A strange paradox: hypochondriacs have a higher risk of dying after all

People who worry too much about their health tend to die earlier than those who don’t, a recent Swedish study has found.

It seems strange that hypochondriacs, who by definition don’t worry but have nothing wrong with them, have shorter lives than the rest of us. Let’s find out more.

First, a word about terminology. The term “hypochondriac” is becoming pejorative. Instead, we recommend that medical professionals use the term illness anxiety disorder (IAD). So, to avoid triggering our more sensitive readers, we should use this term.

IAD can be defined as a mental health condition characterized by excessive preoccupation with health, often with no basis in the belief that a serious health condition exists. It may be associated with frequent visits to the doctor, or it may involve avoiding them altogether because a real and possibly fatal condition could be diagnosed.

The last variant seems quite rational to me. A hospital is a dangerous place and you can die in such a place.

IAD can be quite debilitating. A person with the condition will spend a lot of time worrying and visiting clinics and hospitals. It is costly to health systems in terms of time and diagnostic resources used and is quite stigmatizing.

Busy healthcare professionals would much rather spend their time treating people with ‘real conditions’ and can often be quite dismissive. The public too.

Now, about that exam

Swedish researchers followed about 42,000 people (1,000 of whom had IAD) over two decades. During this period, people with the disorder had a higher risk of death. (On average, those who worried died five years less than those who worried less).

Furthermore, the risk of death from both natural and unnatural causes was increased. Perhaps people with IAD have something wrong with them after all.

Individuals dying from natural causes of IAD had increased mortality from cardiovascular causes, respiratory causes, and unknown causes. Interestingly, they did not increase the death rate from cancer. This may seem odd, as cancer anxiety is rife in this population.

The leading cause of unnatural death in the IAD cohort was suicide, which increased at least fourfold compared to those without IAD.

So how to explain these strange findings?

IAD is known to be strongly associated with psychiatric disorders. Since psychiatric illnesses increase the risk of suicide, this finding seems quite reasonable. If we add to that the fact that people with IAD can feel stigmatized and rejected, it follows that this can lead to anxiety and depression, ultimately leading to suicide in some cases.

The increased risk of death from natural causes is not so easily explained. There may be lifestyle factors. Alcohol, tobacco and drug use are more common in people with anxiety and psychiatric disorders. It is known that such vices can limit one’s longevity and thus contribute to increased mortality from IAD.

IAD is more common in those who have had a family member with a serious illness. Since many serious diseases have a genetic component, there may be good constitutional causes for this increased mortality: life span is shortened by “defective” genes.

What can we learn?

Doctors need to be alert to their patients’ underlying health problems and listen more carefully. When we neglect our patients, we are often caught in the wrong. People with IAD may have a hidden underlying disorder – an unknown consequence, I admit.

Perhaps we can illustrate this point with the case of the French novelist Marcel Proust. Proust is often described as a hypochondriac by his biographers, but he died in 1922 at the age of 51, at a time when the life expectancy of a Frenchman was 63.

Throughout his life, he complained of numerous gastrointestinal symptoms such as fullness, bloating, and vomiting, but his medical assistants got it wrong. In fact, what he described is consistent with gastroparesis.

It is a condition in which the motility of the stomach is reduced and it empties more slowly than it should, causing overfilling. This can lead to vomiting and with it the risk of inhaling the vomit, it leads to aspiration pneumonia and Proust is known to have died from complications of pneumonia.

Finally, a big caveat: writing about IAD can be quite dangerous. French playwright Molière wrote Le Malade Imaginaire (The Imaginary Invalid), a play about a hypochondriac named Argan who tries to marry off his daughter to a doctor in order to reduce the doctor’s bills.

As for Molière, he died during the fourth performance of his work. Pretend hypochondriacs at your peril.

Stephen HughesSenior Lecturer in Medicine, Anglia Ruskin University

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

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