Hypochondriacs Cost Our Healthcare Industry Billions (Annotated)

“What’s the matter?” “I have a headache,” “Maybe it’s a tumor?” “It’s not a tumor!”  In pop culture, we like to poke fun at individuals who fuss over every little ailment with numerous TV characters based on those who possess hypochondriac personas. However, for the sufferer, living each day in constant fear of contracting a serious life-threatening illness is no laughing matter.

Hypochondriasis, as it was previously known in the medical field, is a serious mental condition that places a major physical, emotional and financial strain not only on the sufferer, but also on relationships, family members and the entire health care industry.  To date, there has not been significant medical research dedicated to understanding the condition and many doctors are unsure about how to manage patients who exhibit symptoms.  A working definition was only formulated in the last few decades [3] by the American Psychiatric Association [4] (APA), which defined the disorder as, “the fear or belief of serious illness that persists six months or more despite physician reassurance.”

More recently in May 2013, the condition was re-termed Illness Anxiety Disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [5] of the APA in an effort to shift the focus away from the symptoms of the condition and instead toward the abnormal behavior and feelings evoked by the symptoms. This made it clear that this is primarily a mental disorder where people worry excessively and unnecessarily about medical problems.

In the absence of concrete medical studies it is uncertain how many people actually suffer from illness anxiety disorder, but according to Brian Fallon, professor of clinical psychiatry at Columbia University and co-author of Phantom Illness: Recognizing, Understanding and Overcoming Hypochondria [6], at least 25 percent of patient visits to doctors are believed to have no identifiable medical cause.  Moreover, approximately 12 percent of the population suffers from some form of a fear of illness.

“A factor that contributes to illness anxiety disorder is a person’s genetic makeup,” Fallon told AlterNet. “If you have genes in your family aiding obsessional anxiety, it is likely you will suffer from obsessional anxiety. It is also true that if you grew up as a child where a parent was quite ill or suddenly afflicted with serious illness then this can create a channeled fear that you will develop a disease and also adds to a lack of trust in the world. Others can develop the disorder after losing a loved one to a serious illness or as a secondary illness to depression or anxiety disorder.”

Sometimes, the condition is so extreme that individuals can actually experience physical symptoms created through the mind. Such worry wreaks havoc on the immune system causing a lack of sleep and severe anxiety which can lead to further physiological conditions.  As Arthur Barsky of Harvard Medical School and author of Worried Sick: Our Troubled Quest for Wellness [7] told  WebMD [8], the illness then becomes part of the hypochondriac’s identity and as a result, the individual’s work, family and relationships begin to suffer.

“Contrary to what some skeptics think, hypochondriacs are not pretending or just trying to get attention.  They’re absolutely not fakers or malingerers […] They really feel the distress they’re talking about. It’s just that their feelings don’t have an obvious medical basis,” Barsky said.

So how does one differentiate between a hypochondriac and a person merely concerned about their health? According to Benjamin Liptzin, chair of the department of psychiatry at Baystate Medical Center in Springfield, the primary distinction lies in the extent to which a person believes he or she has a serious illness. As he explained to AlterNet:

“A certain amount of concern about one’s health is a good thing.  This gets us to visit the doctor, to watch our diet, to exercise, take medication – healthy normal people should be concerned about their health. What distinguishes people with the disorder is that it is excessive – these people are not reassured by good news from the doctor or when test results come back negative. They are just convinced there is something their doctor is missing.”

Fallon agrees.

“Hypochondriacs live in constant or intermittent fear that they might be dying or afflicted with a serious illness whereas people who are generally concerned about their health are conscious about their wellbeing rather than live in incessant apprehension of a threat to their health or contracting a serious illness,” he said.

This inability to accept negative test results at face value or a doctor’s assurances leads to a rampant abuse of the healthcare system whereby hypochondriacs spend large amounts of money on numerous and unnecessary medical appointments and procedures like blood tests and MRIs even after results indicate they do not have an illness.

A study by Barsky [9] found that those with unexplained physical symptoms with no medical basis accounted for 16 percent of all medical costs, with the annual cost of hypochondria in the billions of dollars. Fallon believes this to be an accurate figure in light of the ease and freedom with which patients in the US can visit multiple doctors at any given time, at the expense of the insurance companies which beart the costs.

The disorder places a major strain on the doctor-patient relationship as doctors struggle with having to determine to what extent they should investigate a physical medical complaint in the absence of any substantial symptoms. This often results in a doctor ordering excessive medical tests not out of necessity, but merely to ease a patient’s state of mind.

