Hypochondriacs still live shorter lives than the rest of us

People who worry too much about their health tend to die earlier than those who don’t, a recent study from Sweden found. It seems strange that hypochondriacs who, by definition, worry but there’s nothing wrong with them, should enjoy a shorter lifespan than the rest of us. Let’s find out more.

First, a word about terminology. The term hypochondriac is quickly becoming pejorative. Instead, we medical professionals are encouraged to use the term illness anxiety disorder (IAD). So, to avoid triggering our more sensitive readers, we must use this term.

We can define IAD as a mental health condition characterized by excessive worry about health, often with an unfounded belief that there is a serious medical condition. This may be related to frequent visits to a doctor, or it may involve avoiding them altogether on the grounds that a real and potentially fatal condition may be diagnosed.

The last variant I enjoy as quite reasonable. A hospital is a dangerous place and you can die in a place like that.

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 due to the time and diagnostic resources used and is quite disruptive.

Busy health care professionals would rather spend time treating people with real conditions and are often quite indifferent. So can the public.

Now, about that study

Swedish researchers followed about 42,000 people (of whom 1,000 had IAD) for two decades. During that time, people with the disease had a higher risk of death. (On average, those who worried died five years younger than those who worried less.) Furthermore, the risk of death was increased from both natural and unnatural causes. Maybe people with IAD have something wrong with them after all.

People with IAD who die of natural causes have increased mortality from cardiovascular causes, respiratory causes and unknown causes. Interestingly, they did not have a higher mortality rate from cancer. This seems odd because cancer anxiety is prevalent in this population.
The leading cause of unnatural death in the IAD group was from suicide, with at least a fourfold increase in those without IAD.

So how do we explain these strange findings?

IAD is known to have a strong association with mental disorders. As suicide risk is increased by mental illness, then this finding seems reasonable. If we add the fact that people with IAD can feel stigmatized and dismissed, then this can contribute to anxiety and depression, leading to suicide in some cases.

The increased risk of death from natural causes does not seem easy to explain. There may be lifestyle factors. Alcohol, smoking and drug use are more common among anxious people and those with psychiatric disorders. It is known that such vices can limit a person’s longevity and thus they can contribute to the increased mortality from IAD.

IAD is known to be more common in those who have a family member with a serious illness. Since many chronic diseases have a genetic component, there may be good constitutional reasons for increased mortality: lifespans are shortened by faulty genes.

What can we learn?

Doctors need to be alert to the underlying health problems of patients and should listen with more care. When we ignore our patients, we often get caught badly. People with IAD may have a hidden underlying disorder an unpopular conclusion, I admit.

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

During his life, he complained of many gastrointestinal symptoms such as satiety, bloating and vomiting, but his medical caregivers could find little fault. In fact, what he described was consistent with gastroparesis.

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

Finally, a word of caution: writing about IAD can be very dangerous. French playwright Molire wrote Le Malade Imaginaire (The Imaginary Invalid), a play about a hypochondriac called Argan who tries to marry off his daughter to a doctor in order to reduce his medical bills. As for Moliere, he died during the fourth performance of his work. Mock hypochondriacs at your peril.

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

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Image Source : studyfinds.org

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