Hypochondriacs: The real problem is `health anxiety'

Doctors waiting rooms are full of them. The fellow with a dry cough who is convinced it's Sars. The woman who thinks her new freckle is melanoma. The patient who is sure his headache is a sure sign of brain cancer.

Immune to assurances otherwise, they vex doctors, rack up health-care costs and exasperate those closest to them with their incessant aches and pains.

In fact, they do have a medical condition - just not the ones they think they have.

Doctors used to call them hypochondriacs, but the term has taken on negative connotations of whiners and malingerers.

"No smart doctor says to a patient, `I think you are a hypochondriac'," says Dr Wayne Katon, a professor of psychiatry and behavioural sciences at the University of Washington School of Medicine.

"That's a quick way to lose patients."

Now such patients - about 4% to 9% of people who visit a doctor's office each year - are seen as having something akin to an anxiety disorder.

In the way that some people are driven to distraction by fear of planes or spiders or crowded spaces, those with health anxiety - the favoured label - interpret every physical symptom as a sign of impending doom.

"A headache is never just a headache," says Dr Greg Simon, a psychiatrist at Group Health Co-operative.

A stomach twinge can only mean bowel cancer.

A muscle pain portends Lou Gehrig's disease, or perhaps dengue fever.

Treating these patients has long been a struggle.

While the fellow fearing dengue fever may think a blood test is in order, the doctor concludes he needs his head examined.

But reframing the disorder as one of undue anxiety rather than imagined symptoms has opened up new treatment strategies that can help the worried get on with their lives.

The average person experiences two to three inexplicable twinges, pains or aches or other odd symptoms every day, says Dr John Wynn, a psychiatrist at Swedish Medical Centre.

Most of us don't think much about them and they go away.

But for Melissa Woyechowsky, no bump or twitch went without notice.

Her glands felt swollen, so she immediately concluded she had HIV, even though she tested negative repeatedly.

Any bump on her skin was thought to be skin cancer.

Her feet felt numb and tingly, so she went online to search for an explanation.

She became convinced she had a neurological condition.

The doctor's clean bill of health didn't reassure her for long.

"On the way home I'd start to thinking, they must have missed something," she says.

Newly married and in her 20s, she became a full-time worrier who rarely left the house.

Her husband grew so exasperated with her it almost ended their marriage.

Finally, she discovered on the web a new condition: health anxiety.

"I realised it was the one thing for which I had every single symptom."

A psychiatrist prescribed Prozac, which she credits with muffling her blaring health fears.

Now 35, she hasn't obsessed about her health in five years.

For people prone to health anxiety, minor physical sensations or observations can kick off a vicious cycle.

They zero in on a symptom and start obsessing.

The more anxious they become, the more glaring the symptom.

The irony is that it is the patient's ramped-up anxiety that likely causes many of the physical symptoms, ranging from headaches to belly aches, back pain to muscle soreness to sleepless nights.

"Anxiety turns up the volume on body sensations," says Simon. "A patient of mine described the process as being like when the oil light comes on in your car and suddenly you can smell things you never smelled before."

Health anxiety often develops in young adulthood, and usually in people who have another diagnosable mental disorder - often depression, generalised anxiety disorder or obsessive-compulsive disorder.

No-one really knows what triggers it, but some cases seem to be related to a traumatic health-related event, such as a loved one dying suddenly.

Some experts speculate it might be tied to a low threshold for physical pain.