March 22, 2024 • 16 mins
Make no mistake: hypochondriacs are definitely suffering—especially from the constant worry about the conditions they think they might have. Negative test results won't necessarily banish the anxiety, but Dr. Saltz reveals what does work.
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Episode Transcript
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Speaker 1 (00:05):
These are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm doctor
Gail Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, the psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. The term hypochondriasis is
derived from the old medical term hypochondrium, which means below
the ribs, because most people with this condition have abdominal complaints.
(00:47):
When we think of a hypochondriac, we tend to think
about an actor like Woody Allen and his constant fears
and roles that he has some terrible medical illness that,
of course never really exists. Today, I'm answering a listener's
question about hypochondriasis. Hypochondriasis is a person's inaccurate interpretation of
(01:08):
real physical sensations but that actually have no medical cause.
The preoccupation with having a serious medical disease causes them
a lot of distress and compromises their functioning in an
important area of their life. About five percent of people
have this condition, men and women, have it equally, and
(01:32):
it most often develops in a person's twenties. It often
comes along with depression or anxiety, and despite a doctor's
negative test results, a person is not really convinced they
are okay. Over time, they may move on to a
new disease to worry about. There are several theories as
(01:55):
to what causes hypochondriasis. First is people who might have
a lower discomfort tolerance in general, and then they misinterpret
whatever pain or ache their feeling and experience as to
meaning something more than it does. Alternatively, a wish to
(02:16):
be sick so as to escape insurmountable stresses in their
life and be excused from difficult responsibilities. Now this wish
is probably unconscious, and so what they experience is simply
their falling ill or they're very ill, but that underneath
it all might be the root. Then there is the
(02:39):
defense against feelings of guilt and a belief that deep
down they are bad in some way, and the pain
becomes sort of a deserved punishment for past, real or
imagined wrongdoings. Again, another what I would call psychodynamic unders
(03:00):
standing of where this type of anxiety can come from.
And sometimes it's thought that this is really just a
variation on symptoms of depression or an anxiety disorder, and
today we very much think about it as health anxiety,
(03:20):
a type of anxiety disorder. Hypochondriasis often arises after a
traumatic event, like the death or illness of a loved one,
or the person in question themselves surviving a serious illness.
This usually goes away with time, as does this symptom
(03:41):
in children, who by their late teens will then no
longer have the problem. If, for example, if this occurred
in childhood, but sometimes it doesn't go away. Most hypochondriacs
do not want to understand the psychological reason for it,
because they pretty firmly believe it is a medical problem.
(04:04):
A regular checkup to have both the doctor's attention and
the facts that they are fine medically is actually really helpful.
On the other hand, doing unnecessary tests or procedures is
not a good idea and will likely only increase the
concern that something is wrong. Attention to the stress in
(04:28):
their lives and their feelings from loved ones is helpful
as this is generally the underlying problem, not enough attention
from loved ones and too much stress, but positive reinforcement
for the sick role. In other words, oh no, you're
not well, I have to pay extra attention to you.
(04:50):
Only now when you're not well, as opposed to any
other time is a bad idea because it will only
lock in the belief a that they have an illness
and b gives them a positive feeling about being ill.
Group therapy is often helpful because feedback from others going
(05:11):
through the same sorts of things provides a social support
that reduces anxiety and tends to make them less afraid
about illness. While it's tough to live with a hypochondriac,
it isn't helpful to ignore them or tell them they
don't feel anything, because you know what they do. They
(05:31):
really feel the pain, So reacting to their stress without
buying into the illness itself is the best road to take,
and of course encouraging any psychological treatment that they will allow.
The Symptoms of hypochondriasis, which is also known sometimes as
illness anxiety disorder, or health anxiety, typically include a preoccupation
(05:55):
with having a serious illness like individuals with hypochondriasis often
have this intense fear or belief that they have a
severe illness, despite medical reassurance and even evidence to the contrary.
They have excessive health related worries, like constantly worrying about
(06:16):
their health, checking their body for signs or symptoms of illness,
and that even minor bodies sensations or changes are often
interpreted by them as evidence of a serious medical condition.