Such measures serve as a double-edged sword whereby exploring phantom illnesses only heighten the insecurities of the hypochondriac patient who already believes he/she has some rare disease. Many doctors feel pressured to succumb to a patient’s irrational demands to avoid a malpractice action based on misdiagnosis.

Physician Rahul Parikh describes the lack of faith between doctor and patient in his article, “The real reason hypochondriacs drive doctors crazy [10].” He wrote:

“Today’s medical system encourages the approach of hurrying difficult patients out the door. Doctors, unlike lawyers or consultants, don’t bill for their hours. Most of us get reimbursed by insurance companies for tests, and procedures, and prescriptions, often regardless of whether they’re necessary. A hypochondriac on our schedule is a time and money sink. The ugly truth is that modern medicine doesn’t reward those physicians, like primary care doctors, whose main work is to listen to and think deeply about patients and their ailments, whether they are physical or psychological.”

It doesn’t help that we live in a society of medical paranoia where self-help books are encouraged and when we turn on the TV we are confronted with public health messages stressing the benefits of early detection in the absence of symptoms.  Even 30-second drug advertisements manage to provide every possible life-threatening side-effect of taking medication.

The plight of the hypochondriac is amplified by the Internet. Historically, those interested in investigating their physical symptoms had to trek to a library to borrow a book in order to research an illness.  Today, one only needs to Google a symptom of an illness and instantaneously thousands of serious medical conditions appear, often displaying a worst-case diagnosis that happens to match the seeker’s problem.

As Fallon explains, “cyber-chondria” [8] is the addiction to researching medical conditions online whereby the more access a person has to learn about an illness, the more the person thinks he/she has it. He said:

“There is a tremendous temptation for people with illness anxiety to type in their symptoms on the Internet to see if they can find a diagnosis to explain their symptoms.  The problem with that is that the web is filled with information which is both accurate and inaccurate, as well as other patients trying to give people advice and warnings against horrible doctors. This only causes people to feel worse. My recommendation is that if you have a pre-existing illness anxiety, stay away from the Internet!”

So how should a doctor proceed when treating a patient who is exhibiting hypochondriac traits? Liptzin says that when a doctor is faced with a person suffering from an obvious illness anxiety disorder, it is better not to submit to patient pressure.

“Doctors should only do what is necessary and if they are confident that they have ruled out a series of illnesses, they should explain that to the patient and say, Let’s see how you do over the next six months,” he said.

Fallon believes the key for doctors is to differentiate between illness and obsessional anxiety disorders.

“It is hard for doctors at an initial consultation to diagnose hypochondriasis because of the limited amount of time they have with their patients,” he said. “However, if a patient returns after medical tests come back negative, and the doctor has the opportunity to get to know the patient, it is important for the doctor to show compassion and kindness and explain carefully that the cause of the problem may be an underlying anxiety disorder and encourage treatment for anxiety or depression.”

Whether such measures by physicians actually curb erratic patient behavior is debatable, considering that many patients who are unhappy with a diagnosis are likely to continue doctor shopping in search of a validation of their illness. Fallon acknowledges that those who believe they are hypochondriacs can take matters into their own hands to help alleviate the problem.

“People suffering from illness anxiety disorder can do things to help themselves by reducing the focus on physical symptoms and enhancing interpersonal physical relationships,” he said. “Psychotherapy has also proven effective by concentrating on positive behavioral strategies. If the illness anxiety is severe, it is important to see a mental health professional or at the very least learn about the disorder.”

Liptzin believes that while attending clinics with group sessions for those who suffer from the illness may be helpful, it can have the opposite effect.

“Sometimes these clinical sessions only reinforce the disorder as sufferers end up supporting each other’s irrational thought patterns,” he said. “There is not much evidence that medication helps either.  Rather, any type of relaxation technique or meditation or mindfulness is recommended to help reduce the anxiety of the person. What you really need to do is to take your mind off the symptoms and anything that is upsetting you.”

People who believe they may be suffering from illness anxiety disorder can take the Whitley Index Test [11], which has been developed to help identify hypochondriacs. The Mayo Clinic [12] recommends sticking with one doctor, no self-checks or self-diagnosis and attending group therapy sessions. In severe cases, medications like Prozac can be prescribed to treat anxiety disorders with mixed results of success.

It is important to remember that even hypochondriacs do get sick at times. Therefore, it is important to always listen to your body and seek medical assistance when it comes to general health concerns.