Hypochondriacs choose the most serious, but often least probable, explanation for their symptoms. Headache isn’t migraine or stress but brain tumour, chest pain is probably a heart attack, and so on. They tend to have beliefs like: ‘It is normal to feel completely well all the time’, ‘A physical symptom is a sign that something serious is wrong’, ‘You can be 100% sure that you are completely well’ and ‘Doctors often misdiagnose cancer’.
The diagnostic criterion for hypochondriasis is that even when full medical investigation gives no support to their ideas the fear or conviction or having a serious disease remains.
The type of problem reported is culturally variable: the French have liver problems, the Malays have shrinking penises, whilst in Germany and the US tummy trouble is usually a preoccupation. One study comparing depression in China and America found that the Chinese expressed a higher proportion of physical symptoms than American patients and rarely admitted these symptoms stemmed from depression, even when the symptoms cleared up with antidepressant medication.
Hypochondria can involve sexual complaints, skin problems, backaches, insomnia, fear of halitosis and body odours and, in at least one case, a profound hypochondriacal fear of becoming a hypochondriac. The majority of complaints are about pain and more than 70% occur on the left side of the body. The condition is more common in men, lower socioeconomic class and the elderly.
The 'worried well' are a big issue for the NHS, accounting for an estimated quarter of all GP appointments. 3 million people in the UK have imaginary food intolerances, and hundreds of thousands are so anxious about their health as to be unable to work.
The internet encourages self-diagnosis and exacerbates the problem. The most useful treatment is probably Cognitive Behavioural Therapy, but instead more and more investigations are undertaken to attempt to 'prove' to the patient that there is nothing wrong with him.
All the powers of imagination combine in hypochondria.
Medically speaking, the hypochondria are the parts of the abdomen immediately below the ribs.
A medical nickname for hypochondriacs is GOMER, 'Get Out Of My Emergency Room!'
Charles Darwin was plagued by irritable bowels and so kept meticulous records of his flatulence.
Historically the term has had various different connotations, including symptoms that we might now call depression, anxiety or obsessional disorder; these days it is more sympathetically called ‘health anxiety’. Generally it was associated with the melancholic personality type, caused by an excess of black bile. In the Middle Ages there was a vogue for a religious hypochondria called pusillanimata, or scrupulosity: morbid doubt as to the adequacy of one's devotion and a terrible fear not of disease and death but of eternal damnation. Robert Burton’s Anatomy of Melancholy suggests ways of tricking people out of hypochondriacal imaginings: ‘The pleasantest dotage that I ever read was of a gentleman at Senes in Italy who was afraid to piss lest all the town should be drowned; the physician caused the bells to be rung backward and told him the town was on fire, whereupon he made water and was immediately cured’. In the 18th century it came to be thought of as the male form of hysteria, with its seat in the spleen rather than the womb. (Medically, the ‘hypochondrium’ is the place under the ribs – the right hypochondrium contains most of the liver and gall bladder, and the left hypochondrium the spleen.)
Famous hypochondriacs include Charles Darwin, who kept precise records of his own flatulence. Andy Warhol and the pianist Glenn Gould exhibited unambiguous hypochondria as the term is understood today, in the sense of imagining dangers to health when in reality there is none. Gould threatened to sue his record company, believing that he had been seriously injured after one of its employees gently placed a hand on his shoulder; Warhol’s fear of catching AIDS was such that he couldn’t eat a sandwich prepared by a café worker who appeared camp. James Boswell and Charlotte Brontë were unabashed in using the term to describe themselves: Boswell wrote a series of essays under the name ‘The Hypochondriack’, while Brontë’s autobiographical novel Villette offers an in-depth study of its heroine’s ‘hypochondria’.
In spite of being completely healthy, psychoanalyst Marie Bonaparte entitled her diary the 'Journal of a Young Consumptive'.
Howard Hughes picked up everything with tissues to insulate himself from other people's germs.
Hans Christian Anderson became obsessed with a small spot above his eye that he felt might eventually cover half his face.
45% of Americans without any major psychiatric disorder have an unfounded worry about contracting an illness.