They may have frequent doctor visits to some sort of
health care provider, repeatedly seeking assurance about their health or
(06:38):
requesting specific medical tests and procedures. The fear of having
a serious illness can cause significant anxiety and distress for them,
which then can interfere with their daily functioning and their
quality of life. Hypochondriasis can lead to difficulties in relationships,
(06:59):
in war, work, and other areas of life. Due to
this constant worry and this preoccupation with health concerns, they
may do excessive research or seeking out medical information, spending
time online researching illnesses, symptoms, medical conditions, and actually by
(07:19):
reading all this stuff, they often make their health related
worries worse. A lack of reassurance from medical tests is
really notable for people like this. The test comes back
it's normal, or maybe it shows some very minor abnormality
that doesn't mean anything, and the individual with hypochondriasis will
(07:41):
still believe they have a serious illness. It's important to
note that these symptoms are not better explained by another
medical condition, such as anxiety disorder or somatic symptom disorder,
and they must cause significant distress or impairment in functioning
to meet the criteria for illness anxiety disorder. If you
(08:04):
or someone you know is experiencing symptoms of hypochondriasis, it's
really important to seek help from a mental health professional,
to get an evaluation and to get appropriate treatment, because actually,
while we may laugh at Woody Allen in the movies,
this can be a very debilitating problem. After this break,
(08:26):
we'll get to my listener's question. Back with my listener's question,
Dear doctor Saltz, sometime in my mid twenties, when I
(08:49):
was in a particularly stressful situation, I found myself worrying
a lot about whether stomach aches I was having was
actually something really ominous. Truth is, I kept thinking this
is cancer. I worried and worried, and kept complaining that
it could be cancer to people around me, to the
point that someone insisted I go to the gastonrologist. When
(09:14):
I did, he did run some tests and it was
not cancer. It was gastritis. I took some medication and
I got better. But since that time, I've often found
myself worrying that I actually have something really awful. Sometimes
I think it's cancer somewhere. Other times I think it's
(09:37):
some neurological disease or some other weird disease I've read about. Unfortunately,
this consumes a lot of my thinking these days, and
it makes me nervous much of the time. I try
to tell myself it's probably nothing, but that just doesn't work.
Then sometimes the idea does die down mean before up
(10:00):
of weeks, but eventually some other health worry comes to mind,
and then I start all over again. What is this problem?
And what can I do to stop being tortured with
these fears. This sounds like an anxiety disorder given it
has lasted a long time, like years. Yes, the content changes,
(10:23):
but the worry remains, and it's negatively impacting your life
in that it takes up so much of your time,
making you feel nervous, given all of your thoughts are
related to your health. It is a subset of anxiety
disorders called health anxiety or hypochondriasis. It's not that the
(10:45):
feelings you have in your body are not real. It's
that you are very sensitive and you are over interpreting
them to be something that mostly they are not, and
that the thing you worry they mean is off and
something dangerous and dire. So your stomach aches were real,
(11:06):
but they were due to an irritation from too much
acid in your stomach, not cancer, not something serious, actually
something very common and something very easily treated by just
taking an ant acid. And as you know, once reassured,
it did ultimately go away, but then some other worry
popped up to take its place, and that is classic
(11:29):
for health anxiety. The treatment is a cognitive behavioral type
of psychotherapy. Some people who have more extreme symptoms may
also require medication to reduce their anxiety along with psychotherapy,
which teaches you how to recognize these thoughts as anxiety
(11:50):
symptoms and rather than believe they are real, but also
rather than just trying to push them out, which doesn't work,
like when you say us, quit it to yourself, you
label them, ah, this is my anxiety thought. And then
you build tools to allow you to say to yourself,
I will just let them be over time, when you
(12:15):
get better at doing this by not responding to them,
but not pushing them away, you are able to let
them diminish over time. This is simply what happens, and
it is the goal of cognitive behavioral therapy. Finding a
therapist who specializes in CBT for anxiety disorders to help
(12:36):
you learn these tools is what you should do now.
This is a very treatable problem and it will allow
you to greatly reduce your current symptoms and get back
your life. I hope that was helpful. Hypochondriasis, also known
(12:57):
as illness anxiety disorder, can be challenged to treat, but
several approaches can be effective. The first is therapy. Cognitive
behavioral therapy is used to treat hypochdriasis and individuals learn
to recognize and challenge their negative thought patterns and beliefs
about illness. They also learn coping strategies to manage anxiety
(13:22):
and therefore reduce the frequency and the intensity of their
health related worries. Another method is exposure therapy, which means
gradually exposing the person to situations that trigger their health
related anxiety. Through repeated exposure, they learn to tolerate the
(13:44):
anxiety without engaging in compulsive behaviors such as excessive checking
of symptoms or seeking reassurance from others, and then over
time they become desensitized from this exposure and the symptoms lesson.
