Some estimates suggest that one fifth of patients seen by GPs are actually suffering from health anxiety, rather than a physical illness. The character who habitually mistakes their migraine for a brain tumour, or insists their head cold is SARS is often a figure of fun – think Woody Allen or Archie Glover in Only When I Laugh. But for some people, anxiety about their physical wellbeing can become an illness in itself.
Most of us fret about our health from time to time. Perhaps that's why it's so easy to dismiss those most likely to have ‘I told you I was ill' inscribed on their tombstones. However, there is a point at which this sort of anxiety becomes quite debilitating in itself, and develops into hypochondria.
Hypochondriac – me?
Try this test to see if you suffer from health anxiety.
The Whiteley Index is a standard test used to define hypochondria. Answer each of the following questions, awarding yourself between one and five points for each question, according to which answer you give.
How to score your answers
One point = ‘not at all'
Two points = ‘a little bit'
Three points = ‘moderately'
Four points = ‘quite a bit'
Five points = ‘a great deal'
Do you worry a lot about your health?
Do you think there is something seriously wrong with your body?
Is it hard for you to forget about yourself and think about all sorts of other things?
If you feel ill and someone tells you that you are looking better, do you feel annoyed?
Do you find that you are often aware of various things happening in your body?
Are you bothered by many aches and pains?
Are you afraid of illness?
Do you worry about your health more than most people?
Do you get the feeling that people aren't taking your illnesses seriously enough?
Is it hard for you to believe the doctor when they tell you there's nothing for you to worry about?
Do you often worry about the possibility that you have a serious illness?
If a disease is bought to your attention (through TV or newspapers, for example) do you worry about getting it yourself?
Do you find that you are bothered by many different symptoms?
Do you often have the symptoms of a very serious disease?
If your score is high (32-55) it's worth talking to your GP about whether you're worrying too much about your health.
Who's a hypochondriac?
Dr Ingvard Wilhelmsen, a Norwegian specialist in the subject, defines a hypochondriac as someone who is preoccupied with their physical health. ‘This is a person who believes, fears or has been convinced - for at least six months - that they have a serious disease. Medical examinations and tests are unable to reassure them that they are actually well,' he explains.
Hypochondria can take several forms. A person may have a real ailment but exaggerate its seriousness – thinking that a harmless blemish is a melanoma, for example. Or there may be nothing physically wrong with them at all, but they still experience symptoms. Some hypochondriacs even focus on the ordinary functions of their own body, such as their perspiration levels or heart rate, and convince themselves of abnormalities.
Symptoms of an invisible illness
The classic symptoms of hypochondria, or ‘health anxiety' as it is often now termed, include:
repetitive checking of the body for symptoms
repeated visits to the doctor
requests for multiple medical tests
‘doctor hopping': going to different doctors on the same day in an effort to gain reassurance
In many cases, hypochondria can be linked to clinical depression or obsessive-compulsive disorder but, in spite of this, it's unusual for sufferers to be treated by psychiatrists. One explanation for this is that sufferers are so convinced their problems are physical that they don't take kindly to suggestions that it's ‘all in the mind'.
Those with health anxiety can pose a real problem for GPs. Some doctors refer to hypochondriacs as ‘heartsink' patients because that's how they react when the individuals concerned come into their surgery. And this is a surprisingly frequent occurrence – health anxiety accounts for about one fifth of GP consultations, by one estimate.
Dr John Lloyd-Williams, a GP for 30 years, believes that health anxiety is very widespread. ‘It's in epidemic proportions' he says. ‘In a surgery of say, 12 patients, there will probably be three or four of them who might not have anything physically wrong with them, but who think they do.'
Aside from the time spent dealing with physically healthy patients, there is the cost of the medical examinations and tests most GPs feel obliged to offer, even though they do little to reassure chronic health anxiety sufferers. ‘Tests don't necessarily reassure people, but GPs will do them to protect themselves,' Lloyd-Williams admits.
Why are we so worried?
So where has this upsurge in anxiety come from? The dawn of the information age, when data on every kind of disease is readily available, may be partly to blame. In fact there is even a term for the habitual searching on the internet for information about illnesses and their symptoms - cyberchondria.
‘I think it's a manifestation of stress, perhaps from increased pressures in the workplace or family life' suggests Dr Lloyd-Williams. ‘It's a very complex syndrome and a disease in its own right.'
So what treatment options are open to overloaded GPs? One therapy that seems to be showing real results is Cognitive Behavioural Therapy (CBT). This works on two fronts: to encourage the patient to alter their beliefs about their illness and symptoms, and to convince the patient to try to change their behaviour.
‘Hypochondria is an extreme form of anxiety,' explains Gladeana McMahon, spokesperson for the British Association for Behavioural Cognitive Psychotherapies (BABCP) ‘Broadly speaking, CBT helps hypochondriacs to manage this anxiety and reduce the negative effects it has on their wellbeing'.
In most CBT treatments, sufferers' symptoms aren't challenged, but the way in which they interpret them is discussed and alternative explanations are offered. Patients are also given behavioural ‘homework' to do – disciplining themselves to check their body less frequently, for example. ‘Through skilful therapy and commitment, a patient can eventually eradicate the anxiety completely,' claims McMahon. ‘But the treatment can be hard work' she adds, ‘It's not an overnight remedy.'
Hypochondria can be debilitating and badly affect the lives of sufferers and those around them, not to mention the strain that hypochondriacs unwittingly place on the health system. McMahon would like to see more sufferers being referred to a cognitive behavioural therapist to get help. A list of practising members of the BABCP can be found on the association's website at www.babcp.com.