Mohan is a family physician and a Postgraduate Associate Dean working in the UK. He has a keen interest in self-regulated learning.
The Worried Well Epidemic
Some of us think that we are sicker than we really are. We may misread natural symptoms in our body as indicative of disease. It can be a frustrating journey to the person and their Doctor, often resulting in multiple visits, investigations and no resolution. Contrary to giving relief, normal investigations and a lack of diagnosis often makes the ‘Worried Well’ even more worried. The rise of unreliable health information in the media and especially the internet doesn’t help either (I say with no irony).
It is estimated the ‘worried well’ make up to 18% of the population, according to a 2002 Oxford Workplace Wellness Survey. The extreme form of the worried well can be Hypochondriasis. This is a seriously debilitating form of health anxiety. The affected may constantly check themselves for various illnesses and become very tuned to their bodily functions. Every twitch, every skipped heart beat, every bowel sound can get interpreted as a harbinger of doom. It is tough being a hypochondriac in the modern day as there is so much more health information in the media.
Death of a health relative or a friend, stressful life events, global pandemics can all trigger hypochondria. There will be an obsessive quality to this condition where the worry never really goes away despite negative tests and plenty of reassurances from clinicians and family. The worry may get hidden and becomes a guilty secret often triggering obsessive compulsive episodes.
Microsoft researchers Ryen White and Eric Horvitz conducted a large-scale study in 2008 on the subject of Cyberchondria. White and Horvitz defined Cyberchondria as the “unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web.”
The Wikipedia lists the new manifestation of hypochondria as ‘cyberchondria’ where the afflicted research their perceived medical problems on the internet.
The trouble with most health information on the internet is that it can be inaccurate; it doesn’t always articulate risks clearly and makes the random and exotic sound more frequent. There is an observer fallacy involved in bad news – it makes us feel it is more common than it is. There are many stories of people suspecting something bad was happening to them, Doctors ignoring them and then going on to being diagnosed with something.
These are powerful stories and can be potentially upsetting to read. However, the reverse is never news. For every story like those there are thousand others where people have pursued a suspicion of an illness only to find they were healthy after all. This is never a good sound bite or a riveting story.
It is also common to ascribe deadly diseases to simple symptoms - anal itch can be common but websites may link it to anal cancer - while anal cancer can start as anal itch there are a million others where the itch is due to a simple, more mundane ailment.
One of the commonest issues with hypochondria and health anxiety is a phenomenon known as somato-sensory amplification. Here, a person will have a tendency to perceive normal somatic sensations- a nervous tic, a rumbling in the stomach, changes in heartbeat, a nerve sensation, simple numbness, sensory changes in skin or an organ as being relatively intense, disturbing and noxious.
This is common in people with anxiety disorders, mild to moderate stress, Depression and Hypochondria.
As physicians rely sometimes on the patients description of these symptoms, this may lead to battery of unnecessary and expensive tests often leading nowhere.
It is not clear whether there is a genuine increase in sensation and amplification or a perceived increase. There is also something called 'attention focusing' where the particular symptom takes over their attention to obsessive levels. The true test here will be whether the symptoms are more obvious when sitting quietly and otherwise unoccupied ( happen in Somato-sensory amplification) and less so when otherwise occupied and engaged in other activities.
Cost of Hypochondria
Hypochondria is often associated with anxiety and obsessive compulsive features. This also results in reduced faith in Medicine and the establishment and makes one susceptible to quackery. ( Although some are untrustworthy anyway!) There are several entrepreneurial quacks who would love to take advantage of the worried well.
The Worried well spend thousands on multivitamins, health interventions of little value and self-diagnostic tests . There is a strong market peddling on peoples worry and suspicion of traditional health model. Although there are very good alternative remedies such as herbal supplements, ayurvedic therapy, Massage, Yoga etc. there are equally some dubious cures and quacks out there and you have to be careful.
Where are the Healers?
Trouble is traditional Western medicine has become over reliant on tests, scans and a motley investigative methodology that it has stopped listening to people with care and attention. This patient centred narrative methodology is what helps people to feel listened to, understood, explained and healed. This is such a shame as the scientific medical advancements that have resulted in people living longer and longer but not necessarily happier. We currently enjoy some of the best medical advancements in the history of medicine yet the relationship between healthcare and people can be strained to say the least with trust broken in some situations.
We need more healers who can straddle the western medicine with eastern mindset. Healers listen, respond, advice, share and suggest tailored cures that are patient specific. They take into account the patient's lifestyle, background and personal circumstances to combine a holistic management plan that may include modern tests and medications but also caters to the worried soul. They give patients choices and help make the one best suited. They often prefer to have a long term strategy of prevention and lifestyle modification, but will be quick to spot anomalies and situations away from the norm.while pattern recognition is a key skill for a clinician so is recognising outliers and errant symptoms that indicate illness.
