The lesson could well be that even hypochondriacs get sick and need help.
Things should have been blissful for Carla Cantor, a New Jersey free-lance writer who had just had her second child.
But soon after her son’s birth in 1990, Cantor, now 42, began experiencing bad pains in her wrist. Doctors suggested cortisone shots, wrist splints, not nursing the baby. Nothing helped.
As her pain spiraled out of control, so did her panic–and symptoms, which soon included hair loss and sun allergies.
With the doctors seemingly stumped, Cantor began her own research–and soon became panicked that she had systemic lupus erythematosus, an often debilitating autoimmune disease.
One night, feeling “so distraught I didn’t know what to do,” Cantor rushed to an emergency room, where doctors still couldn’t find a cause for her distress. She wound up spending the night–in the psychiatric ward.
In a sense, that night was a first step toward recovery for Cantor, who hopes her book on hypochondria, just out in paperback, may help others living in daily dread of disease (“Phantom Illness–Recognizing, Understanding and Over- coming Hypochondria,” Carla Cantor with Brian Fallon, M.D.; Houghton Mifflin Co.).
As a culture, we seem to have managed, slowly, to destigmatize cancer, even to take away some of the misplaced shame over psychological problems like anxiety and depression.
But hypochondriacs–who, by some estimates, constitute 6 to 12 percent of those who visit doctors–still get no respect.
Worry too much or too loudly about your health when doctors can find nothing seriously wrong, and many people assume you are faking it, hopelessly neurotic or just looking for attention.
Wrong, say psychiatrists who study those who “somatize” excessively, or express emotional distress via bodily symptoms.
Many people who have health worries out of proportion to their medical condition are depressed or have underlying panic or anxiety problems, says Dr. Arthur Barsky, director of psychosomatic research at Brigham and Women’s Hospital in Boston.
Increasingly, researchers suspect some may have a version of obsessive-compulsive disorder, says Dr. Fallon, Cantor’s co-author and a research psychiatrist at the New York State Psychiatric Institute.
The more researchers understand about the inner workings of these patients, the more they are finding treatments that help.
In a small pilot study, for instance, Fallon found that the anti-depressant drug Prozac helped 70 percent of patients, though he says it takes high doses–60 to 80 milligrams a day, not the 20 to 40 mg used for depression. (Don’t increase your dose of Prozac or similar drugs on your own–for one thing, these medications can transiently increase anxiety and agitation.)
Fallon’s preliminary findings are so promising that the National Institute of Mental Health recently awarded him a $500,000 grant to do a bigger placebo-controlled study.
Non-drug therapies may help too, says Barsky, who also has an NIMH grant to study 180 people to see if cognitive-behavioral therapy can teach them to worry less.
There’s no question that on top of their misery–hypochondriacs really feel the symptoms they express–these suffering souls carry an extra burden of stigma, probably because other people tend to ridicule or distance themselves from problems they don’t understand, says Dr. Ken Duckworth, a Massachusetts Mental Health Center psychiatrist.
To be sure, some people really do feign illness–the so-called malingerers and those with Munchausen’s syndrome.
People with hypochondria and so-called somatization disorder are quite different–they really fear they’re sick.
It’s normal to somatize at times or have unexplained symptoms that prompt a medical visit–a mole that might be melanoma, a memory lapse that might be Alzheimer’s.
It makes sense to check out such things. In fact, reassuring the worried well is a large and appropriate part of what doctors do; an estimated 50 percent of primary care visits are by people who turn out to have nothing seriously wrong.
But if your fears are constant and extreme, despite the lack of detectable disease, or if they’re out of proportion to your medical state, it’s time to ask what’s really going on.
For instance, if you repeatedly focus on a symptom and demand that somebody take care of you and even operate on you right away, you may have somatization disorder, says Dr. Charles Ford, a University of Alabama psychiatrist. Such people often worry more about getting rid of the immediate symptom than what the symptom may mean.
