Hypochondriacs die earlier than those who worry less about their health Hello

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 nothing is wrong with them, should enjoy shorter lives than the rest. Let’s find out more.

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

We can define IAD as a mental health condition characterized by excessive health anxiety, often with an unfounded belief that a serious medical condition is present. It may involve frequent visits to the doctor, or it may involve avoiding them altogether on the grounds that a real and very likely fatal condition may be diagnosed.

The last option seems quite rational to me. A hospital is a dangerous place and you can die in such a place.

IAD can be quite debilitating. A person with the disease will spend a lot of time worrying and visiting clinics and hospitals. This is costly to health systems due to the time and diagnostic resources used and is quite stigmatizing.

Busy healthcare professionals would rather spend time treating people with ‘real conditions’ and can often be quite dismissive. So can the public.

Now about this study

Swedish researchers followed about 42,000 people (of whom 1,000 had IAD) for two decades. During this period, people with the disorder had an increased risk of death. (On average, worriers die five years younger than those who worry less.) In addition, the risk of death from both natural and unnatural causes is increased. Maybe people with IAD have something wrong with them after all.

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

So how do we explain these curious findings?

IAD is known to have a strong association with psychiatric disorders. Since the risk of suicide is increased by psychiatric illness, then this finding seems quite reasonable. If we add the fact that people with IAD may feel stigmatized and rejected, then it follows that this can contribute to anxiety and depression, ultimately leading to suicide in some cases.

The increased risk of death from natural causes seems more difficult to explain. There may be lifestyle factors. Alcohol, smoking and drug use are more common in anxious people and those with mental disorders. It is known that such vices can limit longevity and thus may contribute to the increased mortality of IAD.

IAD is known to be more common in those who have had a family member with a serious illness. Since many serious diseases have a genetic component, there may be good constitutional reasons for this increase in mortality: life expectancy is shortened by “defective” genes.

What can we learn?

Doctors need to be alert to patients’ underlying health problems and need to listen more attentively. When we treat our patients with disdain, we can often get caught badly. People with IAD may have a hidden underlying disorder – an unpopular conclusion, I admit.

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

Throughout his life, he complained of numerous gastrointestinal symptoms such as fullness, bloating and vomiting, but his medical staff could find nothing wrong. In fact, what he described is consistent with gastroparesis.

This is a condition where the motility of the stomach is reduced and it empties more slowly than it should, leading to overfilling. This can lead to vomiting and with that comes the risk of inhaling vomit leading to aspiration pneumonia and Proust is known to have died from complications of pneumonia.

Finally, a word of warning: writing about IAD can be quite risky. The French playwright Moliere wrote Pretending to be sick (The imaginary invalid), a play about a hypochondriac named Argan who tries to get his daughter to marry a doctor in order to reduce his medical bills. As for Moliere, he died in the fourth performance of his work. Mock the hypochondriacs at your peril.

Stephen Hughes is a senior lecturer in medicine at Anglia Ruskin University in Chelmsford, UK.

this article was originally published in The conversation.

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