Firstly one must not assume that they are a hypochondriac if they get a symptom that needs assessment and investigation. However if there has been a trigger traumatic incident - like a disease or death in a close friend or family, which then causes a persistent worry or anxiety this could well be an early sign.
It is always safer to consult a clincian and have an open chat. Put the cards on the table and explain the symptoms, signs and any trigger incidents. Cognitive behavioural therapy is very helpful if any persistent hypochondria is identified.
There are too many stories of 'missed' diagnosis and scary anecdotes that can skew ones perception of health. While some are true enough ( God knows I know a few!) in most circumstances the modern investigative abilities are very good and often clinicians are good at ruling out the nasty illnesses. Trouble is they often forget you once they have ruled out anything 'serious' leaving you still with the original symptoms and no explanation. Good family practitioners, someone who knows you for long and can be your guide, is worth their weight in gold. they can often act as a hub for your discussions while referring you on to specialists should matters get out of hand and if a clear picture of an illness emrges from the tests and clinical assessments.
More and more studies are proving that well trained Family practitioners are a boon to any health care organisation. Training in communciation and consultation skills as well as medical specialities helps identify potential problems early and treat accordingly or reassure well.
The survey also classified respondents into another three categories: The ‘Truly Healthies’ are those of us who are well and have not been to the Doctor at all apart from occasional jaunts for holiday jabs and insurance medicals. The ‘Realists’ are those who may have acute or chronic diseases and may have to attend Doctor's surgeries and hospitals for these reasons and do rightly so.
But it is the fourth category that concerns me the most. These are the ‘Deniers’ who may be 17% of the general population. We are deniers if we have had some convincing physical symptom or a sign; say a mole that has grown darker and irregular; blood from any orifice; a significant lump; a worsening symptom that has continued over and beyond good reason. The trouble with being a denier is that we tell ourselves that if we wait long enough it will go away.
We also worry ourselves silly about all the wrong things, that the Doctor or Nurse will think we are being paranoid, overcautious or downright silly. We may be so frightened of what the clinicians are going to find out that we’d rather not hear it. While the worried well have no qualms about ringing their Doctor and demanding an appointment, the Deniers are terrible at seeking help. They also avoid screening tests and health checkups, as they believe if they don’t get it checked, it won’t happen!
Even when they do arrive at the appointment, they commit that classic sin of playing down the symptoms and blaming the family or friend for nagging us into going there in the first place. The Deniers feel shy that they may be mistaken for a hypochondriac!
So if you are denier, do yourself a favour and get that looked into, whatever it is you have been hiding and secretly worrying. Because you are worth it.
© Mohan Kumar 2013
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Thank you for reading this article and hope you found the information useful. Do leave some comments and feedback below. Please do vote as appropriate!
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Appreciate your time and interest, dear reader.
Do come again.
© Mohan Kumar 2013
Victoria from Long Island N.Y on June 17, 2013:
I'm guilty of this. I think it's partly because I'm in nursing school (so I love learning about all aspects of the medical field and diseases etc) and partly because I'm slightly nervous that one day I'll end up having something that could have been prevented had I paid better attention to my health. Awesome hub and something we should all take into account while looking for medical symptoms and trying to "self diagnose" via the internet.
Jeannie Marie from Baltimore, MD on June 17, 2013:
I once searched for my symptoms on WebMD and it said I either had an ear infection or I was schizophrenic. That seems like a huge difference if you ask me. Turns out, it was an ear infection... thank goodness! Great hub and voted up!
Linda Bilyeu from Orlando, FL on June 17, 2013:
This is my 4th visit here. Maybe I have cyberchondria? No, just stopping by to say hello! :)
Martie Coetser from South Africa on June 17, 2013:
Love this hub! Of course, I do google my symptoms, and I do recognise POSSIBLE illnesses, but most of all I trust my doctor and accept his diagnoses.
Thanks for this most needed info, Docmo :)
Alecia Murphy from Wilmington, North Carolina on September 06, 2012:
Great hub! I think that for some reason in Western society- anxiety and knowledge are two factors that are intermingled. We have to know or we'll be nervous and when we do know we still get nervous. Google, WebMD, and Wikipedia have their strengths but you definitely have to take it with a grain of salt. Well done Docmo!
Linda Bilyeu from Orlando, FL on August 25, 2012:
I'd like to read your column. How about a link via message?
