Up to 30% of patients seeking medical treatments are hypochondriacs. Even though they do not have a medical disorder, they overreact to the body's random aches and pains as if they signaled a catastrophic disease. Why do they act this way? How can they be helped?
According to Dr. Arthur Barsky, a psychiatrist at Harvard Medical School, they are unusually sensitive to the body's normal creaks and groans.
"What might be a minor twinge or soreness to most of us is a severe consuming pain to the person who amplifies sensations. These are people who amplify all forms of distress."
Barsky found that some people are more sensitive to physical stimulation. They indicated greater distress to loud, sudden noises and changes in temperature, and they are quick to respond to hunger pangs. However, not all people who have this sensitivity are hypochondriacs. Besides being hypersensitive, hypochondriacs see their sensations as indications of serious medical disorders.
One factor that leads supersensitive people to become hypochondriacs is parents who overreact to childhood illnesses. In a scientific study started in the 1960s, researchers found that the more attention parents give to any symptoms that the children had, the more their children were preoccupied with them. Sixteen years later, these same children – who learned to be vigilant for signs of medical disorders – were more likely to be hypochondriacs as adults. In Barsky's words, "The more attention you pay to a symptom, the more intense it gets."
This saying is demonstrated by an experiment devised by Dr. James Pennebaker, a psychologist at Southern Methodist University. Men exercised on a treadmill, randomly assigned to listen to either a tape of city sounds or the sound of their own breathing. After completing the exercise, those who listened to their own breathing indicated more physical symptoms such as a headache or a racing heart. However, there were no physiological differences noted between the subjects. In a simpler experiment, Pennebaker asked subjects to either concentrate on any sensation of nasal congestion or on the sensations of free breathing. Those attending to signs of nasal congestion were more likely to judge their nose as being stuffy.
Unfortunately, it does not help to merely tell hypochondriacs that they are not really sick. They will still have sensations that verify their belief that they are ill. To treat hypochondriacs, Barsky has his clients meet in small groups for eight weeks to learn about the "perception of physical symptoms."
The hypochondriacs are taught that paying attention to symptoms will intensify these symptoms. As an example, the group members are told of dental patients who were asked to rate their pain – either every 20 minutes or after 2 hours. Rating the pain every 20 minutes made it seem more severe. The hypochondriacs learn that this is the same process that is occurring with them.
Clients also deal with their beliefs that normal twinges and pains are related to some curable illness. In fact, Barsky sees a paradox here. "Having come to imagine that somewhere there is a treatment for almost everything that ails us, we experience symptoms as a mistake, an injustice, a failure of medical care." Rather than putting up with minor aches and pains, this attitude encourages people to continually search for a cure – even if there is nothing wrong to be cured!
With training from Barsky, hypochondriacs usually understand that their frantic search for a medical cure has kept them from dealing with their bothersome symptoms in a more positive way. "We talk about how to cope with something like chronic low-level back pain or constant fatigue. Patients learn practical strategies like conserving their energy or how to relax." Barsky's training does not stop the aches and pains. "People's symptoms don't get better, but they aren't bothered by them as much."
Barsky doesn't try to convince hypochondriacs that their aches and pains are not real. However, he tries to change how they interpret their sensations.
"These people have not reconciled themselves to the fact that they have to live with some kind of symptoms. They have the fantasy that there will be discrete answers to what is bothering them, and a real cure. The paradox for them is that they can't get better psychologically until they accept that they won't get better physically."
Barsky urges his clients to accept some discomfort, so they can give up their fruitless search for medical solutions. In other words, once you have investigated your symptoms and found no underlying disorder, accept them as part of living.
"In comparison, the inevitable pains of normal living
help us to appreciate the times of pleasure and joy."
On the other hand, we may fear that ignoring symptoms may allow diseases to get progressively worse and become fatal. Essentially, it comes to a question of balance. We all need to balance our fears about illness with our acceptance of the small aches and pains that are normally part of our lives. ("Ouch, there's that pain in my side again!")
* Adapted from Daniel Coleman's "Behind Abnormal Fears, Normal Aches and Pains," The New York Times, November 29, 1988.
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