The unbearable loneliness of being a hypochondriac

How does constant anxiety about health shapes one's personality? And relationships with others?

Can a headache lead to a brain tumour? What's with the shooting pain in my leg? It's not gone, even though I popped a few Panadols. Jeez, I don't think I am able to breathe properly. Someone take me to the doctor right now! I think my end is near!!
Sounds hysterical? Even comical? Popular culture has often painted hypochondriacs almost as a specie unto themselves, even though it has committed itself to talking about mental health every now and then. Hypochondria, which is, to put it simply, the clinical anxiety about one's state of health, is not a new phenomenon and has been satirised in literature (way back in 1673, French playwright Moliere even had a three-act play The Imaginary Invalid based on the condition).
Today, the narrative has broadened. Technology has ensured that a barrage of information is just a click away, which has, in turn, given rise to self-diagnoses (essentially, the act of looking up symptoms online and voila! you are likely to know what exactly you're suffering from). Just last year, there was even talk of Google providing a list of 'related conditions' depending on the symptoms you search for on the Internet. In a nutshell, in case you're a hypochondriac, even before you head to the doctor's, the Internet can tell you what exactly is bothering you physically.
Except that it doesn't really know that the ailment does not exist outside your mind.
What does it mean to live with hypochondria? How does it shape an individual's personality? And his or her relationship with the world? To understand, let us peek into the unbearably lonely world of a hypochondriac, even if from the outside.
BEING A HYPOCHONDRIAC
Kruttika Kallury is a 31-year-old yoga instructor based in Al Nahda in Dubai, who cannot emphasise enough the importance of relaxing one's mind! However, not too long ago, she was faced with the prospect of supporting a very dear friend Chetan (name has been changed), who was suffering from constant anxiety over his health. It started on a casual note, as it always does. Chetan would often talk about how he was displaying symptoms for a particular disorder. Since he was quite "quirky" otherwise, friends - including Kruttika - did not think much of his obsession, and sometimes even joked about it. Things took a more serious turn as he began to feel convinced that he was suffering from every new disease he heard of. "He would read up everything that is available on the Internet and start convincing himself that he had those symptoms. We discovered this was a very real problem," she recalls. As a strategy, his peer group stopped talking about any health issues among themselves, even if any of them fell ill. However, once Chetan started getting panic attacks, the friends circle decided it was time to persuade him to seek medical help. It came in the form of one of the common friends, who happened to be a clinical psychologist. "He began to help Chetan out by counselling him. In fact, this psychologist friend of ours is someone who even tells us how to make little changes in the way we approach Chetan's struggles," adds Kruttika.
Despite receiving help, Chetan has chosen not to tell his mother about it (his parents divorced when he was young, and he has been living with his mother ever since). What could have prevented him? Was he worried that she would be worried too? Or do men tend to feel more apologetic about hypochondria since their societal roles expect them to rise above physical and emotional vulnerabilities?
"Chetan deals with a lot of guilt regarding his compulsive, obsessive nature. As the 'son', he is expected to be strong enough to shoulder that responsibility without showing his weakness," asserts Kruttika.
Clinical psychologist Elena Maria Andrioti does not believe that there are major gender differences in how men and women react to their diagnoses of hypochondria. But she admits, "It is believed that women experience more intense somatic symptoms than men and I have noticed this in my practice as a psychologist well."
DEFINING HYPOCHONDRIA
Even though 'hypochondria' as a term denoting anxiety over one's physical well-being continues to be part of popular lexicon, mental health professionals worldwide have reconceptualised the idea and bifurcated it into two neat categories of somatic symptom disorder and illness anxiety disorder. "The reason they did this is to improve the understanding of the label that is hypochondria and have more effective treatment strategies," says Andrioti, before she gives a detailed analysis of the difference between the two disorders.
Illness anxiety disorder, she explains, is when a patient is concerned about having or developing a serious medical disease. The excessive and unfounded fear of having an ailment causes a lot of distress and impairs daily functioning. An actual medical condition is often absent and the symptoms are usually perceived in an inaccurate way by the patient. This often results in repeated (unnecessary) check-ups.
