Hypochondria: a sane response to life or a psychiatric illness,? asks Muiris Houston
HYPOCHONDRIASIS IS one of the most challenging and sometimes trying illnesses to cross a doctor's threshold.
Although the butt of many jokes through the ages, in its severest form an obsession with one's own health is classified as a psychiatric illness.
Hypochondriasis has interesting Greek origins. The hypochondrium is an anatomical term used to describe the area just below the rib margins at the uppermost part of the abdomen (hypo - below; chondros - cartilage).
In ancient times, the spleen was looked upon as the seat of melancholy. With the spleen located in the hypochondrium, the term hypochondriac was applied to patients whose complaints did not seem to have a basis in disease.
Hypochondria is linked to the placebo effect's evil alter ego: the nocebo effect. The nocebo effect makes people who worry about illness become ill.
For example, researchers have found that women who believe they are prone to heart disease are almost four times as likely to die as women with similar risk factors who do not hold such fatalistic views.
Nocebo (from the Latin "I will harm") illustrates the power of the human mind.
Arthur Barsky, an American psychiatrist with an interest in the nocebo effect, has shown that warning patients about drug side effects increases the number of people who suffer the side effects.
The type of person most likely to experience worse side effects and a poorer response to drugs is a patient with a history of vague, difficult to diagnose complaints, who is sure that whatever treatment is prescribed will do little to alleviate their problem.
The advent of the internet has led to a modern form of hypochondriasis called cyberchondria.
Googling even minor symptoms has the potential to produce a long list of possible causes, with the inevitable inclusion of something rare, exotic, but deadly.
And I am convinced that the explosion of home-testing kits for various illnesses are a hypochondriac's delight.
There are over-the-counter kits for cholesterol and blood-sugar monitoring, fertility tests and bowel cancer.
Apparently there is even one to detect meningitis, although given the rapid progression of the infection, quite how you are to find the time to pop around to the local pharmacist for the kit in the short period between the onset of symptoms and becoming seriously unwell remains unclear.
Even the most accurate diagnostic tests are correct about 95 per cent of the time, leading to the real possibility of some poor soul believing he has a terminal condition after a spot of home testing, when in reality he is as healthy as a trout.
But I suspect it is this very fallibility that makes home-testing kits popular with hypochondriacs.
It offers up an entire new vista of disease to be analysed, discussed and dissected before it is brought to a doctor's attention.
However, there is another more serious aspect to hypochondria beyond society's humorous response to the topic, and doctors' knee-jerk classification of hypochondriacs as "nuisance" patients.
Paul Salvoskis, an anxiety disorder expert from London's Maudsley Hospital, prefers the term "persistent health anxiety" to hypochondria.
"People get anxious about what is important to them . . . those with severe health anxieties seem to interpret their bodily variations differently from other people."
It seems that for people with severe health anxiety, information from TV, radio and newspapers trigger feelings of hyperawareness of the body which are very real and need to be taken seriously.
Famous hypochondriacs include Charles Darwin, James Boswell, Marcel Proust and Leonard Bernstein.
Despite his many achievements, Darwin complained constantly of vague stomach ailments and persistent exhaustion, while Boswell went through life convinced he had an incurable sexually transmitted disease.
In the absence of immortality, every hypochondriac is eventually proved right.
And, for some, hypochondria is the only sane response to modern life.
Dr Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he is unable to respond to individual medical queries