Also possible is medication. Medication like serotonin reuptake inhibitors or
(14:07):
serotonin nor epernephrine reuptake inhibitors may be prescribed to help
alleviate anxiety in general and depression symptoms as well that
are often associated with hypochondriasis. Medication should be used in
conjunction with therapy rather than a standalone treatment, because over
time one would come off medication once having learned the
(14:31):
techniques and have responded to the techniques, so that that
can stay in place. Education and reassurance is helpful because
providing accurate information about health and about illness. The reassurance
sometimes of a healthcare provider, for example, having your checkup
to know basically you're okay, can alleviate some of the
(14:54):
fears and concerns of people with hypochondriasis. However, this needs
to be done in a way that doesn't reinforce or
validate their excessive health worries. Like a doctor who says,
let's do a bazillion test to just make sure, make sure,
make sure. Mindfulness and relaxation techniques. Techniques of mindful meditation,
(15:18):
deep breathing exercises, progressive muscle relaxation can all help individuals
with hypocondriasis manage their stress and anxiety levels, which can
drive their symptoms. And support groups. Connecting with other people
who've had similar experiences can help validate, provide understanding and
(15:39):
support for people with hypocondriasis, and support groups also offer
practical coping skills and encouragement in using them. It is
important for treatment to be tailored to the specific individual
and the circumstances, and sometimes it requires patience and persistence
(15:59):
to see improvement. This multidisciplinary approach I'm referring to involves
mental health of professionals, sometimes a primary care physician who
would talk to the mental health professionals so they can
understand what the patient is struggling with and provide appropriate
but not overkill reassurance, and other healthcare providers if needed
(16:23):
to manage hypochondriasis effectively. Do you have a problem I
can help with? If so, email me at how Can
I Help? At senecawomen dot com. All centers remain anonymous
and listen every Friday to how can I Help with me?
Doctor Gail Saltz
These are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm doctor
Gail Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, the psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. The term hypochondriasis is
derived from the old medical term hypochondrium, which means below
the ribs, because most people with this condition have abdominal complaints.
(00:47):
When we think of a hypochondriac, we tend to think
about an actor like Woody Allen and his constant fears
and roles that he has some terrible medical illness that,
of course never really exists. Today, I'm answering a listener's
question about hypochondriasis. Hypochondriasis is a person's inaccurate interpretation of
(01:08):
real physical sensations but that actually have no medical cause.
The preoccupation with having a serious medical disease causes them
a lot of distress and compromises their functioning in an
important area of their life. About five percent of people
have this condition, men and women, have it equally, and
(01:32):
it most often develops in a person's twenties. It often
comes along with depression or anxiety, and despite a doctor's
negative test results, a person is not really convinced they
are okay. Over time, they may move on to a
new disease to worry about. There are several theories as
(01:55):
to what causes hypochondriasis. First is people who might have
a lower discomfort tolerance in general, and then they misinterpret
whatever pain or ache their feeling and experience as to
meaning something more than it does. Alternatively, a wish to
(02:16):
be sick so as to escape insurmountable stresses in their
life and be excused from difficult responsibilities. Now this wish
is probably unconscious, and so what they experience is simply
their falling ill or they're very ill, but that underneath
it all might be the root. Then there is the
(02:39):
defense against feelings of guilt and a belief that deep
down they are bad in some way, and the pain
becomes sort of a deserved punishment for past, real or
imagined wrongdoings. Again, another what I would call psychodynamic unders
(03:00):
standing of where this type of anxiety can come from.
And sometimes it's thought that this is really just a
variation on symptoms of depression or an anxiety disorder, and
today we very much think about it as health anxiety,
(03:20):
a type of anxiety disorder. Hypochondriasis often arises after a
traumatic event, like the death or illness of a loved one,
or the person in question themselves surviving a serious illness.
