who can help you understand what you’ve read and try and get you to move forward in your thinking and how to deal with it. Because the treatments right now are either what’s called cognitive behavioral therapy, where you are taught how to deal with your anxieties and or and or it can be either one or drug treatment, which is usually antidepressants.
Krys Boyd [00:20:58] Yeah. We’ll talk more about those in a couple of minutes. I also want to point out the reality that this is not a binary thing, right? That people with somatic symptom disorder and illness anxiety disorder will, in fact get physically sick from time to time.
Joanne Silberner [00:21:13] Absolutely. Yeah.
Krys Boyd [00:21:15] And so doctors have to be careful as well not to make patients think they’re being dismissed because then they might just sort of lose that patient for good.
Joanne Silberner [00:21:26] Right? Yeah. And you don’t want somebody who’s suffering to walk out the door. But I have to say, it’s hard for doctors nowadays. They’ve got 15 minutes with a patient. And if they’re coming in with symptoms, you’ve got to go through their symptoms. And, you know, ruling them out takes time. And, you know, by the time you get to the end of sitting there, you know, sending the patient on for further testing or whatever, you don’t really have time to sit down and do the kind of counseling and reassurance. One of the people I talked to with hypochondria he did, who wrote a book about it, he dedicated the book to his physician. And I talked to his physician and both of them said the same thing, that the only reason that. This guy is able to deal this hypochondria is that his physician was really able to spend a lot of time with him. And that was because he had what’s called a concierge practice where this guy that’s the money he pays that pays the physician an annual amount. And for that, he can talk to him whenever he wants. So he was able to talk to him as the symptoms developed and the physician was able to take the time and explain things to him. And that’s what it took for this guy to get over it.
Krys Boyd [00:22:41] I don’t want to get too far afield here, but concierge practices sound ideal. You know, you do get more time with your physician. You get maybe greater access. As you mentioned, there’s a charge that many or most people can’t afford to pay. Just to digress for a moment here. Do you know, Joanne, is there a great call in the health care system for making medical school classes larger?
Joanne Silberner [00:23:09] I haven’t followed that very much. You know, I hear that every every once in a while, you know, more men like in Washington State here, we just started another a second medical or another medical school for that purpose. But and the hope is that they’ll practice in a state. But I think that there is a little bit of a call for it, but we probably have too many specialists and too few primary care doctors, and that’s a hard one to deal with because when somebody comes into medical school, they may say, Yeah, I want to be a primary care doctor. And when they get out, they say, No, I think I’d like the life of a neurologist more, you know, And there you go.
Krys Boyd [00:23:47] Yeah, the money’s better. The hours, maybe better than nothing. So as you mentioned, Joanne, the good news in the 21st century is that we have gained some really quality insight into how people with mental illnesses can be treated. The first line care recommendations for patients suffering from health anxiety disorder and somatic symptom disorder are cognitive behavioral therapy or drug therapy. How does CBT work, generally speaking, for people with hypochondria?
Joanne Silberner [00:24:15] Will you go in for sessions either most likely with a psychologist or another health care worker who specializes in talk therapy and they help you figure out behavior. So let’s say, you know, every time you read something in the medical journal that you happen to subscribe to, you get anxious that you have it. And the cognitive behavioral therapist might say, let’s talk about not reading that particular not reading medical journals. You know, let’s let’s give you something else to read. Let’s you know, it’s looking at the behaviors and treating now, not trying to get at what caused the hypochondria because nobody actually really knows what causes it. So, you know, the idea of two years of psycho analysis, you know, it’s just not a it’s not practical and B, it’s not particularly effective. But cognitive behavioral therapy has been proven to be effective because it looks at your behaviors and tries to get you if you have cyberchondria, you know, well, you know, instead of going out to the computer to look at medical conditions, maybe, well, let’s play Fortnite. I don’t know if I’d actually recommend Fortnite, but, you know, let’s do this. You know, what about if you tried doing something else, let’s replace it. Every time you think of something that makes you anxious. Let me give you another thought to put in your head. Like when you feel that anxiety. Come on, think of your summer vacation. You know, just let’s replace one thought with another. And I’ve talked to a few people who’ve had cognitive behavioral therapy who said, you know, it didn’t make everything go away like this. One woman I talked to said she recently had three close relatives die close together. And she went and suddenly every symptom she had was one of the symptoms that one of her relatives had had. She said she had to go back to her training. It didn’t cure her. You know, the CBT she’d done did not cure her. I shouldn’t say you don’t get CBT, you take part in it. And the CBT she had learned she had to go back to that the habits and think about what she had been told and replacing one thought with another. So again, she wasn’t cured, but she was given tools to deal with anxiety.
Krys Boyd [00:26:30] So in terms of drug therapy, anxiety is certainly a component of hypochondria. Do patients are they typically prescribed anti-anxiety medications or antidepressants or both or a combination?
