What is Wrong With Me?

We all know someone;
perhaps even ourselves,

who has asked that question.

It has been estimated that at least one in 20 people who visit a doctor are hypochondriacs. It is very probable that many more than that invent their own reality and imagine their disease. People can and do imagine all manner of things, not least of all, their health. That is because there is medical information overload like never before. All one needs to do is search the InterNUT. Just be advised, a person who tries to be his or her own doctor, has a fool for a patient. Doctors also can be wrong - and too often they are. The fictional Dr. House never got it right the first time and he worked with a team. Hypochondriacs are going to look for a diagnosis until they find the one they like.

The following quotes re: hypochondriasis are from Jeff Pearlman's website:

(Quotes)

"I am dying of colon cancer."

"I know it, even though I haven't been diagnosed as such.
My doctor says I probably just have a muscle strain. But she's wrong - I know she's wrong."

"This is how my brain works - and I loathe it.
For the past several months I've been experiencing a dull pain in my left groin/stomach area. It occurs mainly when I do physical activity, but I'm aware of it many other times, too. I've been told it's not a hernia or a strainer groin. So I have diagnosed myself with colon cancer."

(End of Quotes)

Hypochondria: The Impossible Illness For millions, a cough is not merely a cough; it's a drumroll of death, and no amount of diagnostic assurance can convince them otherwise. But the crosstalk between mind and body is such that we may all have a bit of the hypochondriac within. By Jeff Pearlman, published on January 01, 2010 - Psychology Today

He writes:

I am Dying

"I know I am dying, because, well, I just know. I'm certain of it. I can feel it. That pain on the left side of my stomach still hasn't gone away. It's been there for eight or nine months now. The ultrasound came up negative. So did the CT scan, the MRI and the colonoscopy."

"It's probably nothing," said one doctor.

"You likely pulled a muscle," said another.

"I'd ignore it," advised a third.

"They are wrong. I know they are wrong. So, with nowhere else to turn, I seek out reassurance. "What do you think my stomach pain is?" I ask. "Do you think I'm OK?""

Eyes roll. "You're fine," my father says. "You're fine," my mother says. "You're fine," my sister-in-law says."

"You're 37 years old. You run marathons. You play basketball every Monday. You've never even broken a bone," my wife says. "You're fine."

"I don't believe them. I can't believe them. I refuse to believe them. I wish I could believe them."

(Pearlman's Article Continues)

This is what it is to be a hypochondriac - what it is to live a life too often based upon the raw, carnal fear of inevitable, forthcoming, around-the-bend death. Though I was only recently diagnosed with the disorder, it has plagued me for more than a decade. Over the past 10 years, I have been convinced that I am dying of (in no particular order): brain cancer, stomach cancer, pancreatic cancer, testicular cancer, lung cancer, neck cancer, Lyme disease. When one ailment is dismissed by doctors, I inevitably rush to the Internet to learn why they are wrong. What? I don't have colon cancer? Then it must be....(ibid)

"A full-throttle hypochondriac like me convinces himself, beyond reassurance, beyond comfort, beyond anything, that a cut is never merely a cut, that a cough is never merely a cough. He doesn't merely think he feels the pain. He literally feels the pain." (ibid)

It begins innocently enough. Just recently, for example, I woke up with blurry vision in my left eye. I was OK for a while. I rubbed the eye. Tried lubricating drops. But when the vision remained blurred for several days, my mind began to wander. Is something wrong with that side of my brain? Why is my neck hurting? I mentioned it to my wife, who said, "You're probably fine - don't go to the computer." I went to the computer, where I Googled "blurred vision and tumor." A whopping 199,000 results came up, many of which confirmed my worst nightmares. On cue, I was overcome by dread. Actually, a blackness. I didn't want to talk to anyone. I didn't want to think. Or eat. "I was dying. I knew I was dying." -

My lowest moment came two summers ago, when - in the midst of an otherwise uneventful trip to Florida to see the in-laws—I was overcome by despair about the Lou Gehrig's disease eating away at my body. What brought it on? I'm not certain. Stress, perhaps. Or anxiety. My arms were heavy, my breathing was strained. I locked myself in a bedroom and told my wife to handle our two children without me. Finally, she insisted I get help. "This isn't going well," she said. "You need to talk to someone." - (ibid)

"I immediately contacted a therapist, who convinced me of my irrationality. But now there's this pain in my stomach." - (ibid)

"This damned pain ... the greeks invented the term to describe ailments caused by movement of the upper region of the abdomen - from hypo (below) and chondros (breast bone cartilage). By the late 19th century, however, hypochondriasis had come to mean "illness without a specific cause."" - (ibid)

