How to Deal with Health Anxiety and Hypochondria: What Doctors Need to Know

When most of us think of hypochondria or health anxiety, we think of the stereotypical sitcom portrayal of an old woman who keeps telling everyone she's going to die and the put upon relatives commenting, "she's been dying for years" right before she clutches her chest and fakes a heart attack.

As a person who has seen a loved one suffer from health anxiety, I can assure you that there is nothing funny about it. Constant worry about random but very real pains, symptoms that mimic those of serious diseases, the pain of spouses, family and friends who don't understand what you're going through and the seeming indifference of doctors all combine to make the person who suffers from health anxiety feel depressed, confused, angry, and overwhelmed.

Unfortunately, doctors seem to have no idea how to deal with a patient who suffers from health anxiety. The following are things that physicians need to know when they treat a person with health anxiety or hypochondria.

FORGET MALPRACTICE, THE PERSON WITH HEALTH ANXIETY NEEDS CONFIDENCE

Let's say that you or I go to the doctor because we're having pains in our chest. The doctor does a couple of tests and says, "everything looks okay." We breathe a sigh of relief, go on our way.

Not if you're a person with health anxiety. You tell them, "but the pains are so real. Are you sure I don't have something wrong with my heart?"

"Well, I can't guarantee you that, but if you're worried about it........"

In dealing with my loved ones and others, I've noticed a troubling trend among doctors, their inability to say anything definitive or to say with certainty that they can rule something out. My impression is that this is so they aren't one day trapped by saying, "no you don't have cancer" and then the person is diagnosed with it three months later.

As a doctor, if you know you're dealing with a patient with health anxiety, HAVE CONFIDENCE. If you know you're right, say it loud and forcefully. As soon as they hear you say, "well...." you've lost whatever confidence they had in what you said before.

DON'T RUN UNNECESSARY TESTS

The obvious thought that a doctor might have when dealing with a person with health anxiety is to run lots of tests, even if they know they are unnecessary. If you run all the good stuff and it all comes up blank, then the person with health anxiety will certainly be relieved and reassured they don't have what they thought they have.

Guess what, that probably won't work, and your patient and/or their insurance company will have spent lots of money needlessly.

Negative results don't necessarily prove anything to the person with health anxiety, it's just one more frustrating dead end in determining where their symptoms come from. If you are confident in your initial assessment and feel that additional tests are unwarranted, don't order them anyway. They aren't going to help. Instead, explain why the tests you ran are adequate and why you're confident in them.

PREPARE TO BE CHALLENGED

Yes, I know you went to college forever and a day. I know that you're well respected in your field. I know that you have multiple awards and have written extensively on your field. But you sir (or madam) do not know everything. And you're no match for the biggest piece of kryptonite to hit a patient with health anxiety, the Internet.

People with health anxiety seldom trust what anyone tells them, especially if their symptoms don't immediately go away. All of your degrees, experience, and knowledge fly out the window if the still ailing patient can find one anecdote or fact somewhere that supports the possibility you are wrong. Yes, this is unreasonable, silly, and frustrating. But it is part of the larger ailment of health anxiety that it is very difficult to reassure them if alternate explanations for their symptoms exist.

So how do you deal with it? Again, be confident, but be kind. Listen to the individual and try to poke holes in their concerns by providing facts and statistics. If you cannot do this immediately, offer to do research for the patient when you get a spare moment and get back to them.

WATCH WHAT YOU SAY

If you know that your patient has health anxiety, be careful what you say. Any comment you make can and will be used against you if you can find nothing wrong with the patient.

If you see something abnormal, be honest, but be sure to follow up with explanations as to why a test could be abnormal and why you are confident that those abnormal results don't mean the patient has anything wrong with them.

It is important to realize that the patient with health anxiety is NOT easily reassured, and will require clear and unambiguous discussions if there is any hope of reassurance.

ABOVE ALL, BE PATIENT AND KIND

How do you reason with someone who pokes holes in everything you say? Why should you? This crazy person sitting in my exam room should trust me, listen, and get on with their life. Here's the thing. They cannot help it. For whatever reason, the irrational fear they have won't go away when they get news that would instantly comfort the rest of us. When you get angry and dismissive, the person with health anxiety immediately feels a combination of distrust for you and disgust with themselves. The very person who is supposed to help them has dismissed them, and their already jumbled feelings get worse.

So when the patient comes to you who seems impossible, validate that the pain and symptoms they are feeling are real, but not dangerous. Explain to them in a calm and rational tone that you do not believe there is anything wrong with them. Since many people with health anxiety will research what they've told you on the Internet, offer to take their call if they have questions for you when they get home.