Health: They're Worried Sick ; Hypochondriacs Used to Be Seen as a Nuisance. Now Doctors Recognise Health Anxiety as a Real Illness - That Can Be Treated. Hugh Wilson Reports
Wilson, Hugh, The Independent (London, England)
Ryan Smith thinks he has worried about his health for a long time, perhaps since childhood. But in 2002, health anxiety took over his life. "My anxiety went through the roof. I found out someone I'd known had died of Aids. I developed an immense fear of contracting HIV, to the extent that I would avoid all situations where there might be the slightest risk. I would avoid a whole circle of friends. I had no sex life whatsoever. I wouldn't even kiss anyone."
Smith's GP referred him to a psychiatrist, who advised him to wear an elastic band round his wrist, and twang it whenever he felt his fears were getting out of hand. "I didn't even try it," he says. "I knew it would achieve nothing, apart from a nasty sore." Instead, he found one of the few private therapists to specialise in treating severe health anxiety - better known as hypochondria - with cognitive behavioural therapy (CBT).
"The treatment was highly effective," he says. "I have a sex life again. I don't avoid anyone. I'm not fully cured and I'm not sure I ever will be, but I've learned to live with my condition. I have some control back."
Ryan's experience hints at something that the majority of health anxiety sufferers - and many GPs - still don't know: that an effective treatment exists. In 2004, a large-scale trial by doctors at the Brigham and Women's Hospital in Boston - the first of its kind in the US to look at potential hypochondria treaments - found that psychological intervention, and specifically CBT, significantly improved symptoms. Another recent study in Australia showed that attention-training techniques could be used whenever a fear of illness threatened to dominate a patient's thoughts.
"Hypochondria is a common, chronic and debilitating condition, but no intervention has proven to be clinically effective in treating it, largely due to our lack of understanding and research," says Arthur Barsky, the director of psychiatric research at the Brigham and Women's Hospital. "Our data shows that CBT is a tool physicians can use to care for patients, making a big difference in how they feel."
That conclusion comes as no surprise to Paul Salkovskis, a professor of clinical psychology at King's College London, who has been looking at CBT as a treatment for health anxious patients since the 1980s. The new studies add to a growing body of evidence that it works, he says. The problem is that very few people suffering severe health anxiety will ever see a specialist in CBT, particularly if they can't fund the treatment themselves.
"In trials, between 60 and 70 per cent of sufferers are either completely better or very much improved after a year. But there are very few people trained in it, and even we don't have the funding to deliver it. The scandal is that GPs can't access CBT so they continue to send patients for outmoded treatments that don't work. When a severely health-anxious patient is told to `lie on the couch and tell me about your relationship with your mother', he doesn't see the relevance and he drops out."
Experts hope - perhaps forlornly - that the recent spate of research might signal a change in attitude towards hypochondriacs, who have often been regarded as nuisances to be dismissed from surgeries as quickly as manners and ethics allow. Certainly, it's no coincidence that the focus on treatments for anxious patients has come at a time when hypochondriacs consume (according to one study) over 10 times more healthcare resources than the average patient. But it might also be a belated recognition that, for sufferers, severe health anxiety is as serious a threat as physical illness and could be getting worse.
According to Professor Salkovskis, unpublished research hints at how serious that threat could be. Statistics garnered from patients diagnosed with hypochondriasis 30 years ago show that, in general, the doctor was right and the headache was just a headache. …