“I know I’m dying, doctor. No one can figure out what I have but I’m sure it’s a tumor. The MRI comes back negative but the headache tells me the tumor is there. But it is so small that the MRI does not see it. You will see it in two months, when I am dead. I have agreed to come to your office so that you can make me sleep, I have not slept a wink for three days, but you are not going to make me believe that there is nothing wrong with me”. This is the testimony of Jerónimo, a patient who came for consultation with an anxiety disorder due to illness, the new name for hypochondriasis in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM).
We live in a society that is constantly striving to improve and maintain its health. However, a small proportion of the population lives in terror of suffering from a disease from which they do not suffer. They are those who suffer from nosophobia and hypochondria. For them, a headache is a drum roll for an approaching death. However, these two concepts are often mistakenly lumped together and confused under the generic term hypochondriasis. But this confusion of terms can lead to an erroneous approach to patients.
Hypochondriasis or sickness anxiety disorder
Hypochondriasis is a disorder in which the patient firmly believes that he or she is the victim of a serious illness and that he or she is not being diagnosed. It affects 5% of the population and usually appears between 20 and 30 years of age, reaching its peak around 40.
There are no gender differences. It is believed that people who suffer from hypochondria tend to have a high rate of medical illness in childhood, as well as overprotective and overly preoccupied upbringings. In addition, there is often early exposure to death or a family member with serious illness.
People with hypochondria may or may not have physical symptoms, from which they establish their belief. However, the person with hypochondria spends many hours searching for information on the Internet, in associations… about the disease they believe they have, as well as the percentage of reliability of the diagnostic tests that exist. The abundant amount of information on the Internet has aggravated hypochondriasis to the point of being called cyberchondriasis.
On the other hand, a negative test does not reassure the patient, on the contrary, since they believe that they have made a mistake, that their sensitivity is not sufficient or that it was not yet the right time to perform the test, and that when it is done again it will be positive. They believe that the doctor who did not know how to diagnose them is not a good doctor and that is why they did not know how to reach the diagnosis. This makes them look for “a better one”, and they are considered addicted to “doctor shopping”.
Often these people have other symptoms such as insomnia, sadness, crying, difficulty in concentrating and decreased work, domestic or academic performance. In addition, absenteeism due to sick leave and medical visits is normal, as well as some job instability and economic problems, including medical expenses.
Types of hypochondriasis and how to distinguish them
There are several types of hypochondria, depending on the characteristics and symptoms presented by the patient, according to Dr. Brian Fallon, a psychiatrist at Columbia University:
- Obsessive-anxious hypochondria. This is the most common hypochondriasis. The patient is continually on the lookout for new symptoms, continually checks tests and shows rigid thinking. However, there are usually no or minimal physical symptoms.
- Depressive hypochondria: Depressive symptoms abound, as hypochondriacal fear is related to feelings of guilt. The patient experiences the disease as a deserved punishment. There may be a risk of suicide.
- Somatoform hypochondriasis: physical symptoms are predominant, showing a real disease, although it is not as serious as the patient considers it to be.
What is nosophobia?
Nosophobia is similar to hypochondria but in this type of patient the fear of suffering a fatal disease in an undetermined future is irrational and uncontrollable. In these cases the fear of having a disease is so intense that the patient tries to avoid any circumstance that could confirm it. Thus, he/she prefers to close his/her eyes and live without knowing it because, sometimes, the anxiety is so intense that it prevents even watching movies about diseases.
Patients with nosophobia are often also afraid of growing old. They do everything possible to stay and appear young. It is also common for these patients to show thanatophobia, or fear of death, as it is the greatest threat to them.
What is the difference between hypochondriasis and nosophobia?
In both disorders it is the preoccupation with illness that is the common link. However, there are certain differences:
- In hypochondria the patient is certain that he already suffers from a disease, while in nosophobia the fear is to contract the disease.
- The hypochondriac patient relies on a doctor shopping to prove that he suffers from the disease, while the patient with nosophobia avoids going to the doctor.
- The hypochondriac patient has rigidity of thought and believes he or she is a carrier of a terminal disease. The nosophobic patient does not worry if he is far from what can cause the disease.
- In hypochondriasis the patient constantly informs himself about the disease. The nosophobic, on the other hand, is not even able to watch a series, because he does not feel identified.
- The patient with hypochondria suffers from anxiety, insomnia, depression… which translates into work, family and social relationships.
How to treat hypochondria or nosophobia disorders from Psychiatry
The treatment of such disorders should be psychotherapeutic, specifically cognitive behavioral therapy. In both cases cognitive restructuring will be useful. However, while in hypochondriasis exposure with response prevention offers good results, in nosophobia systematic desensitization will be chosen.
Pharmacological treatment will also be recommended in cases of hypochondriasis. The specialist in Psychiatry will be the one who will have to prescribe, if necessary, the treatment. In patients with obsessive-anxious and depressive symptoms, SSRIs have been shown to be useful.