Hypochondriasis: the disease that doesn’t exist?

After the favorable outcome of a medical examination, healthy individuals derive relief and energy. For hypochondriacs, however, peace of mind is ephemeral. Fear persists, prompting them to believe they are suffering from various diseases. Despite this, hypochondria is still an object of social derision. Nevertheless, it is a real and significant psychological disorder.

Brief history of hypochondria

Hypochondria, a concept rooted in history, has its origins in the ancient Greek belief that emotions, including fear, were located in the abdomen, hence the term „hypochondrias disease,“ referring to the lateral areas above the thoracic diaphragm. 

In 2013, the term „hypochondria“ was removed from the DSM, replaced with „somatic symptom disorder“ and „illness anxiety disorder„. The advent of the internet has led to „cyberchondria,“ with online searches generating imaginative self-diagnoses, compromising the doctor-patient relationship. 

Hypochondria, in addition to negatively affecting quality of life, can result in panic attacks and be associated with depression or other psychiatric disorders. Despite the interest in diseases, the unscientific approach and obsessive search for symptoms are exhausting. Hypochondria should be regarded as a psychological disorder with significant impacts on both the individual and the health care system.

Are hypochondriacs at risk of dying sooner?

According to research conducted by Karolinska Institutet, hypersensitivity to the possibility of contracting a life-threatening illness is associated with a five-year reduction in average lifespan compared to individuals without the chronic worry. 

The study, published in Jama Psychiatry, involved 42,000 individuals followed over a 20-year period, including 1,000 subjects with hypochondria. The results revealed that those who suffered from hypochondria showed a significant reduction in life expectancy. In addition, patients with hypochondria had an almost four times higher risk of suicide and a higher risk of mortality due to respiratory diseases, such as influenza and Covid, as well as circulatory and neurological disorders. 

The research team analyzed data from the Swedish National Patient Registry, which provides information on the health status of all patients in the country. The results showed that the majority of patients with hypochondria (57%) were female, and the vast majority also had other anxiety disorders (78%).

What are the causes of hypochondria?

The hypochondriac’s constant apprehension, sometimes triggered by normal physical sensations such as sweating or swelling, can induce a state of chronic stress, which is recognized as a well-documented cause of physical disorders. The mechanism of stress and anxiety can activate the secretion of stress-related neurotransmitters and hormones, which in turn can stimulate increased levels of systemic inflammation

Numerous research studies have established a correlation between chronic inflammation and a wide range of issues, including a compromised immune system, which reduces the body’s ability to effectively fight infection and disease.

What are the possible treatments?

Those suffering from hypochondria can access different forms of treatment, both psychotherapeutic and pharmacological. According to Laura Bellodi, head of the Center for Anxiety and Obsessive-Compulsive Spectrum Disorders at Irccs Ospedale San Raffaele in Milan, the general practitioner can provide initial comfort, but over time his or her role may lose effectiveness. 

Cognitive-behavioral psychotherapy is indicated to help recognize and address cognitive and emotional distortions, offering practical strategies for daily living. Medications that act on serotonergic neurotransmission, such as tricyclics and selective serotonin reuptake inhibitors, are effective but can cause side effects that can compromise long-term therapy. 

In this regard, a Slow Medicine survey highlighted the changing role of the physician when faced with hypochondriac patients, often taking on a role as a psychological counselor. Many physicians believe that longer visits are necessary to better understand the patient’s concerns and identify their root causes. However, the relationship between doctor and patient can become adversarial, with excessive demands for unnecessary diagnostic tests from patients, which strains trust and the relationship between professional and patient.

A recent study in the scientific journal CORTEX found altered brain connectivity in hypochondriacs, highlighting the psychological nature of the disorder. It is important to recognize the serious impact of illness anxiety on the lives of patients and their families. Nowadays, it is therefore crucial to overcome the concept of „imaginary sick people“ and consider hypochondria as a real clinical condition.