How should doctors deal with hypochondriacs?

I can tie the birth of my hypochondria to a single moment.

During an otherwise normal morning shower, I felt a sharp pain in my lower right abdomen. The pain was so jarring, I resigned myself to the idea of a burst appendix. As quickly as the pain made itself known, it left.

For months afterwards, I felt a sensation in my lower right abdomen, one I still can’t quite describe—possibly muscular or maybe neurological. Not really painful, but uncomfortable and annoying. The unknowing gnawed at me, and I became determined to find an answer. However, a carousel of apathetic doctors found nothing, which only fueled the anxiety around my health. “What if I have a tumor?” I thought. “Or worse—cancer?”

Though it’s been years since I experienced that pain in my abdomen, anxiety pertaining to my health has never left. I’ve gone through periods of running to the doctor for any small ache or pain and even occasionally not leaving the house because I’m convinced a lumpy bruise is actually a blood clot. Feeling ill or a strange new ache or pain can often trigger a panic attack in me, or days of deep sadness and fear of my mortality. I’m often able to keep these anxieties under control, but they’re always sitting there, waiting to rear their ugly head.

I’m not alone in my health anxiety. It’s a growing concern that many doctors struggle to handle.

The rise of hypochondria

Somewhere between 2 to 5 percent of Americans suffer from what’s commonly known as hypochondria (and formerly called hypochondriasis). In 2013, the fifth edition of Diagnostic and Statistical Manual of Mental Disorders replaced hypochondriasis with somatic symptom disorder and illness anxiety disorder, which are two unique conditions.

According to the American Psychiatric Association, somatic symptom disorder is when a patient spends “significant focus on physical symptoms, such as pain, weakness, or shortness of breath, that results in a major distress and/or problems functioning.” These symptoms could be in connection with an underlying medical condition.

Illness anxiety disorder, on the other hand, is when a patient experiences similar distress to somatic symptom disorder but has no physical symptoms.

Both disorders can interfere with daily life, cause strain in relationships, and put the sufferer in a constant state of fear and despair.

It’s not clear in the research where health anxiety stems from, according to William Schroeder, LPC, NCC, and co-owner of Just Mind Counseling in Austin, Texas.

“Some believe that it’s a part of the OCD spectrum,” Schroeder said. “This is debatable though, as those with OCD often have a family history of generalized anxiety disorder and those with hypochondria tend to have a family history of somatoform disorder.”

Other theories of how hypochondria manifests point to depression, PTSD, or other anxiety disorders.

Schroeder, who has 14 years of clinical experience, has seen a half a dozen severe hypochondria cases in his career, and several more moderate ones. With the rise of omnipresent media and easy access to the internet, that number may increase.

Many individuals who suffer from hypochondria are triggered by “health scares in the news” and searching symptoms online any time they feel ill, according to Centre for Clinical Intervention. (Ironically, WebMD wrote an interesting article about how the internet has made hypochondria—or cyberchondria—worse.)  

Additional triggers include unfamiliar or uncomfortable physical sensations in the body, learning about someone else’s death or illness, medical appointments, and inconclusive test results. These triggers will often cause individuals to seek out medical professionals over and over again, with mixed results.

In other words, we hypochondriacs can be a little challenging. In fact, we’re sometimes called “difficult patients.”

Dealing with hypochondriacs

Boingoc Mary Dinh, DO, at WellSpan Good Samaritan Hospital in Pennsylvania, works with and is empathetic to patients suffering from hypochondria, but admits “it can be exhausting and financially draining to work on every slight complaint that’s interpreted as life-threatening.”

Rachel Mehendale, MD, shares Dinh’s empathy, but doesn’t think doctors have enough time to really help this population.

“The doctor that often seems dismissive has just consoled a crying family or spent two hours on the phone fighting with insurance to cover a patient’s MRI or medications,” said Mehendale, who’s also a neurology instructor at Columbia University Irving Medical Center. “Then after all that, we are only allotted 15-20 minutes per patient in the clinic, so we can’t spend as much time as we’d like really expanding on our patient’s issues. The structure of the current medical system makes it hard for us to practice with the humanity we are capable of. We really do try our best.”

The reality is, physicians are being stretched thin, and burnout is a growing issue in the medical industry.

In the 2019 Medscape National Physician Burnout, Depression and Suicide report, 44 percent of physicians experienced burnout. Top causes include tending to too much paperwork (10-19 hours on average), spending too much time at work, increasing computerization, and lack of respect from co-workers. These stress factors can leave little time for physicians to provide the support hypochondriacs are looking for.

However, physicians are trained to take their patients seriously, even ones that may be proving “difficult.” It is their priority to rule out any underlying health issue. If nothing presents itself, the next step is diagnosis of somatic symptom disorder or illness anxiety disorder, and then therapy. In rare instances, the physician may be able to work with the patient.

“You can either choose to treat the patient yourself, or if you feel uncomfortable, you can always refer them to a psychiatrist,” Dinh said. “I’m currently treating a patient with this disorder and we are slowly building a rapport by making more frequent appointments. I see this patient once every two weeks with hopes of slowly spacing them out when she is more open to the idea of cognitive behavior therapy. As the patient begins to improve in therapy, they will require less and less reassurance and observation from me.”

In most cases, hypochondriacs are directed to a therapist or counselor who has the time and training to understand what is ultimately a form of mental illness. Schroeder listed selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Zoloft, Celexa, and Lexapro; cognitive-behavioral therapy; psychoanalytic therapy; group therapy; and somatic experiencing as tools to help. This not only helps the patient get the care they need: It also frees up time for physicians.

A path forward

For me, I finally had a physician truly listen to me and ultimately diagnose me with anxiety. She prescribed me low-dosage Celexa, which has mostly—but not always—kept my health anxiety in check. I still have bouts of health-related anxiety attacks, but I no longer run to the doctor seeking answers. Instead, I’ve found ways to cope with my anxiety.

Listening to Dinh and Mehendale’s struggles, and thinking back on my own experiences of feeling as though I didn’t receive the empathy I was looking for from physicians, I now understand how challenging it is for medical professionals to deal with people like, well, me. While my fear, and every hypochondriac’s fear, is very real, and it’s remarkably frustrating for a medical professional to not give you the empathy or answers you’re looking for, it’s important to remember they’re trying their best.

And in reverse, I’d say to physicians that we hypochondriacs are not trying to be difficult—we’re terrified. This terror overtakes us and the only way to calm it is to seek your guidance and expertise. When we think we’re dying, we may not realize that going to you is the wrong choice—that mental health counseling is a better fit. So, please be patient with us as well. We’re scared, and we need help.