When Feeling Ill is Not Enough

We are all a bit of a hypochondriac, when you don't feel well or something hurts; you take note and probably feel slightly anxious. However, this is extremely different than the individual who constantly reports symptoms of an acute medical illness, and is jumping from doctor to doctor for a second, third or even a fourth opinion that they can accept. Inevitably you have been on a call related to a hypochondriac; they insist that the current ailment is serious and needs immediate emergency care (even though they were cleared by the emergency department ½ an hour ago with a clean bill of health). Your biggest clue that they may have hypochondriasis is when they insist, without being asked, I am not a hypochondriac.

You have been to this residence six times in the past five months with the reporting party describing vague but life threatening symptoms. He/she demands a trip to the emergency room. You call the FD, who also knows the citizen well. Off they go to the hospital, but rarely with lights and sirens. Sometimes paramedics, exhausted of going to the same residence for the same complaint daily (or even more frequently) request police assistance to help with the problem. Or maybe you have a partner who chronically calls in ill before his assigned shift. It is not that he is seeking a Saturday off to go party or to watch the Monday night game; he actually is in bed all day treating his symptoms, worrying, and searching the Internet to self-diagnose which disease he is suffering from.

It is estimated that up to fourteen percent of the population suffer from hypochondriasis. Additionally, almost half of the population does have periods of intermittent and unfounded worry about illness; and half of this group is healthy. Think about the swine flu virus. If you have had symptoms of a cold or flu recently, it is probable that the thought of the swine flu has entered your head, and you talked to someone else about your concerns. Exaggerated concerns about health are very common in our society. Unfortunately, hypochondriasis comes with a huge price tag. In the Unites States alone, it causes over $20 billion a year in unnecessary medical procedures and examinations. That figure does not include the costs of emergency services responding to calls for service. It may, however, explain why your department takes so much money out of your check every two weeks for medical insurance!

What is Hypochondria?

Hypochondria is a somatic disorder that is characterized by the uncompromising belief that the individual has one or more serious and/or potentially life threatening medical conditions. The individual will misinterpret rather common and benign physical symptoms as a sign of serious disease, and persist in this belief in spite of reassurance from doctors. Discoloration on the skin convinces them they have a melanoma. Healthy digestive sounds are believed to be colitis, and will require surgery and a colostomy bag for life. Shortness of breath must mean the individual is having a heart attack and may need a heart transplant. Although they may admit that their fears are exaggerated, they persist in the belief that they are truly, and probably, seriously ill. Hypochondriacs go from doctor to doctor, trying to find a doctor that will confirm and treat their perceived illness.

Hypochondriacs do not fake illness; they truly believe they are ill. A hypochondriac's symptoms are not delusional; they are based on some true discomfort or pain. The individual becomes preoccupied with his/her symptoms and of all the possible catastrophic diseases he/she may have. This preoccupation frequently causes significant familial, social, and occupational impairment. It is very troublesome to those closest to the hypochondriac; you would just like to shake him into reality and scream it is all in your head, get over it! However, there is no way to talk them out of their symptoms. Additionally, there is often a secondary gain by having a perceived serious illness: attention from family, friends, co-workers, bosses, and even doctors. The hypochondriac may also be relieved from regular responsibilities.

Symptoms of hypochondriasis usually begin during childhood, but the disorder is not diagnosed until young adulthood. Hypochondriasis frequently becomes chronic, but there be periods of remission, in which they are completely symptom free. Men and women are affected by hypochondriasis equally. Symptoms usually intensify after a major loss. Untreated the disorder tends to get worse rather than better. The disorder often accompanies other mental illnesses including depression, anxiety and psychotic disorders.

Symptoms of Hypochondriasis

The patient will present to the doctor or hospital with many (if not most) complaints that cannot be attributed to any true or specific illnesses; even after extensive medical examinations and testing. When reassured there is nothing seriously wrong with him, hypochondriac will likely become upset with the medical staff. He will probably seek out another opinion (or maybe three). Hypochondriacs usually spend countless hours on web sites like wrongdiagnosis.com or webmd.com to determine a probable diagnosis for their symptoms.

  • Preoccupation with illness of the fear of illness
  • Persistent, unqualified concerns about health (not appearance) but is not delusional
  • Appropriate, thorough medical exam and testing does not reassure the patient that they are well
  • May have associated depression, anxiety organic brain syndrome, or psychotic disorders
  • Misses work, gatherings, events because of perceived illnesses
  • Patient seeks advice of many doctors, going from one to another, to find one that will diagnose disease or illness
  • Symptoms seem to shift and change and are often non-specific or lack detail
  • Symptoms last for at least six months

Treatment for Hypochondriasis

Because the patient reports significant physical complaints, doctors must first perform a thorough physical examination with appropriate blood tests, x-rays and other tests to rule out or verify the validity of his/her physical complaints. Real disease and/or illness can be overlooked in patients who been diagnosed with hypochondriasis, because their complaints were previously unfounded. Thus, it becomes essential that the physician review all possible causes for symptoms before ruling out a true disease or disorder. If disease is ruled out, the patient may or may not be receptive to referrals for treatment of hypochondriasis.

One third of hypochondriacs will experience significant improvement in their condition with appropriate treatment. Antidepressants (Prozac, Luvox), anti-anxiety, and antipsychotic medications have been beneficial. Additionally, the individual is frequently referred for psychotherapy to teach them how to change their responses to anxiety. The hypochondriac must resist the urge to self-diagnose. He/she needs to seek medical treatment and reassurance from one, and only one, trusted doctor. They also need to break their addiction to surfing the web to self-diagnose.

The Internet and the Hypochondriac

Thanks to the Internet, becoming a hypochondriac is much easier than it used to be. The easy availability of health information on the web has certainly helped countless people make educated guesses about their health and medical treatment; but it can be catastrophic for people who are likely to worry. Hypochondriacs researching an illness scour websites for information. They generally are not discriminate on which resources they search, blogs even add to their worries. Even the most reputable sites heighten their concerns.

Hypochondriacs tend to latch onto diseases with ambiguous symptoms: HIV, lupus, multiple sclerosis, chronic fatigue syndrome, etc. Vague symptoms are hard to diagnose. Getting CAT scans or MRIs with each new symptoms is an expensive waste of resources. However, a hypochondriac may demand these tests.

Conclusion

Hypochondriacs have trouble accepting that normal, healthy people also have physical symptoms. Acute hypochondria can ruin an individual's life and the lives of people he/she cares about. At first hypochondria looks like kooky, neurotic behavior, but it often leads to a devastating obsession. It is impossible to talk them out of this obsession, and offering additional medical advice will only backfire.

Officers, you will still have to respond to requests for assistance from the fire department. You will also have to cover a shift or two for the hypochondriacs in your station. But there is good news. The first good news is your inevitable overtime. The second good news is that your hypochondriac beat partner and/or Joe Civilian is probably not contagious.

Stay well.



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