Frustrated by Patients With Hypochondria? What to Do

Shelly Reese

Disclosures

April 24, 2013

Introduction

Dealing with hypochondriacs isn't easy.

"Hypochondriasis has been around since the age of Hippocrates, and the truth is, such patients have been challenging since the age of Hippocrates," says Jeffrey J. Cain, MD, President of the American Academy of Family Physicians. "Any physician who's busy with a waiting room full of patients will feel the challenge."

Hypochondriacs suffer from an abiding belief that physical symptoms are a sign of serious illness even when medical evidence indicates otherwise, and treating these patients can be exasperating. Not only are they not reassured by their visits, they often second-guess and become angry with their physicians for failing to get to the root of their problems. They demand more tests at a time when physicians are under pressure to curtail unnecessary tests and procedures, and they move among multiple providers, making it difficult to manage their care.

Hypochondria: Often Misunderstood

The term "hypochondria" gets tossed about liberally and often inaccurately, says Arthur Barsky, MD, Vice-Chair for Psychiatric Research at Brigham and Women's Hospital in Boston. Hypochondriacs are different from medically concerned patients with unexplained symptoms whose worries can be allayed with medical tests and reassuring words. They are also different from patients who surf the Internet and show up for an appointment with reams of printouts, only to leave with a sheepish grin when they discover their swollen glands aren't really an indication of Ebola.

"There are a lot of people who are concerned about their health and have unexplained symptoms, but who respond to reassurance," says Dr. Barsky, who estimates hypochondriacs represent some 4%-6% of primary care patients. Hypochondriacs, in contrast, resist reassurance. As a result, their condition, which has provided ample fodder for Woody Allen's jokes, is often perceived as a character weakness or eccentricity. "It's a very pejorative term, and one that meets with a lot of opprobrium," Dr. Barsky says.

But attitudes toward hypochondria may be softening. Many physicians see the condition as a type of anxiety disorder, and the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), due out this spring, includes a new term: complex somatic symptom disorder.

It's not just the language that is changing. Researchers are working to better understand the condition. Payers -- hoping to reduce hypochondriacs' excessive healthcare spending -- are exploring ways to help patients cope with their conditions. And patient-centered medical homes, with their emphasis on coordinated, team-based care, are becoming more common and may be instrumental in enhancing hypochondriacs' care.

Despite these steps forward, modern life presents enormous challenges for the hypochondriac. Every turn of the calendar page brings a new "disease awareness month." Thirty-second television spots and magazine ads remind viewers and readers to "ask your doctor," and the Internet is a minefield of medical horrors. Modern life hasn't created more hypochondriacs, Dr. Barsky says, but it's given them more to worry about.

"The Internet is a pretty significant problem," he says. "Most of these patients report that they start looking up symptoms and diagnoses in the hopes of finding reassurance, but it just makes them more alarmed and more concerned."

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