How does one handle a person who is convinced that he has a life-threatening disease even when doctors assure him that it is not so?
In the past three years, Devang Sharma has made 29 hospital visits, changed four specialists and got 40 diagnostic tests done for his septuagenarian father who is convinced he has several serious maladies. Despite assurances to the contrary, Rajeshwari Mohan, 46, dreads she is in the early stages of Alzheimer’s Disease, especially when she forgets where she kept the car-keys, when she can’t recall a childhood friend’s name, and whenever she returns — absentmindedly — to complete an already finished task. The palpitations of Sridhar K., 37, have been thrice diagnosed as anxiety attacks, but he is convinced it’s heart disease.
All three are suffering from hypochondria — a mental disorder in which there is a belief that real or imagined physical symptoms are signs of serious medical illness despite assurances and other evidence to the contrary.
Dr. C.R. Chandrashekhar, Professor of Psychiatry, NIMHANS, elaborates: “When a person believes for six months or more that he has a disabling disease or life-threatening disorder or is excessively pre-occupied with functioning of one or more organs, he has Hypochondriacal Disorder. However, when similar persistent doubts occur but intensity and duration are not enough to be labelled a disorder, he has Hypochondriacal Symptoms. Finally, ‘Transient Hypochondriac Symptoms’ are what many of us experience — false alarms or sudden, unfounded fears when we suspect that a bodily sign indicates onset of some disease especially when we have just read about it or someone we know has died of it.”
Hypochondria has no age or gender bias. Also, symptoms may change and shift. Hypochondriacs brood over their symptoms and ‘disease’ while bathing, driving, eating, travelling, in-between work; worry about its repercussions, gather information from books, magazines and the Internet… These ‘big fears about small symptoms’ persist despite negations from doctors and diagnostic tests. Leading often to a pattern where hypochondriacs ‘doctor-shop’ driven by an agenda: to prove they are ‘really’ ill.
Risk factors include certain personality types and circumstances, explains Hyderabad-based psychiatrist D. Sridhar Reddy, like “anxiety-prone, neurotic or attention-seeking personalities, those with poor coping skills or low-confidence. Feeling deeply lonely or neglected could be a cause. Not having enough constructive work is a major factor.”
Another underlying factor, says Kolkata-based psychiatrist Dr. Rajneesh Sengupta, is close and continuous observation of symptoms and progress of disease in a real patient. This might affect one psychologically. Devang’s father grew up in a backward village where he saw many succumb to illnesses from lack of medical attention. Sridhar’s two relatives died of heart disease. While accompanying these relatives to hospital, he would read the charts about heart problems and later hear the doctor talk. These nurtured his anxieties. It could be also be a grossly misunderstood problem. In Rajeshwari’s case it was high stress plus excessive multitasking, which was affecting her memory and not Alzheimer’s.
Uncertainty breeds anxiety. So, your doctor could be guilty too, reveals Dr Chandrashekar. “This is sometimes an iatrogenic or doctor-induced phenomenon. Doctors who are vague in their diagnosis because of carelessness or worse because they failed in diagnosis and also doctors who order repeated tests from a commercial motive fuel the problem.” Also, for some unscrupulous doctors, a hypochondriac, especially a wealthy one, is a comfortably constant source of income, so they play along and nurture patient-anxieties. Ironically, hypochondria can sometimes lead to real sickness if the patient has undergone too many invasive tests.
So, what’s the cure? Certainly not dismissing hypochondria as overactive imagination. It can be a debilitating mental disorder. If the physician or family outright challenges/criticises the hypochondriac, or accuses him of malingering or ‘dramatising’, it might cause psychological damage. Psychiatrists point out that the precondition to treating any mental disorder is to accept the person and resolve to minimise his distress.
The standard medical approach is CBT or Cognitive Behaviour Therapy. Dr. Manju Mehta, Professor, Clinical Psychology, AIIMS, explains: “CBT is a multi-pronged intervention. We first counsel family members to not reinforce hypochondrial behaviour. They must ignore it; instead, treat him as a normal person. Second, we train the patient in distraction techniques — instead of focusing on the symptoms, he must do something Constructive (the keyword) that interests him like gardening, music, kitchen-work... We teach positive thinking, since negative thoughts are a major characteristic. Through detailed analysis we identify the problem areas: not having friends, not doing well at work, unable to take criticism, and help build confidence and skills in these deficit areas.”
Finally, attitude matters. We are human; sometimes our heart skips a beat, the stomach gets upset and we get sores and swellings. Get a test, do what the doctor ordered. But after that, get on with your life.