Joanne Silberner [00:26:44] And that’s a great question because both have been proven effective. And when I say effective and they’re sort of in the same range of effectiveness as the antidepressants for depression, in that it’s not 100% and it’s not even 75%. It’s a little lower than 50% for for hypochondria, which when you get I wasn’t able to find anybody who had a prescription. You know, if you have illness, anxiety disorder, you get this. Actually, I did find one guy who divides out illness anxiety disorder from somatic symptom disorder. And he goes for cognitive behavioral therapy for the illness anxiety disorder and for antidepressants for somatic symptom disorder. But that that research is still sort of going on going forward. It you know, if you if the doctors in your area tend to do you know may tend to do one, they may tend to do it the other or both, there’s no real way to say who should get what. And it’s also it’s what’s available in your area, You know, getting a hold of a therapist, a mental health therapist is a difficult in a lot of parts of the country. And that’s actually one of the reasons why we were talking about telehealth a little earlier. People are working on telehealth. They’re also working. There’s some interesting research and just playing computer programs, self-taught computer programs. But if you live in an area where there are therapists or if you’re part of a group practice, if you’re you know, if you’re going to a in a health system where it’s a whole group of people who are you have access to, you might be sent to them before drugs are tried. It’s also a personal preference. You know, some people don’t want to take drugs or some people don’t want to talk to a therapist. So I think doctors are making individual decisions based on what’s available and what they think the patient will accept.
Krys Boyd [00:28:43] Given the disrespect that some people suffering from hypochondria perceive within the modern health care system. I was fascinated to learn from your article that there was a time when the condition was almost what cool with a certain segment of society.
Joanne Silberner [00:28:58] Yeah. And there’s some really beautiful writing about it from some very, very thoughtful people who were able to describe their hypochondria. And yeah, it was, it was cool for a while, you know, it was, you know, the swooning woman or the man who was just there. Well, I’ll tell you, James Boswell is one of my favorites. He was the he was a biographer of an English writer named Samuel Johnson. And, you know, people say everyone should have a Boswell because, you know, Boswell was just such an incredible clown before. And he himself had hypochondria. And he said a hypochondriac fancies himself at different times suffering death in all the various ways in which it has been observed. And thus he dies many times before his death. I mean, it is such a romantic note, you know, sort of a black romantic moment there just to be able to talk about it like that. There was a French philosopher named Jacques Derrida who had said throughout his life, he says life will have been so short. And he ended up dying of pancreatic cancer at 74. So it wasn’t from his hypochondria, but it was it was a sort of romantic mess that went along with it. And of course, it was only among wealthy people who could afford that, that sort of romanticism.
Krys Boyd [00:30:26] Joanne, do you know whether people who turn out to be suffering from hypochondria tend to be resistant to mental health treatment to the extent that they believe there is something catastrophically wrong, potentially with their bodies rather than with their minds?
Joanne Silberner [00:30:41] Yeah, that’s, you know, denial is is of that sort. It can really affect your willingness to accept any kind of treatment or even seek it. That’s a real problem.
Krys Boyd [00:30:54] What can physicians do to care for these patients in ways that, like help the whole person, respect the whole person, but also ask them to kind of confront reality?
Joanne Silberner [00:31:07] Well, it’s how you ask them to confront reality, I think and this isn’t based on research data that I can point to, but the sense I get from talking to physicians who are concerned about this is arguing with the patient will get you nowhere, you know, absolutely nowhere. And that doctor I talked to who took care of the patient I talked to, I asked him how many times does he use the word hypochondria in a month? And he said he said, not once in my career. He said I would never tell someone that they were a hypochondriac and I would never tell them that they have hypochondria except for this one guy who wrote the book, because in writing the book they had a lot of discussion. But he said, I don’t use that word. I say, You know this, and he tries to point out to them what this anxiety is doing to them, you know. So he tries to point out that there is relief that that he’s not denying that this person. Is in pain and of either psychological pain or even, you know, if they’ve got that rapid heartbeats or some of the other diffuse symptoms not that are what is determined there unrelated to an illness, he’ll say, you know, this is interrupting your life. And I think that, you know, in his case, they’ll talk to him. But in other cases, you know, he might have in the past when he was an academic physician, had to send them on to a therapist because of a lack of time. And he would say, you know, we can well, let’s deal with this concern because it’s hurting you. It’s limiting your ability to enjoy life, to do your job, you know, whatever it is. But he’ll point out that they have symptoms that can be alleviated and not point out that. That they have hypochondria. And he will you know, and obviously this guy is is able to really fully address