In the year 2010, hypochondriasis is as covert and confounding as ever. Regarded as a mental disorder in the Diagnostic and Statistical Manual (DSM) and categorized as a somatoform disorder, it is defined as "preoccupation with fears of having, or the idea that one has, a serious disease, based on a misinterpretation of bodily symptoms. This preoccupation must have been present for at least six months and persists despite adequate medical reassurance." - (ibid)

"It is estimated that one of twenty Americans who visit doctors suffer from the disorder, though all figures are frustratingly inconclusive: One can be a lifelong hypochondriac and never know it, just as one can be convinced one is a hypochondriac and, in fact, be physically ill." - (ibid)

"Indeed, hypochondriasis is the Big Foot of disorders, studied, discussed, but persistently elusive. Some people who are hypochondriacs might classify themselves as merely physically sick. "It's very hard to quantify," says Peter T. Swanljung, medical director of the General Adults Unit at Friends Hospital in Philadelphia. Part of the problem is that hypochondriasis exists on a broad spectrum. The worst-case hypochondriacs can delve into the deepest depths of depression, lengthy, unwieldy funks evoked by self-diagnosis and fear of the unknown. Consequently, somewhere in Tulsa, a man is worried that the cut on his foot is a flesh-eating virus. He frets and frets and frets for a week, then gradually forgets about it. A month later, he fears that the spot on his arm is a deadly goose virus. It fades, too." - (ibid)

"Despite official recognition in the DSM, those with hypochondriasis are often treated with the respect and seriousness of a Scott Baio film festival. "It's an obsession, and oftentimes people don't want to listen to someone's obsessions," says Gail Martz-Nelson, a Denver psychologist specializing in anxiety disorders. "'I'm terrified I have HIV, I'm terrified I have cancer, I'm terrified I have lymphoma.' People hear that and dismiss it or laugh it off. But being a hypochondriac can be crippling. It's not a joke." - (ibid)

"Hypochondria: The Impossible Illness For millions, a cough is not merely a cough; it's a drumroll of death, and no amount of diagnostic assurance can convince them otherwise. But the crosstalk between mind and body is such that we may all have a bit of the hypochondriac within..." - (ibid)

Many struggle with anxiety and who hasn't been affected by stress and even an extreme form of anxiety, depression, panic attacks?

Jeff Pearlman wrote "Generally speaking, hypochondriacs aren't merely hypochondriacs. Most struggle with anxiety or depression or both..."

He suggested, "Hypochondriacs aren't merely hypochondriacs.." and Peter T. Swanljung, M.D. of Friends Hospital says, "When someone is anxious about having an illness, the anxiety level goes up, the stress level goes up..." And this also can "lead to headaches, to stomach and digestive problems. Anxiety definitely can cause pain, and if you're a hypochondriac you react to that pain in a unique way."

(Dr. Peter T. Swanljung in his position at Friends Hospital treats patients with a wide variety of affective, psychotic, and substance use disorders, including supervision and training of Drexel medical students and psychiatric residents.

And Dr Swanljung said, no amount of reassurance helps those who are convinced they have a serious disase or condition, etc.

Caroline Goldmacher-Kern, a psychotherapist in NY who specializes in anxiety disorders, says: "The brain is so powerful that it really can convince itself of illness...You know something is wrong because you believe what you're thinking, and what you're thinking is what you perceive to be feeling. So you can have five people tell you it's all in your mind and that's not good enough."

Suzanne Koven, an MD internist at Massachusetts General Hopital, says, "but in fact, all illnesses are psychosomatic...All illnesses involve both mind and body," She points out that "the simplest sore throat brings a tide of emotion, sometimes fear (What if I miss too much work? Will I lose my job?), sometimes guilt (Will anyone catch this from me?), sometimes anger (Who did I catch this from?). And conversely, emotions often communicate in the language of the body: a tension headache, for example, or stress-induced upset stomach."

Although hypochondria is formally regarded as a mental disorder, Koven, who sees hypochondriacs every day in her medical practice, has a slightly more expansive view. "We all walk that side of the street a bit. None of us are disembodied; we all have personalities and fears and hopes. It's a matter of degree." She suggests, all of us, "get something subconsciously from the illness role,"

Hypochondria is Not Uncommon

It is not uncommon. Choosing a disease is almost like ice cream and deciding on the flavor. It is especially easy today with so much medical information on the InterNUT. It is just too easy to diagnose oneself - and often do it wrong.

