According to a recent study in Sweden, people who worry excessively about their health tend to die earlier than those who don't worry. It seems strange that hypochondriacs, who by definition worry but aren't actually sick, have a shorter life expectancy than the rest of us, right?
Before we delve into the reasons, it's worth looking at the terminology. Since the term “hypochondriac” is becoming more and more derogatory, doctors prefer to speak of illness anxiety disorder.
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We can define it as a mental disorder characterized by excessive concern about health, often combined with the unfounded belief that a serious illness is present. Sometimes it involves frequent visits to the doctor, other times it involves avoiding them altogether for fear of being diagnosed with a fatal illness.
Illness anxiety disorder causes the affected person to spend an excessive amount of time worrying and visiting clinics and hospitals. Aside from stigmatizing those who suffer from it, it is also quite costly for healthcare systems, wasting time and diagnostic resources.
Typically overworked health care professionals would rather devote their time to treating people with “real illnesses.” Therefore, it is not uncommon for them to behave contemptuously when admitting these patients.
Suicide cases are increasing
A team of Swedish researchers tracked about 42,000 people over two decades – 1,000 of whom suffered from anxiety about illness. During this time, they found that people with this disorder had a higher risk of death. In addition, the risk of dying from both natural and unnatural causes increased.
How can these strange results be explained? Does this mean that something bad might happen to people with hypochondria?
When they analyzed the results more deeply, the researchers found that people who died of natural causes had higher mortality from cardiovascular, respiratory and unknown causes. Curiously, they showed no increase in cancer mortality, even though fear of cancer is widespread in this population.
On the other hand, suicide was the leading cause of unnatural death in the illness anxiety disorder cohort, with an increase of at least fourfold compared to the remaining subjects.
More psychiatric disorders, depression, addictions and suicide
This disorder is known to be closely related to psychiatric disorders. Given that the risk of suicide increases with psychiatric illness, this finding seems entirely reasonable. Additionally, people with hypochondria can feel stigmatized and disrespected, which can lead to anxiety and depression, which in some cases can ultimately lead to suicide.
The increased risk of dying from natural causes seems less easy to explain. There may be lifestyle factors. Without going into detail, the use of alcohol, tobacco and drugs is more common among anxious people and those suffering from a psychiatric disorder. Given that these addictions can limit life expectancy, their presence may partially explain the increased mortality due to illness anxiety disorder.
We also know that this problem is more common in people who have a family member suffering from a serious illness. Since many serious diseases have a genetic component, life expectancy could be shortened due to “defective” genes.
What can we learn?
Healthcare professionals should pay attention to and listen more carefully to the possible underlying health problems of seemingly hypochondriacal patients. Looking down on our patients can often make us look bad.
The case of the French writer Marcel Proust can serve as an example here. Proust is often described by his biographers as a hypochondriac, even though he died in 1922 at the age of 51, when the life expectancy of a Frenchman was then 63 years.
Over the course of his life, he suffered from numerous gastrointestinal complaints such as bloating, flatulence and vomiting. But the doctors who treated him found nothing unusual.
However, what you described is consistent with gastroparesis. This is a disorder in which the movement of the stomach is restricted, the stomach empties more slowly than it should and becomes overfilled. This can lead to vomiting and therefore the risk of inhaling the vomit, which can lead to aspiration pneumonia. It is now known for certain that Proust died as a result of pneumonia. Chance?
Finally, a warning: writing about this disorder can be quite risky. French playwright Molière wrote “Le Malade Imaginaire” (The Imaginary Invalid), a play about a hypochondriac named Argan who tries to get his daughter to marry a doctor in order to lower his medical bills. Molière died during the fourth performance of his work. If you make fun of hypochondriacs, you do so at your own risk.
Stephen Hughes is a lecturer in medicine at Anglia Ruskin University in Chelmsford, UK.
This article was originally published in The conversation.
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