Funny thing about hypochondria. If you have the disorder, you may be the last person to know. What you might experience is being told “there’s nothing wrong with you” despite what feel like pretty worrisome symptoms — not to mention quite a bit of stress over the fact that no one seems to be taking them seriously. “Your brain can’t figure it out, so it searches and searches for the worst case scenario” is how one sufferer describes her resulting anxiety after years of undefined ailments.
Of course, many older people worry that something might be wrong with their health despite reassurances from doctors. So what tilts someone away from valid concerns and into the realm of hypochondria? “It becomes a ‘real thing’ when it causes enough distress to interfere with everyday life and someone’s ability to function,” says Kumar Dharmarajan, M.D., a geriatrician and chief scientific officer at Clover Health. That might include spending excessive amounts of time online researching symptoms or avoiding normal activities and social interactions.
Dharmarajan says that among the older population, such worry frequently centers on memory loss. “We all have moments when we forget something,” he says, “but for folks with hypochondria, they might fear they’re developing dementia.” Tests that come back negative don’t convince them otherwise.
What used to technically be called hypochondriasis is now diagnosed as either illness anxiety disorder or somatic symptom disorder. Many patients suffering from these disorders don’t receive an official diagnosis or treatment. Instead, they keep worrying, keep wondering, keep visiting doctors and getting tests, trying to find out what illness they might have. The anxiety, says Dharmarajan, can cause stress so severe that a patient “may avoid people, places or activities altogether. And it might harm relationships with friends and family, and even cause financial distress from medical bills.”
Because mind and body are connected, it’s never “all in your head,” says Gerald A. Shiener, M.D., director of consultation and liaison, psychiatric services and integrated care at Detroit Medical Center. Often physical symptoms — including stomach upset, bowel issues, shoulder aches, neck aches — arise out of stress and anxiety about other areas of life. For seniors, he says, this commonly includes concerns about retirement, finances, a loss of vitality and changes in identity that come with getting older, or a friend or family member who has a major illness. “We don’t know what’s wrong and we assume it’s with the body,” Shiener says. “Often the solution is to go to the doctor for help.”
Hypochondria is commonly treated with talk therapy, notably cognitive behavioral therapy, which can provide patients with coping skills to manage their worries. “In most cases, this isn’t something you can just grow out of,” Dharmarajan says. “You generally need to manage it your whole life, which is why I think psychotherapy is important; it can help you rationalize your stress and anxiety.”
Dharmarajan also recommends practicing stress management and relaxation techniques, participating in activities with others and avoiding regular use of alcohol, which he says can lead to symptoms such as heart arrhythmia … which become something else to worry about. And, an especially hard pointer, he admits: Avoid searching the internet for possible health conditions. Some patients might also be treated with SSRIs, a form of antidepressant.
Beyond that, here are a few other suggestions for dealing with the disorder in yourself or a family member.
What to do if you think you have hypochondria:
1. Develop a relationship with a doctor who knows you and whom you trust. Trust the physician to monitor your health, and schedule follow-up appointments as needed.
2. Get treatment. If your doctor refers you to a mental health professional, take advantage of that person's expertise and services — they can help you with underlying stress and anxiety that could be causing symptoms.
3. Avoid researching on the internet. While the internet can be a helpful source of information, for someone prone to illness anxiety, too much information can actually increase symptoms of anxiety. “Do not rely on information from the internet from unreliable sources,” says Robert Roca, M.D., chair of the American Psychiatric Association’s Council on Geriatric Psychiatry. “It’s always best to check out symptoms with a care provider who knows you well and can give you a professional and personalized assessment of what the condition might be.”
4. Carry on. Isolating yourself tends to worsen health, not protect it, Roca says. “Engage to the greatest extent possible with your usual activities.”
Tips for a family member:
1. Take them seriously. Don’t dismiss their complaints or say things like “It’s probably nothing” or “it’s all in your head,” advises Shiener.
2. Be an advocate. Accompany your family member to the doctor, help to describe their complaints, and take note of what the doctor says, should you need to remind the worried family member later. For instance, you might say, “The doctor said whatever is causing these symptoms isn’t serious and isn’t progressive.”
3. Encourage mental health support. If the patient is referred to a psychiatrist, reassure them that the mind and body are connected, so mental health care is a necessary part of treatment. “Frame it as, ‘It’s difficult dealing with uncertainty and a problem that can’t be identified or solved by traditional medical treatment,’” Shiener says. Another reason to seek mental health help: Hypochondria is frequently related to another condition such as obsessive-compulsive disorder (OCD), panic disorder, anxiety disorder or depression, Roca says. Treating these underlying conditions can help alleviate the illness anxiety.