Strange paradox: Hypochondriacs face greater risk of death after all

A recent study from Sweden found that people who worry excessively about their health die earlier than those who do not.

It seems strange that hypochondriacs, who, by definition, worry, yet there is nothing wrong with them, should enjoy shorter lifespans than the rest of us. Let us know more.

First, a word about terminology. The term “hypochondriac” is becoming increasingly derogatory. Instead, we medical professionals are encouraged to use the term illness anxiety disorder (IAD). Therefore, to avoid irritating our more sensitive readers, we must use this term.

We can define IAD as a mental health condition characterized by excessive anxiety about health, often accompanied by an unfounded belief that a serious medical condition is present. This may involve more frequent visits to the doctor, or it may involve avoidance altogether on the grounds that a real and possibly fatal condition may be diagnosed.

The latter version seems quite logical to me. Hospital is a dangerous place and you can die in such a place.

IAD can be quite debilitating. A person with this condition will spend a lot of time worrying and visiting clinics and hospitals. It is costly to health systems due to the time and clinical resources used and is significantly stigmatized.

Busy health care professionals will spend more time treating people with “real conditions” and can often be quite neglectful. So the public can also do it.

Now, about that study

Swedish researchers tracked nearly 42,000 people (1,000 of whom had IAD) over two decades. During that period, the risk of death increased among people with the disorder. (On average, people who worried died five years younger than those who worried less.)

Additionally, there was an increased risk of death from both natural and unnatural causes. Maybe there is something wrong with people with IAD after all.

People with IAD who died of natural causes had increased mortality from cardiovascular causes, respiratory causes, and unknown causes. Interestingly, they did not have increased mortality from cancer. This seems strange because cancer concerns are prevalent in this population.

The main cause of unnatural death in the IAD group was suicide, with an increase of at least four times compared to those without IAD.

So how do we interpret these curious findings?

IAD is believed to be closely related to mental disorders. Since psychiatric illness increases the risk of suicide, this conclusion seems quite reasonable. If we add the fact that people with IAD can feel stigmatized and rejected, this means that this can contribute to anxiety and depression, which can ultimately lead to suicide in some cases.

The increased risk of death from natural causes seems less easy to explain. There may be lifestyle factors. Alcohol, smoking, and drug use are more common in anxious people and those with mental disorders. It is known that such ills can limit one’s longevity and hence they may contribute to increased mortality from IAD.

IAD is thought to be more common in people who have a family member with a serious illness. Since many serious diseases have a genetic component, there may be good constitutional reasons for this increase in mortality: lifespan is shortened due to “faulty” genes.

What can we learn?

Doctors must be alert to patients’ underlying health problems and listen more carefully. When we neglect our patients, we can often get into serious trouble. That people with IAD may have a hidden underlying disorder is an unpopular conclusion, I admit.

Perhaps we can illustrate this point with the case of French novelist Marcel Proust. Proust has often been described by his biographers as a hypochondriac, yet he died in 1922 at the age of 51, when the life expectancy for a French man was 63 years.

During his life, he complained of numerous gastrointestinal symptoms such as fullness, bloating, and vomiting, yet his medical attendants found nothing wrong. In fact, what he described is consistent with gastroparesis.

This is a condition in which the motility of the stomach is reduced and it empties more slowly than expected, causing it to become overfilled. This can cause vomiting and also increases the risk of inhaling vomit, which can lead to aspiration pneumonia, and Proust is believed to have died from complications of pneumonia.

Finally, a word of caution: writing about IAD can be quite risky. French playwright Molière wrote Le Malade Imaginaire (The Imaginary Invalid), a play about a hypochondriac named Argan who tries to arrange for his daughter to marry a doctor in order to reduce his medical bills.

As for Moliere, he died in the fourth performance of his work. Mocking hypochondriacs is at your own risk.

stephen hughesSenior Lecturer in Medicine, Anglia Ruskin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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