people’s medical symptoms because he’s got the time and the people he’s talking to have the have the means. But you know what part of this is in any kind of medical system for the doctor to be clear about how, you know, the person’s health or what he’s been able to determine or what she’s been able to determine. One of the interesting angles of this is something that I call in numeracy, and that’s people’s inability or difficulties in understanding numbers. And they have found this. People with hypochondria have difficulty. Sort of understanding them. So if I tell you you have a 1 in 100 or 1 in 1000 chance of having an illness, you may said the great, you know that that’s great. If I tell somebody with hypochondria, you have a 1 in 100 or a 1 in 1000 or whatever chance of an illness, they’re going to say, See, it’s a possibility. So one suggestion from I talked to one of the researchers who did a study on how people with hypochondria understand numbers. He said, you know, present it to them as even one and, you know, you’ll only have a 1 in 1000 chance because that’s still a chance. That’s a real chance to them. You say to them, you have a 999 out of a thousand chance of being just fine. You know, you have to present the numbers to people very carefully for them to really understand it correctly. And then another group of researchers looked at how reassure able people were. And so they set up these scenarios where people watched a doctor talking to a patient and the doctor would talk to. And then there were two separate sets of videos. One was where the doctor was just very straightforward, you know, the 1 in 100 chance. And, you know, this is these are the possibilities and this is what it looks like. And the other doctor was the same doctor, same patient, but different, you know, a different video. The doctor was very reassuring. And they found that the people with hypochondria watching the reassuring one were less reassuring when they asked, What do you think this patient’s fate is going to be? The ones with the with hypochondria thought, well, they’re going to get sick or they are sick. They they weren’t reassured by the most reassuring scenario that could be set up.
Krys Boyd [00:35:30] I hesitate almost to say this aloud for fear of awakening the viral gods, but I have still never had Covid to my knowledge.
Joanne Silberner [00:35:38] Oh my gosh.
Krys Boyd [00:35:39] But I will say, especially in those early months of the pandemic, I was sort of hyper vigilant about any little symptom that I might have felt. Can something like an epidemic or a highly reported health crisis trigger episodes of hypochondria in people who are vulnerable?
Joanne Silberner [00:35:57] Absolutely. Actually, there’s this not it’s not really clear how common hypochondria is. Part of it is based on the definition of it, and part of it is based on well, actually, a lot of it is based on how you define it and how you test for it, what kind of questions you ask. So nobody really knows the incidence, but it’s clear that the incidence went up during Covid. Absolutely. It completely went up during Covid. It can go up, you know, after you’ve had an illness. But definitely, you know, epidemics can can set it off. And especially with something like Covid, where, you know, the symptoms were pretty common, you know, as certainly since it’s worn off a little bit, the symptoms, you know, fever, aches, pains, other problems, you know, they certainly look like they could be Covid. And one of the sort of the father of hypochondria research, a guy named Arthur Barsky at Harvard, who’s really that he did all the early work when nobody was looking at it. And, you know, I asked him, you know, what causes hypochondria? And what he said, nobody really knows. And then he said, you know, he said, I blame drug company advertising for a lot of cases. He says, every time you turn on the TV, they give you a list of the few symptoms. You know, you see this list of your symptoms, go see your doctor. You know, the symptoms are, you know, fatigue. There’s things that can happen to you episodically. And then you see this commercial and it’s all fancy and it’s very professionally done. And they’re telling you, go see a doctor. He said, Yeah, of course, you know, people are going to go for them. He doesn’t think it causes hypochondria, he said, but it certainly can trigger it in vulnerable people.
Krys Boyd [00:37:46] Sure. And those ads also I mean, people’s lives are made better and saved by pharmaceuticals. I’ll stipulate that. But those ads imply that, like once you have access to this medication, you’ll be out riding a tandem bike all the time and nothing will ever bother you again. I mean, it is, you know, for people with even general anxiety, it’s tempting to think that maybe that could be a fix for you.
Joanne Silberner [00:38:07] Absolutely. Absolutely.
Krys Boyd [00:38:10] So you mentioned that nobody really knows what causes this, why some people have a tendency toward hypochondria and others don’t. What does anybody looked into with regard to genetic links?
Joanne Silberner [00:38:24] There’ve been a couple of studies, and the most interesting one I found was it was a Twins study. They looked at identical twins and fraternal twins. So with identical twins, you’ve got the same genes for pretty much the same genes. Fraternal. Still similar, but but not identical. And they found very slight suggestion wasn’t statistically significant. If there is a genetic component, it’s a small one. They just haven’t been able to to find that.
Krys Boyd [00:38:53] I’ve also wondered about whether it is socially heritable. Like if you grow up with a parent who has health anxieties, those attitudes and behaviors displayed by that parent might be instilled in a child because they feel like what is normal.