This usually goes away with time, as does this symptom
(03:41):
in children, who by their late teens will then no
longer have the problem. If, for example, if this occurred
in childhood, but sometimes it doesn't go away. Most hypochondriacs
do not want to understand the psychological reason for it,
because they pretty firmly believe it is a medical problem.
(04:04):
A regular checkup to have both the doctor's attention and
the facts that they are fine medically is actually really helpful.
On the other hand, doing unnecessary tests or procedures is
not a good idea and will likely only increase the
concern that something is wrong. Attention to the stress in
(04:28):
their lives and their feelings from loved ones is helpful
as this is generally the underlying problem, not enough attention
from loved ones and too much stress, but positive reinforcement
for the sick role. In other words, oh no, you're
not well, I have to pay extra attention to you.
(04:50):
Only now when you're not well, as opposed to any
other time is a bad idea because it will only
lock in the belief a that they have an illness
and b gives them a positive feeling about being ill.
Group therapy is often helpful because feedback from others going
(05:11):
through the same sorts of things provides a social support
that reduces anxiety and tends to make them less afraid
about illness. While it's tough to live with a hypochondriac,
it isn't helpful to ignore them or tell them they
don't feel anything, because you know what they do. They
(05:31):
really feel the pain, So reacting to their stress without
buying into the illness itself is the best road to take,
and of course encouraging any psychological treatment that they will allow.
The Symptoms of hypochondriasis, which is also known sometimes as
illness anxiety disorder, or health anxiety, typically include a preoccupation
(05:55):
with having a serious illness like individuals with hypochondriasis often
have this intense fear or belief that they have a
severe illness, despite medical reassurance and even evidence to the contrary.
They have excessive health related worries, like constantly worrying about
(06:16):
their health, checking their body for signs or symptoms of illness,
and that even minor bodies sensations or changes are often
interpreted by them as evidence of a serious medical condition.
They may have frequent doctor visits to some sort of
health care provider, repeatedly seeking assurance about their health or
(06:38):
requesting specific medical tests and procedures. The fear of having
a serious illness can cause significant anxiety and distress for them,
which then can interfere with their daily functioning and their
quality of life. Hypochondriasis can lead to difficulties in relationships,
(06:59):
in war, work, and other areas of life. Due to
this constant worry and this preoccupation with health concerns, they
may do excessive research or seeking out medical information, spending
time online researching illnesses, symptoms, medical conditions, and actually by
(07:19):
reading all this stuff, they often make their health related
worries worse. A lack of reassurance from medical tests is
really notable for people like this. The test comes back
it's normal, or maybe it shows some very minor abnormality
that doesn't mean anything, and the individual with hypochondriasis will
(07:41):
still believe they have a serious illness. It's important to
note that these symptoms are not better explained by another
medical condition, such as anxiety disorder or somatic symptom disorder,
and they must cause significant distress or impairment in functioning
to meet the criteria for illness anxiety disorder. If you
(08:04):
or someone you know is experiencing symptoms of hypochondriasis, it's
really important to seek help from a mental health professional,
to get an evaluation and to get appropriate treatment, because actually,
while we may laugh at Woody Allen in the movies,
this can be a very debilitating problem. After this break,
(08:26):
we'll get to my listener's question. Back with my listener's question,
Dear doctor Saltz, sometime in my mid twenties, when I
(08:49):
was in a particularly stressful situation, I found myself worrying
a lot about whether stomach aches I was having was
actually something really ominous. Truth is, I kept thinking this
is cancer. I worried and worried, and kept complaining that
it could be cancer to people around me, to the
point that someone insisted I go to the gastonrologist. When
(09:14):
I did, he did run some tests and it was
not cancer. It was gastritis. I took some medication and
I got better. But since that time, I've often found
myself worrying that I actually have something really awful. Sometimes
I think it's cancer somewhere. Other times I think it's
(09:37):
some neurological disease or some other weird disease I've read about. Unfortunately,
this consumes a lot of my thinking these days, and
it makes me nervous much of the time. I try
to tell myself it's probably nothing, but that just doesn't work.
Then sometimes the idea does die down mean before up
(10:00):
of weeks, but eventually some other health worry comes to mind,
and then I start all over again. What is this problem?
