It happens to every medical student sooner or later. You get a cough that persists for a while or feel a funny pain in the stomach or notice a tiny lump under the skin. Ordinarily, you would just ignore it--but now, armed with your rapidly growing store of medical knowledge, you can't help worrying. The cough could mean just a cold, but it could also be a sign of lung cancer. A twinge might be internal bleeding. The lump is probably a lymph node--but is it bigger than it should be? Could it be Hodgkin's disease?
For doctors in training, nurses and medical journalists, hypochondria is an occupational hazard. The feeling usually passes after a while, leaving only a funny story to tell at a dinner party. But for the tens of thousands who suffer from true hypochondria, it's no joke. Hypochondriacs live in constant terror that they are dying of some awful disease, or even several awful diseases at once. Doctors can assure them that there's nothing wrong, but since the cough or the pain is real, the assurances fall on deaf ears. And because no physician or test can offer a 100% guarantee that one doesn't have cancer or multiple sclerosis or an ulcer, a hypochondriac always has fuel to feed his or her worst fears.
Hypochondriacs don't harm just themselves; they clog the whole health-care system. Although they account for only about 6% of the patients who visit doctors every year, they tend to burden their physicians with frequent visits that take up inordinate amounts of time. According to one estimate, hypochondria racks up some $20 billion in wasted medical resources in the U.S. alone. And the problem may be getting worse, thanks to the proliferation of medical information on the Internet. "They go on the Web," says Dr. Arthur Barsky, a psychiatrist at Harvard Medical School and Brigham and Women's Hospital in Boston, "and learn about new diseases and new presentations of old diseases that they never even knew about before." Doctors have taken to calling this phenomenon cyberchondria.
Most physicians tend to think of hypochondriacs as nuisances--patients they are just as happy to lose. But a few clinicians, like Barsky and Columbia University neuropsychiatrist Dr. Brian Fallon, have begun to take the condition more seriously. "It's not correct to say there's nothing wrong with a hypochondriac," Fallon asserts. "There is something wrong, but it's a disorder of thought, not of the body." And, as he points out, disorders of thought are neither imaginary nor untreatable.
That's something Fallon realized a little more than a decade ago. He was studying obsessive-compulsive disorder (OCD) when he noticed it had a lot in common with hypochondria. "Both disorders," he says, "involve intrusive, worrisome thoughts, the need for reassurance and a low tolerance for uncertainty." Psychiatrists had lately come to think that OCD could be treated with Prozac and similar drugs, and Fallon decided the medications might work for hypochondria as well. With only 57 subjects, the study was too small to be definitive, but it was certainly promising: about 75% of those who got the drug showed significant improvement.