I'm an entertaining patient so I'd like me as a patient also. Most of the time.
Mohan Kumar (author) from UK on August 25, 2012:
I like having well informed patients who get their facts from reliable sources - I really don't mind people googling and looking for info - I write a bimonthly health column in the local newspaper and encourage people to be more informed. You can be my patient any time!
Linda Bilyeu from Orlando, FL on August 25, 2012:
I've been reprimanded on a few occasions for googling to help family members, now the docs ask me if I've found anything I'd like to share with them. Google has its up sides and down sides. Either way I love Google. And again, I wish you good luck. I wonder if you would want me as your patient. I'm thinking probably not:)
Mohan Kumar (author) from UK on August 25, 2012:
Thank you sunshine. In my line of work, half the day is spent convincing those who really are ill that they should believe it and the other half who aren't that they should stop Googling! Thats's what prompted this hub.
Linda Bilyeu from Orlando, FL on August 25, 2012:
I've known many and still know many hypochondriacs and oh my! Google is their BFF. It's sad how they see themselves in so many illnesses and think they have so many diseases. I could sympathize with the doctor and the patient because they are both baffled. Best of luck to all of you. Excellent hub!
Yvonne Spence from UK on July 31, 2012:
Docmo, I totally misread this title and thought it was about a well that was worried and was baffled about deniers. (All I could think was you were using the word that describes nylon's thickness!) Anyway, it intrigued me enough to read, and the hub is very interesting. It's good to read this from a doctor's perspective.
I think many people are afraid of seeming like hypochondriacs and so put off doctor visits. My husband definitely used to be a denier - one time I eventually persuaded him to visit a doctor and it turned out he had glandular fever. (He was also the same about other people, never thinking I was ill.) He has improved on this lately and will now visit the doctor without any nagging!
I think your point about there needing to be a more holistic approach is a very good one, and I sort of see Western medicine/health care as very good for emergencies and less so for maintaining optimum health.
kelleyward on June 03, 2012:
This is a fantastic topic for a hub! I know many people with hypochondria and I heard the quote the other day that said, "The worst sickness is getting attached to one's sickness" Seneca and I thought that was a point well made! Sharing this one! Voted up!!! Kelley
Gail Sobotkin from South Carolina on September 05, 2011:
Excellent comprehensive hub that covers the spectrum from hypochondriacs to those who ignore and deny serious symptoms that do need medical attention.
Voted up, useful and interesting.
Mimi721wis on April 22, 2011:
Hi Docmo, Great info. When I was in nursing school it was common for students to self diagnose themselves and other. My instructors told us that sort of thing happened ever semester. I guess a tiny bit of hypochondria is normal. I've always heard it's only when something interferes with a normal life style that it becomes a problem.
Feline Prophet on February 06, 2011:
Very well said, Docmo! I'm so thankful that I have never succumbed to cyberchondria!!
s.carver from San Francisco on January 27, 2011:
Really interesting hub! And I am glad finally to have a name for cyberchondria! I recently self-diagnosed some pain I was feeling in my foot. Where would I have been sans Google? Other than at my doctor's office sooner for that cortisone shot...!
Thanks for this one. Voted up.
Mohan Kumar (author) from UK on January 07, 2011:
Thanks Sunnyglitter, There is a lot of cyberchondria with everyone free to dispense what they 'think' is good advice and opinion. Trouble is not everyone who gives opinions checks their facts and not every opinion is appropriately evidence based. I recently saw a question in the forum where someone had joint pains and the first person to answer asked them to go get checked for leukemia! no wonder we get cyberchondria. Appreciate you dropping by.
Sunnyglitter from Cyberspace on January 07, 2011:
I've been guilty of cyberchondria and being a denier. This was a very interesting article. Nice job.
Mohan Kumar (author) from UK on December 08, 2010:
Thanks richtwf, glad you enjoyed this hub. I agree that negative thinking and worrying is perhaps a bigger epidemic than many other diseases yet there's very little positive prevention strategies. I fully agree that positive psychology and personal stress management needs to be taught from an early age to help people succumb to these problems later. Enjoyed the poem too.
richtwf on December 08, 2010:
An excellent hub and enjoyed this one.
I think if we can be taught to control our minds then in my opinion the general health of many would be better. Excessive worrying and negative thinking is not good for our health. Prevention is always better than cure so people really need to examine their minds and thoughts and help themselves so that they don't suffer stress related disorders. There will always be hypochondriacs and those suffering from stress related problems and to reduce the number of these cases I think there is a real need to educate in schools how we can manage stress and negative thinking so that our health is not compromised.
Cheers for sharing this hub!
P.S. You might like this poem: