Hypochondriasis Multiple Illness Phobias F452 3007

Fears of multiple bodily symptoms and a variety of illnesses are called hypochondriasis. Fear focusing on a single symptom or illness in the absence of another psychiatric problem is an illness phobia, a kind of specific phobia. The distinction is arbitrary at some point.

Sufferers worry endlessly that they have various diseases. They fear that minor pain in the abdomen or chest or a tiny spot on the hand or penis denotes stomach or lung or skin cancer or a sexually transmitted disease. They may constantly search their body for evidence of disease. No skin lesion or body sensation is too trivial. They misinterpret normal tummy rumblings. Their worry itself produces fresh symptoms, such as abdominal pain and discomfort due to gut contractions, which reinforce their gloomy prognostications. Women may examine their breasts for cancer so vigorously and often that they bruise their breasts. Repeatedly normal examinations and investigations that would satisfy the average person allay the worry only briefly, with further reassurance-seeking soon following. Sufferers may make hundreds of phone calls and visits to doctors throughout their district in a vain quest for reassurance.

A physical illness might trigger hypochondriasis or sensitize someone to develop symptoms later, but commonly there is no history of past disease to explain it. Indeed, in a few cases development of the feared disease resolved the fear. One man was so frantic with fear of sexually transmitted disease that he was admitted to a mental hospital. After discharge he got syphilis with a visible ulcer. From that moment his fear disappeared and he attended happily for regular anti-syphilitic treatment.

Illness fears might be triggered by circumstances which sufferers start to avoid, as in a woman with a fear of epilepsy who would not go out alone lest she have a seizure. A man who had had so many X-rays that he thought he might get leukaemia refused to be out of contact with his wife more than a moment in order to get her constant reassurance.

Some illness phobias reflect currently fashionable worries about disease, so we can expect now a surge in phobias of SARS (severe acute respiratory syndrome) just as the last few years of the 20th century saw the advent of AIDS fears and its earlier years saw many fears of tuberculosis. Some illness fears may simply reflect a failure of patient and doctor to communicate well; a taciturn doctor's silence may be misinterpreted as an ominous sign of frightening information being concealed.

Hypochondriasis can cause extreme distress and disability. A woman had gone to 43 hospital casualty departments over three years and had every part of her body X-rayed. At various times she was scared she would die of stomach cancer, a brain tumour, thrombosis. Examinations never revealed any abnormality and she emerged each time from the hospital ''rejuvenated—it's like having been condemned to death and given a reprieve''. But within a week she would seek out a new hospital ''where they won't know I'm a fraud. I'm terrified of the idea of dying, it's the end, the complete end, and the thought of rotting in the ground obsesses me—I can see the worms and maggots.'' She was petrified of sex with her husband, imagining she could rupture and burst a blood vessel, and afterward would get up at two in the morning and stand for hours outside the hospital so she knew she was in reach of help.

Differential Diagnosis

• Specific (illness) phobia. Worry about a single illness can be called a specific illness phobia, and of several illnesses hypochondriasis, but, as noted, the distinction becomes arbitrary at some point.

• Obsessive-compulsive disorder. The more the worry generates repeated stereotyped checks and requests for reassurance and investigations, the more the hypochondriasis overlaps with OCD.

• Depression. The more the worry about illness began at the time the low mood began, and the more it waxes and wanes as the depression does, the more accurate it is to call the problem depression rather than hypochondriasis.

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