Biology 202

2006 First Web Paper

On Serendip

Hypochondriacs live in the constant fear that they have a serious disease. Although their suspicions are quite unrealistic, the very fact that they possess such incessant thoughts is reason enough for them to seek professional medical help. Hypochondriacs are keenly sensitive to their body and to their bodily sensations; so to a hypochondriac, a headache is interpreted as a brain tumor and chest pains as a heart attack even though doctors continually assure the patient that it is highly unlikely that he/she would actually have the disease. According to Dr. Arthur Barsky, director of psychiatric research at Brigham and Women's Hospital in Boston, a hypochondriac is so in-tuned to his/her body that what seems to be an "average" sensation to someone who does not have hypochondriasis becomes unbearable to a hypochondriac (1). Unfortunately, medical reassurance does not comfort the ailing patient; instead, he/she insists that more tests be ran or that a second opinion should be sought. Needless to say, disagreeing doctors and patients almost always ends in frustration for both parties involved. About one in ten patients believe that they are inflicted with a terminal disease despite confirmations from their doctors that they are healthy (2). Perhaps, the patients are in denial, but regardless of the issue of whether they have a terminal illness or not, hypochondriacs have a staggering affect on a developed country's healthcare system. It has been estimated that each year hypochondriacs drain $150 billion out of the U.S medical system (3). It has become clear to me that hypochondriacs should not be regarded as illegitimate patients and must not be dismissed from receiving medical care. But, the question remains: how do doctors treat something that really isn't there?

In order to care for a patient, the doctor must have some idea of what is going on to cause the patient to act so obsessively. In the case of hypochondria, so little is known about the condition that there is not yet an effective clinical treatment (3). There can be a bouquet of reasons why a disease that has been recorded since the time of the ancient Greeks is still not well known. No one wants to admit that they are misinterpreting or over exaggerating the messages their bodies are sending them. There is a stigma that surrounds the word "hypochondria;" some medical professionals run the other way when they notice the hypochondriac tendencies of a patient (2). Contrary to the belief that Hypochondriacs fake their symptoms, they, in fact, cannot voluntarily control their physical symptoms. So they are actually experiencing pain, but yet there is no solid medical explanation as to why they feel the way they do. Although being able to categorize hypochondriasis into a broader spectrum of disease whether it be mental or somatic may not seem to be of primary concern to those looking to treat hypochondriasis, it is for being able to relate it to other disorders offers an interesting insight to how the disorder works and possible treatments.

Categorizing hypochondria is still a controversial topic in the medical fields. Some experts believe that it can described as an obsessive compulsive disorder (OCD). Brian Fallon, an assistant of clinical psychiatry at Columbia University, considers hypochondriasis to be a type of OCD since patients are continually obsessing over bodily sensations and consequently seeking medical treatment (4). In his clinical studies, he has shown that Prozac, an antidepressant, can be effective in treating hypochondriasis (4). Prozac, a type of selective serotonin re-uptake inhibitors (SSRIs), is used to treat OCD and other related disorders by inhibiting the reabsorbance of serotonin by the presynaptic cell, thereby increasing the effective amount of serotonin available in the neural synapse (5). This treatment implies that hyponchondriasis is actually a mental disorder—one of chemical imbalances—and that the patient's body is not really "experiencing" the physical symptoms he/she claim to be having, but that it's all a product of the brain. Only the patient has the privilege of accessing what his/her body is experiencing, and I believe that whether a patient is in legitimate pain or not is not to the discretion of anyone but the patient, him/herself. However, I cannot argue against the evidence that Fallon's clinical study produces. Fallon's observations have caused me to re-evaluate my idea of hypochondriasis, but these findings seem to raise more questions than answers. If we envision the nervous system consisting of boxes, then Fallon's research means that hypochondriasis originates inside a box within the larger box, that there does not need to be some external input in order to produce an output. Although this explanation is possible, there are still some inconsistencies that exist within the observations that are available concerning hypochondriasis (6).

Treatment with anti-depressants are not the only option hypochondriacs have in combating their illness. Recently, cognitive-behavioral therapy (CBT) has gained popularity when dealing with hypochondriacs. CBT blends the benefits of both behavioral and cognitive therapy in order to treat the habit of thinking that you're always ill as well as the thinking patterns that may have an effect on your physical symptoms (7). Barsky conducts clinical research on hypochondriacs and CBT. Observations from his research suggests that CBT is an effective treatment plan for hypochondriacs as compared to regular medical care (2). Dr. Ingvard Wilhelmsen, a gastroenterologist in Bergen, Norway, believes in finding the cause of hypochondriacs symptoms and focusing in that rather than managing the physical symptoms (8). Because of his approach, Dr. Wilhelmsen is able to successfully treat many of his patients who have been frustrated by conventional medical treatment.

At first glance, I thought that the two treatments, medication vs. CBT, were pointing to different causes of hypochondria. One suggests a physical chemical imbalance in the central nervous system, while the other indicates a strong psyche control of the body. But perhaps medication and CBT are more similar than I had originally thought. Maybe hypochondriasis is too complicated to neatly categorize it into a type of disorder whether it be mental or physical. If Fallon's Prozac treatment refers to taking care of the neurotransmitter imbalance in the smaller box that is within a larger box, then perhaps Barsky's and Wilhelmsen's ideas could be illustrating the complex organization of boxes, inputs and outputs. The evidence from both Dr. Barsky and Dr. Wilhelmsen experiences does not refute Fallon's observations using Prozac. Neither one completely rules out the other; in fact, they just might be complementing treatments or treatments that focus in on a different "type" of hypochondria. Referring back to the box analogy, there is a possibility that two, unrelated input signals or even a different box in which an input signal begins produces the same or very similar output signals. Although these clinical observations offer new insight to the disease and the management of it, there still lingers that elusive bridge that links the mind with the body, continuing to haunt modern medicine and psychology.

References:

1) Hypochondria? Get Over It, an informative article originating from the New York Times.

2) Sick with Worry. Can Hypochondria be cured?, an article from the New Yorker.

3) Severe Hypochondria helped by Cognitive-Behavioral Therapy , an online article describing Dr. Arthur Barsky's treatment.

4) Study: Hypochondriacs Need Treatment, a link to Columbia University Record, Brian Fallon

5) Prozac, information on Prozac

6)Fallon, BA, et. al. Hypochondriasis and its relationship to obsessive-compulsive disorder. The Psychiatric Clinics of North America. 2000 Sept. 23. Vol 3: 605-16.

7) Cognitive Behavior Therapy, The CBT Website

8) Norwegian Doctor Takes Patients Who Only Need Understanding , Wall Street Journal article on Dr. Ingvard Wilhelmsen


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