Still, it is psychiatry that offers patients the best hope of getting control of their anxiety. That often leads general practice doctors into a delicate dance, as they try to find ways to refer patients to psychiatrists without offending them.
Just mentioning the word hypochondria to a patient, Barsky said, can cause trouble.
"That comes across as, you're telling me I'm a faker, the malingerer, that it's all in my head," he said. "It's tremendously pejorative."
As a result, some experts have suggested that doctors drop the word altogether, substituting the term health anxiety, which has fewer negative connotations.
If a name change can allow more patients to accept their problem, the logic goes, perhaps more patients will seek treatment. Cognitive therapy, as demonstrated by Barsky's study, has proved surprisingly effective in helping patients who read into every ache and pain a portent of disaster.
In the study, the patients, whose fixation on illness had greatly interfered with their daily lives, did not see their symptoms disappear. But they did learn to pay much less attention to them.
The therapy taught the patients to re-examine their assumptions about the symptoms.
"We talk with patients about other possible explanations for their headaches, their tension or their lack of sleep," Barsky said.
The therapists, who included psychologists, social workers and nurses, also coaxed patients to temporarily suspend some of the usual ways they reassured themselves, like checking the Internet for health information, taking their pulse or blood pressure and scheduling appointments with doctors.
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