Contact: Timothy Scarella, MD
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A winter cough lasting a few days easily could signal lung cancer, a bloated abdomen after a holiday weekend prompts terror over the prospect of ovarian cancer, and that heart test showing clear arteries probably needs to be redone—it missed the obvious blockages.
Extreme as these examples seem, most of us have known people similarly plagued by ongoing, intense worry about having or developing an illness. Their symptoms are fleeting or mild, but they’re on a never-ending quest for reassurance from doctors that never comes, because no amount of objective information seems to reassure them. Although they’re often derided as peculiar hypochondriacs, people with such intense fears over health are surprisingly common, they have a bona fide mental disorder and—the best news—there’s recent evidence that treatments can relieve their constant worry. A new report on this disorder appears in the June issue of Psychosomatic Medicine, journal of the American Psychosomatic Society. This is part of a special series in the journal addressing clinical applications of state-of-the-art research in psychosomatic medicine.
Varying studies suggest that about one out of 10 people suffers from excessive worry about their health, including many who have Illness Anxiety Disorder (IAD), a specific condition spelled out in the recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM5), says Timothy Scarella, MD, Instructor in Psychiatry at Harvard Medical School. He’s coauthor of the report with colleagues Arthur Barsky, MD, and Robert Boland, MD.
Most people with the disorder are “regulars” in doctors’ offices, but a minority are so paralyzed by fear that they stay away from medical settings, and that too can lead to problems, notes Scarella. Usually, IAD begins when adults are in their 20s to 40s. It’s fairly common for patients also to have depression or additional anxiety disorders—panic attacks, phobias, PTSD—and parents who were nervous people worried about health.
While IAD takes a terrible toll on a person’s well-being, it also costs the health care system and taxpayers a lot of money. Patients with IAD visit primary care doctors, specialists and emergency departments more frequently than the average person; they also lose more work days, suffer more financial losses and make greater use of disability benefits than the general population and even than patients with medical illnesses but no health anxiety.
With widespread access to the Internet and prescription drug commercials on U.S. television, those prone to worrying about their health are exposed daily to information that triggers health-related fear, says Scarella. “The Internet provides an endless trove of information—that and TV ads listing symptoms can give you new ideas about diseases you might be experiencing.”
If you have the symptoms of IAD, or family and friends say your high fear level appears unjustified by the reality of your health, Scarella suggests first getting a thorough medical checkup. If everything tests out normal, “it’s important to acknowledge your anxiety to your primary care doctor,” he recommends. Your doctor should collaborate with a mental health clinician to create a treatment plan for the IAD. Research shows that Cognitive Behavioral Therapy (CBT) can lower health anxiety by providing accurate facts about the probability of illnesses and potent strategies to effectively challenge fearful thoughts. Medications also can help, he adds.
“Don’t feel fatalistic, that you always will be consumed with worry,” Scarella emphasizes. “This really is an anxiety problem, and it’s treatable. Just be assertive about getting the mental health treatment you need.”
The American Psychosomatic Society (APS) (http://www.psychosomatic.org), founded in 1943, is an international multidisciplinary academic society that organizes an annual scientific meeting and educational programs. Psychosomatic Medicine is its scientific journal. The membership of over 700 is composed of academic scientists and clinicians in medicine, psychiatry, epidemiology, health psychology and allied health services. The mission of the APS is “to advance and integrate the scientific study of biological, psychological, behavioral and social factors in health and disease.”