And what can I do to stop being tortured with
these fears. This sounds like an anxiety disorder given it
has lasted a long time, like years. Yes, the content changes,
(10:23):
but the worry remains, and it's negatively impacting your life
in that it takes up so much of your time,
making you feel nervous, given all of your thoughts are
related to your health. It is a subset of anxiety
disorders called health anxiety or hypochondriasis. It's not that the
(10:45):
feelings you have in your body are not real. It's
that you are very sensitive and you are over interpreting
them to be something that mostly they are not, and
that the thing you worry they mean is off and
something dangerous and dire. So your stomach aches were real,
(11:06):
but they were due to an irritation from too much
acid in your stomach, not cancer, not something serious, actually
something very common and something very easily treated by just
taking an ant acid. And as you know, once reassured,
it did ultimately go away, but then some other worry
popped up to take its place, and that is classic
(11:29):
for health anxiety. The treatment is a cognitive behavioral type
of psychotherapy. Some people who have more extreme symptoms may
also require medication to reduce their anxiety along with psychotherapy,
which teaches you how to recognize these thoughts as anxiety
(11:50):
symptoms and rather than believe they are real, but also
rather than just trying to push them out, which doesn't work,
like when you say us, quit it to yourself, you
label them, ah, this is my anxiety thought. And then
you build tools to allow you to say to yourself,
I will just let them be over time, when you
(12:15):
get better at doing this by not responding to them,
but not pushing them away, you are able to let
them diminish over time. This is simply what happens, and
it is the goal of cognitive behavioral therapy. Finding a
therapist who specializes in CBT for anxiety disorders to help
(12:36):
you learn these tools is what you should do now.
This is a very treatable problem and it will allow
you to greatly reduce your current symptoms and get back
your life. I hope that was helpful. Hypochondriasis, also known
(12:57):
as illness anxiety disorder, can be challenged to treat, but
several approaches can be effective. The first is therapy. Cognitive
behavioral therapy is used to treat hypochdriasis and individuals learn
to recognize and challenge their negative thought patterns and beliefs
about illness. They also learn coping strategies to manage anxiety
(13:22):
and therefore reduce the frequency and the intensity of their
health related worries. Another method is exposure therapy, which means
gradually exposing the person to situations that trigger their health
related anxiety. Through repeated exposure, they learn to tolerate the
(13:44):
anxiety without engaging in compulsive behaviors such as excessive checking
of symptoms or seeking reassurance from others, and then over
time they become desensitized from this exposure and the symptoms lesson.
Also possible is medication. Medication like serotonin reuptake inhibitors or
(14:07):
serotonin nor epernephrine reuptake inhibitors may be prescribed to help
alleviate anxiety in general and depression symptoms as well that
are often associated with hypochondriasis. Medication should be used in
conjunction with therapy rather than a standalone treatment, because over
time one would come off medication once having learned the
(14:31):
techniques and have responded to the techniques, so that that
can stay in place. Education and reassurance is helpful because
providing accurate information about health and about illness. The reassurance
sometimes of a healthcare provider, for example, having your checkup
to know basically you're okay, can alleviate some of the
(14:54):
fears and concerns of people with hypochondriasis. However, this needs
to be done in a way that doesn't reinforce or
validate their excessive health worries. Like a doctor who says,
let's do a bazillion test to just make sure, make sure,
make sure. Mindfulness and relaxation techniques. Techniques of mindful meditation,
(15:18):
deep breathing exercises, progressive muscle relaxation can all help individuals
with hypocondriasis manage their stress and anxiety levels, which can
drive their symptoms. And support groups. Connecting with other people
who've had similar experiences can help validate, provide understanding and
(15:39):
support for people with hypocondriasis, and support groups also offer
practical coping skills and encouragement in using them. It is
important for treatment to be tailored to the specific individual
and the circumstances, and sometimes it requires patience and persistence
(15:59):
to see improvement. This multidisciplinary approach I'm referring to involves
mental health of professionals, sometimes a primary care physician who
would talk to the mental health professionals so they can
understand what the patient is struggling with and provide appropriate
but not overkill reassurance, and other healthcare providers if needed
(16:23):
to manage hypochondriasis effectively. Do you have a problem I
can help with? If so, email me at how Can
I Help? At senecawomen dot com. All centers remain anonymous
and listen every Friday to how can I Help with me?
Doctor Gail Saltz
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