Andrioti adds that Cognitive Behavioural Therapy (CBT), a form of psychotherapy that challenges the negative thoughts that lead to the experience of severe anxiety, is very effective and is often recommended to treat illness anxiety disorder. CBT, in general, is used to address various mental health issues as well, such as mood disorders and other forms of anxiety. But how does it work? "I focus on the anxiety that leads to the symptoms experienced. It's similar to, say, fear of heights or any other phobia. In some cases, patients can also be prescribed anti-depressants to help with some of the symptoms, specifically when illness anxiety disorder leads to the occurrence of symptoms related to depression due to the impairment it causes to one's daily functioning."
The somatic symptom disorder, on the other hand, is a condition where the patient experiences exaggerated symptoms in multiple parts of the body (stomach pain, joints pain, to name a few). These symptoms lead to a disruption of daily life activities. "What happens here is that you have disproportionate and persistent thoughts about the seriousness of these symptoms, which lead to the experience of a deep anxiety about your health. The treatment, in this case, focuses on how a patient is coping with these experiences," says Andrioti. "We use CBT here, but the content of the therapy differs greatly."
She adds that those suffering from this condition often visit hospitals to conduct tests. "Medical practitioners actually go through these tests and end up noticing that there is no medical cause to these symptoms. It is then that they are usually referred for psychiatric evaluations."
In both illness anxiety disorder and somatic symptom disorder, the first point of contact for the patient is usually a medical practitioner. Their role in assessing the real need of the patient is challenging, not to mention emotionally draining. Dr Veda Riza, a family medicine specialist at MediClinic, says, "One of the biggest challenges is to gain the trust of the patient. Hypochondriacs are convinced that they have significant health issues and often feel they are not being listened to. This can break down the doctor-patient relationship. The other challenge is for the physician to overcome their frustration. A hypochondriac's behaviour can prove to be challenging to the treating physician. This can present itself with the dilemma of how much to investigate. Investigating itself may feed into the patient's hypochondriac behaviour. And not investigating at all may make the patient mistrust the doctor even further, as they could feel their symptoms are not being treated seriously."
HOW IT IMPACTS RELATIONSHIPS
Every mental health condition impacts relationships, and hypochondria is no different. Take, for example, Chetan's reluctance to tell his mother about his condition. Perhaps it stems from a fear of altering their dynamic, or it could be an outcome of a taboo revolving around mental health issues, in general. Silent suffering in case of hypochondria can be dangerous because, as Rania Abdel Ghaffar, a relationship and happiness educator points out, hypochondria turns every resource of happiness into a resource of anxiety. To cite an example, she recalls attending to someone who was convinced he had an ailment. "I told him, 'Let's look up on the Internet and see what are the chances of you having this problem.' We looked up and I think there was 70-80 per cent probability that he didn't have the ailment. But he responded, saying, 'Are you telling me there is a 20 per cent chance that I may have it?'" she says. "Such people's minds cannot grasp a comforting piece of information. So, being aware that this is their choice is the first step towards seeking help."
This inability to process positive information takes its toll on a patient's relationships. Immediate family and friends often tend to become the first casualty as self-preservation begins to take precedence over everything, and everyone, else. "A relationship means that you have become a part of someone else's life and vice versa. Hypochondria takes you away from yourself, which, in turn, takes you away from whoever is related to you. All of a sudden, a person finds that he does not have a place in your life because you're now on a journey of self-preservation. This affects social and personal interactions as well. Since you are being aloof, they will come up with ways to make up for your non-existence. They will love you, but eventually they may not need you," she says.
Come to think of it, what exactly does a hypochondriac fear? The state of being ill? Or death itself? "The whole point is because I am afraid of dying, I am afraid of falling ill," says Andrioti.
Nearly all mental health experts we spoke to admit that hypochondria is on the rise (thanks to the expansion of technology), though its severity varies. However, one thing they unanimously agree on is this: the only real help is seeking psychological intervention as soon as the general practitioner prescribes so.
anamika@khaleejtimes.com