Quoting from Dr. Koven (in Psychology Today), "Symptomatology, she adds, may be simply the "flavor" that a person's ruminations take on. "Illness is a very common content of the ruminations in obsessive-compulsive disorder, anxiety, and depression." For her, an important question is at what point a person's lack of reassurability about health becomes pathological. There's no firm line. The causes of hypochondriasis seem no more concrete than the symptoms. Some argue that, given the larger axis of anxiety and depression, the condition is largely genetic. Others believe it's learned. "A child is raised by a mother who always fears her kids are sick," says Brian A. Fallon, director of the Center for Neuroinflammatory Disorders and Biobehavioral Medicine at Columbia University. "Then the child becomes an adult and worries irrationally about health issues." Stress is often a catalyst, as is personal tragedy, such as the death of a loved one.

Hypochondriacs have increased anxiety levels and doctors are therefore recognizing the problem (though not all of them) but an increasing number of them are and they are treating their patients with antidepressant drugs because these drugs do help. While not always, when they do work well, they work very well.

The use of Prozac and similar medications is now under formal study. Columbia's Doctor Brian Fallon, a leader in the area of somatoform disorders and Arthur Barsky, a professor of psychiatry at Harvard Medical School, are conducting the largest trial ever undertaken of this disorder in a randomized, placebo-controlled clinical trial comparing cognitive behavioral therapy, Prozac, and a combination of the two.

Those with hypochondria resemble patients with Obsessive Compulsuive Disorder.

As it was pointed out by Dr. Brian Fallon of Harvard, patients worry excessively and feel compelled to do something, like visit the doctor over and over. On the other hand, the inability to explain multiple symptoms may be related to medicine's inadequate understanding of conditions like fibromyalgia. The disorders might be linked by excessive production of pro-inflammatory cytokines.

It may be that the mechanism controlling normal immune response is dysregulated and cytokine production is not turned off, leading to ongoing symptoms of fatigue and malaise. As we learn more about the relationship between the brain, the immune system, and the endocrine system, ... a new view will emerge of patients with multiple unexplained symptoms. - ((ibid)

Can Anxiety Cause Vision Problems?

The symptoms vary, from blurry vision, tunnel vision or just assuming you have something else and sometimes thinking you are dying. Much of this can simply be stress; it often can be caused by stress and stress and anxiety can take a serious psychological and physical toll on a patient. It is not unusual to encounter problems with vision, among other things.

(Also see Anxiety Guru.)

Hydrochondraisis can lead to increased fatique, muscle tension and an excessive production of adrenaline. Tunnel and blurry vision can also be related to an excessive production of adrenaline. Elevation of intraocular pressure might not be significant, but there can be blurry vision. And there is a relationship to the body's fight and flight responses.

Hypochondriasis is tied to fatigue, muscle tension, and the excessive production of adrenaline. Chronic stress (because of ongoing anxiety) leads to an over production of adrenaline. This has several potentially nasty effects on the body but of importance to us is the fact that it can increase intraocular pressure. And although the elevation of intraocular pressure may not be significant it can cause blurry vision and problems with peripheral vision. Tunnel vision is also related to the excessive production of adrenaline. Excess adrenaline secreted into the blood stream may cause tunnel vision. One of the bodies mechanisms most clearly tied to anxiety is the fight or flight response.

Hypochondriasis is a condition in which the sufferer believes or fears that they have an undiagnosed serious illness. It can cause much anxiety and repeated seeking of medical help and traditionally has been considered difficult to treat. A number of different psychotherapies have been suggested as treatments for sufferers of hypochondriasis, some of which have been tested in clinical trials.

"What is hypochondriasis? In the past, hypochondriasis was described as a type of somatoform disorder, a mental illness in which a person has symptoms of a medical illness, but the symptoms cannot be fully explained by an actual physical disorder. More recent research indicates hypochondriasis may better be considered an anxiety disorder. In particular it is a form of abnormal health anxiety that may be rather mild or quite severe and disabling." - See Cleveland Clinic

"Psychotherapy (a type of counseling) can be helpful in changing the thinking and behavior that contribute to the symptoms. Therapy also can help the person learn better ways to deal with stress, and improve his or her social and work functioning. Unfortunately, most people with hypochondriasis deny there are any mental or emotional problems, making them fairly resistant to psychotherapy. Cognitive behavioral therapy has proven successful when adapted to the special needs of these patients. (ibid)

Medically Unexplained Symptoms
"Medically unexplained physical symptoms (MUPS) or medically unexplained symptoms (MUS) are patient symptoms for which the treating physician, other healthcare providers, and research scientists have found no medical cause. The term does not necessarily imply that a physical cause does not exist, but rather notes that cause(s) for given symptoms are uncertain, unknown or disputed - there is no scientific consensus. A task force of the US National Institutes of Health states, "Medically unexplained syndromes (MUS) present the most common problems in medicine." Estimates of primary care consultations with medically unexplained symptoms range from 15% to a high of 66% in specialty settings..." - Wikipedia

Hank Roth

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