Every doctor recognizes them.
The man who discovers a bruise on his thigh and becomes convinced that it is leukemia. The woman who examines her breasts so frequently that she makes them tender, then decides that the soreness means she has cancer. The man who has suffered from heartburn all his life but after reading about esophageal cancer has no question that he has it.
They make frequent doctors' appointments, demand unnecessary tests and can drive their friends and relatives -- not to mention their physicians -- to distraction with a seemingly endless search for reassurance. By some estimates, they may be responsible for 10 percent to 20 percent of the US' staggering annual health care costs.
Yet how to deal with hypochondria, a disorder that afflicts one of every 20 Americans who visit doctors, has been one of the most stubborn puzzles in medicine. Where the patient sees physical illness, the doctor sees a psychological problem, and frustration rules on both sides of the examining room.
Recently, however, there has been a break in the impasse. New treatment strategies are offering the first hope since the ancient Greeks recognized hypochondria 24 centuries ago. Cognitive therapy, researchers reported last week, helps hypochondriacal patients evaluate and change their distorted thoughts about illness. After six 90-minute therapy sessions, the study found, 55 percent of the 102 participants were better able to run errands, drive and engage in social activities. Antidepressant medications, other studies indicate, are also proving
effective.
"The hope is that with effective treatments, a diagnosis of hypochondriasis will become a more acceptable diagnosis and less a laughing matter or a cause for embarrassment," said Dr. Arthur Barsky, director of psychiatric research at Brigham and Women's Hospital in Boston and the lead author of the study on cognitive therapy, which appeared in the March 24 issue of The Journal of the American Medical Association.
Almost everyone has inexplicable physical symptoms from time to time, and many people experience a moment of worry that their odd rashes, bumps or pains are signs of real trouble. But an official diagnosis of hypochondria, according to the American Psychiatric Association, is reserved for patients whose fears that they have a serious disease persist for at least six months and continue even after doctors have reassured them that they are healthy.
In patients with hypochondria, experts say, ordinary discomforts appear to register more intensely than they do for other people.
Looking in
"The person's nervous system is like a radio whose volume has been turned up so high, the background static becomes intolerable," Barsky said.
Researchers have found that hypochondria, which affects men and women equally, seems more likely to develop in people who have certain personality traits. The neurotic, the self-critical, the introverted and the narcissistic appear particularly prone to hypochondriacal fears, said Dr. Michael Hollifield, an associate professor of psychiatry at the University of New Mexico.
As many as two-thirds of hypochondriacs also have other psychiatric disorders. Studies suggest that 40 percent suffer from major depression, 10 percent to 20 percent have panic disorder, 5 percent to 10 percent have obsessive-compulsive disorder and some have generalized anxiety disorder.
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