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It probably is the most recognizable – and corny – one-liner about the medical profession:



But for patients who suffer from the somatoform disorder hypochondriasis, following that simple advice would be virtually impossible. No battery of tests or team of specialty physicians could assuage these patients' obsessive worries that their everyday, easily-explained aches and pains are actually life-threatening diseases.

As a mental health disorder, hypochondriasis is not as widespread as its cousins in the category of somatoform, including anxiety and depression (although both are frequently co-morbid). But for the 1 to 5 percent of people who satisfy the criteria for a full-fledged diagnosis, hypochondriasis can be consuming.

"They estimate about 25 percent of a general practioner's (patient population) will have some degree of somatization disorder," said Ryan Hall, MD, a psychiatrist in Lake Mary. "It becomes a diagnosable condition when it interferes with a patient's life, generates anxiety and becomes overwhelming for them," said Hall, 32.

Hall said "one of the key things that differentiates hypochondriasis from somatoform disorder is that hypochondriacs are more worried about what the symptoms could mean. So, it's always 'I have a cough, so therefore I am dying,'" Hall said. "Whereas people with pain disorders are more like 'I have a pain and I need the pain taken care of,'" he said.

Hall, who also is an affiliated instructor in the Department of Psychiatry at the University of South Florida in Tampa, noted that co-morbid psychiatric conditions lead to hypochondriacs becoming even more fixated on their worries. "And one of the worst things you can do is tell them 'It's all in your head, don't worry about it,'" Hall said. "They feel people aren't taking them seriously. Then they wind up doctor shopping and never develop a long-term relationship" with any physician, he said. "They feel like they're being passed off.

"To be honest," said Hall, "a lot of GPs (who have patients with severe hypochondria) are just as happy to see them go someplace else. They take up a lot of time and resources … They come to be seen as kind of a nuisance," Hall said.

The observation about these patients being reluctant to seek psychiatric care is shared by James Edgar, MD, who practices in Tampa.

"A true somatization disorder patient does not take kindly to a psychiatric referral," said Edgar, 63.

Edgar's view of this disorder is decidedly pragmatic, perhaps astutely old-school. "Now we call it somatization disorder," he said, but if you cut to the chase, you are talking about obsessive compulsive symptoms. They are compulsively doing something to try to alleviate that anxiety."

"I don't treat disorders; I treat people," Edgar said, noting a combination of "psychotherapy and medication usually is the best approach."

But attempting to treat this particular anxiety with medication can be a challenge, Edgar said. "Sometimes they don't want to take an anti-anxiety agent because they feel like they need to be worried and vigilant. (Medicine) might take away the edge they feel they need" to discover their malady, he said.

So, while everyone agrees that most people who are hypochondrial also have obsessive personalities and tend to fixate on things, a growing concern in the mental health field regards some patients' newest fixation: the Internet.

There actually is a term for hypochondriacs who constantly surf the Internet looking for explanations about their preoccupation with symptoms and embellished illnesses. They are called "cyberchondriacs."

"When they came up with the term, they didn't mean it in a pejorative sense, but it has taken on that meaning since," said Hall, referring to the organization Harris Interactive, which coined the colloquial designation.

"These people have always been out there," said Hall, and in the old days they would look up things in the Merck Manual. Nowadays, with the Internet, the information is much easier to find." And what they find is not only the information about the disease, but also the symptoms, he said.

"So, instead of going to the Merck Manual and looking up 'lung cancer,' now they go to Google and put in 'cough' or 'diarrhea' and then they are just off to the races, overwhelmed with information," Hall said. "They already are compulsive to begin with, and they throw themselves into tracking down everything that comes back from the search engine," he said.

"What makes this potentially problematic," Hall said, is that "the information is there very quickly and it can identify their worst fears," even though a lot of it is anecdotal."

Blogs are ripe for misinformation, regardless of the posters' sincerity, and often serve only to reinforce the fear the cyberchondriac already has. Even worse, it is fertile ground for what Hall calls "snake-oil salesmen ... who not only give you information about the disease, but who also encourage you to try their (alleged cure) and give them your credit card number."

Although the overall numbers of people who compulsively seek health-related information on the Internet seem to have crested, Hall said, citing Harris Poll data, it still concerns him there is a core group of people who overdo it.

Hall recommends that patients who retrieve information on the Internet discuss it with their physician. Doctors should be open to those discussions, he said, and not be threatened by it. Especially in the case of somatoform disorders, it is important that patients not perceive that doctors are hiding information from them.

Cyberchondria doesn't phase Edgar. "This is nothing new. People often get concerned because they think it's something new. As I see it, this fits into the general rubric of OCDs, of which hypochonrdriacs also fit. You still have to look deeper to see what you're dealing with," he said.

But all physicians must be diligent in not confusing hypochondria with malingering, according to Winter Park's James Hundley, MD.

"In hypochondria, there is a true belief that there is something wrong. There is no hidden agenda that is conscious. They truly believe they have (something bad) and they are anxious about it," he said.

"But a malingerer purposefully misrepresents an illness in order to gain something. ... There's always a hidden agenda," Hundley said. "Hypochondriacs will spend tons of money pursuing solutions, whereas malingerers don't want anything done to them because they don't want to be found out."

Tags:

cyberchondriacs, hypochondria, hypochondriasis, James Edgar, James Hundley, Ryan Hall, University of South Florida in Tampa

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