Hypochondria: what if it really is something serious?
The mole is definitely cancerous, the headaches are clearly a sign of a brain tumour: hypochondria is a spiral of anxiety that is very hard to escape without professional support. But friends and family can also help – if the fear of illness is taken seriously.
The nurse on the ward says: “The hypochondriac in cubicle 5 has died”. The doctor replies: “Now he’s gone too far...”.
Ok, so it’s not a great joke. But perhaps jokes like these can never really be funny, because they’re based too heavily on prejudices and misunderstandings.
The constant fear of falling ill severely restricts life. If those affected are dismissed as “neurotic” or “worrywarts”, the situation can quickly get out of hand. To help people who are constantly worried about their health, it’s important to understand the factors that cause and promote hypochondria.
5 factors that promote hypochondria
Incorrect terminology
Sneering
Avoidance
Non-stop visits to the doctor
Internet research
How psychotherapy helps with fear of illness
Treatment for hypochondria focuses on changing thought patterns and regaining quality of life. Dr Steffi Weidt explains how it works.
The line between a person who is meticulous about their health and a person with a pronounced fear of illness is often blurred. How do you diagnose hypochondria?
When a person suffers, their suffering is very real. It doesn’t matter whether that person is medically right or wrong. Often, fear of illness and worries revolve around an unpleasant physical sensation that the patient misinterprets. But the perception itself is correct. As a doctor, I have to take these concerns seriously.
How do you gain the trust of patients suffering from hypochondria when that’s precisely what they’re lacking?
I do so by taking a close look at their medical history, going over previous examination findings and considering the improbable. Even if a person has been examined a hundred times, perhaps the right thing hasn’t been considered yet. Only once all the t’s have been crossed and the i’s dotted, can psychotherapy begin.
Some patients have a vague sense of discomfort, while others have a more specific fear. They try to regulate these unpleasant emotions by being examined by a doctor or researching online. And that can work in the short term, but over time the brain realises it needs another examination to feel better and more secure.
How can you tell that psychotherapy is helping?
When patients are better able to withstand this uncertainty – without examinations or internet research. The brain can also break down established, internalised patterns and relearn them, thus helping to banish old insecurities. Patients have to understand that their discomfort is justified, even if for other causes than initially assumed. That can help them feel better.
As a next step, I help the patient write a letter to their doctor asking them not to perform certain examinations if, from a medical perspective, they are not acutely useful – no matter how much the patient urges them to. This helps them reclaim their life and become more tolerant of physical symptoms by not immediately interpreting them as the end of the world.
How can relatives help?
By making sure they don’t fall into the role of co-therapist, because they aren’t equipped for this position. If their partner wants to go to the doctor or read something in the internet, they should let them. For relatives, it’s important to understand the mechanisms behind the illness and how to deal with it.
Sometimes it’s simply a matter of seeking careful reassurance from family members instead of the doctor: “You don’t think it’s a heart attack either, do you?” Such questions can also go unanswered sometimes.
About the expert
Dr Steffi Weidt is a lecturer and chief consultant at the Psychiatric University Hospital Zurich and an expert in the treatment of hypochondria.