Joanne Silberner [00:39:11] Or the other way around. The channel could be objecting or it could say, I want to get away from that. That’s a great question. And a not just a parent, but just a society. You know, is it more common where it’s more accepted or more common where it’s not as accepted, just, you know, for the contrary ness of it all? I don’t know. But I would be really curious. I’d love to know the answer about whether if you’ve got a parent or close relative, are you more susceptible? You know, one of the issues may be that there’s so much environmental and environmental component. You know, we were just talking about Covid and pandemics can really increase your risk. And of course, you’re exposed to the same thing that your parents are generally. So with that to it, I don’t know.
Krys Boyd [00:40:02] To go back for a moment to Cyberchondria. Many of us will have Googled our symptoms when we aren’t feeling well. And sometimes, you know, we are able to legitimately self-diagnose. Is there a way to know we might be developing a problem using these ubiquitous online tools?
Joanne Silberner [00:40:21] There have been studies showing that the more you use the tools, the more susceptible you are to it. And of course, is that cause for effect? Who knows? If it gets to that life limiting issue, is it life limiting? Are you not doing other things? So you’re not having any enjoyment in life because you’re spending all your time on the computer or because you’re spending all your time thinking about getting on to the computer and you’re, you know, kicking your brother or sister off the family computer, you know, is it interrupting your life and going? It is. A number of people assured me it’s absolutely normal to look up something when you’ve heard something from your doctor or when you have a symptom. It’s very normal to go to the computer. The question is, how long do you stay on the computer?
Krys Boyd [00:41:10] Lots of us have heard about medical students, like going through this period where as they are learning about all the ways human bodies can fail. They start to overinterpret the significance of day to day changes. Do we know is there something about medical school that also helps people get over that?
Joanne Silberner [00:41:27] Well, the great question again. There have been studies showing there is something called medical student syndrome. There have been studies show that there’s not. So there’s disagreement within the medical community of whether that happens. And I sort of suspect, you know, having had many friends go to medical school, that it happens a little bit, but they’re too busy, you know, to to deal with it. I mean, certainly they they’re learning material and they’re learning to look out for things and you’d think they’ve got it. I think that there has to be something to it that they’ve got to start going through things themselves because they’re learning about things that, you know, as a layperson, you know, we wouldn’t think about. And suddenly they’re thinking about it, but suddenly they’re, you know, staying up all night and having all these other things going on in their life. So and I know that medical school, you know, does exist. I suspect it does. But you’ll get some argument there.
Krys Boyd [00:42:26] You spoke to a woman with hypochondria for this piece and she told you she is less afraid of death than of dying and suffering. What did she mean by that?
Joanne Silberner [00:42:37] Yeah, she was just terrific. She’s a columnist for The Observer, I think, in The Guardian in England, and she’s really thoughtful about it. She said it’s not you know, I think that if you don’t have hypochondria, you know, your fear of death might be one thing. But if you do have hypochondria. That’s not what you’re worried about. You know, she’s much more worried about suffering. What was she going to do? You know, she’s got kids who going to do the take kids to school. Who is going to make them lunch? You know, all these things. You know, if she was incapacitated, who would take her place? It wasn’t dying or death. It was the path there that she was obsessed about.
Krys Boyd [00:43:24] Many of us might have someone in our lives who appears to us, even if we’re not experts, to be a little obsessed or filled with anxiety around their own health. What can we do to be a source of comfort to these folks without necessarily validating their fears?
Joanne Silberner [00:43:41] That’s a great question. I talked to a couple of therapists who treat people and they said the first thing to do is to express empathy. You know, somebody is worried about something. Don’t deny what they’re worried about. First of all, you’re not qualified unless you’re a physician who has put these people through all sorts of medical tests. You can’t really say, I’m sure you think, I’m sure it’s nothing. It’s not going to help. If you see that, it’s life limiting. You know, beyond expressing sympathy. You can say, you know what? Maybe you should see a doctor. How about if I make an appointment for you with my doctor? Or you suggest to give them a couple of strategies? Would you want to talk to a doctor? I can help you do that. Or if would you like to talk to a therapist? And you and the therapist can make the decision about whether they should start with a doctor. You know, somebody you’ve seen, go to 400 doctors and come home and say, you know what, These damn doctors, they can’t figure out what’s wrong with me. And you can say, that’s got to be rough. You know, maybe you should talk to a therapist about, you know, a mental health therapist about it who can help you figure this out. You know, offer strategies and don’t deny, basically.
Krys Boyd [00:45:01] Joanne Silberner is co-founder of the Association of Health Care Journalists and author of the Scientific American article, “Hypochondria is a Real and Dangerous Illness. New Research shows.” Joanne, this has been so interesting. Thanks so much for making time for the conversation.
Joanne Silberner [00:45:16] I’ve enjoyed it. Thank you.
Krys Boyd [00:45:18] Think is distributed by PRX, the public radio exchange. You can find us on Facebook and Instagram and listen to the podcast where you get podcasts. The website is think.kera.org Again, I’m Krys Boyd. Thanks for listening. Have a great day.
