Promising Hypochondria Treatment

A breakthrough study found that psychotherapy can help hypochondriacs deal with their fears. But the treatment has its limits: A quarter of the patients quit after being told the problem was in their heads.

Hypochondria is a mental, not physical, illness. Getting sufferers to believe that is part of the challenge in treating them.

"Most hypochondriac people never will go to a psychiatrist," said study author Dr. Arthur Barsky of Harvard's Brigham and Women's Hospital. "They'll say, `I don't need to talk about this, I need somebody to stick a biopsy needle in my liver, I need that CAT scan repeated."'

The study involved 102 patients assigned to receive psychotherapy and 85 who got routine medical care. Among those who completed the six therapy sessions, almost 57 percent showed significant improvement in symptoms and quality of life after a year, compared with 32 percent of the comparison group.

"It's actually a landmark study. This is an understudied and underappreciated problem," said Dr. Joshua Straus, medical director for consultation psychiatry at Chicago's Northwestern Memorial Hospital.

Hypochondria involves persistent, unfounded fears about having a serious disease and affects about 5 percent of patients who seek help from primary-care doctors. Medication can help treat hypochondriacs' anxiety, but until now there has been little evidence of an effective treatment for the underlying disorder.

"Having some demonstrated way to intervene and help them is a terrific advance," said Straus, who was not involved in the research.

The study, by Barsky and colleague David Ahern, appears in Wednesday's Journal of the American Medical Association.

Among the 102 participants, 25 quit before completing all six sessions and almost 14 percent never attended any sessions. The treatment "didn't fit with their belief system" that their illnesses were real, Barsky said.

Hypochondria is notoriously hard to treat, in part because patients often "doctor-shop," or switch doctors repeatedly until they get tests or a diagnosis they can accept.

Scientists are uncertain about what causes hypochondria, but some think it might be genetic or learned from parents who overreact to illness. Some cases are triggered when patients or someone close to them suffers a serious health scare. The ailment typically begins in childhood or early adulthood and can last a lifetime.

Carla Cantor, a 49-year-old New Jersey writer whose book "Phantom Illness" details her struggles with hypochondria, said accepting mental health treatment is not easy because hypochondria has such a stigma. In fact, some psychiatrists and patients call the condition "health anxiety" instead.

In college, Cantor was convinced her headaches were caused by brain tumors. Later on, she thought she was dying of lupus and was hospitalized for three days of tests that turned up nothing. After being told that she was depressed, Cantor finally began to believe that she had hypochondria.

"You're experiencing bodily symptoms as terrifying," she said. "It's very hard for people to let it go."

Anti-depressant medication has helped, but Cantor said she thinks treatment like Barsky's can also work.

The study involved six 90-minute sessions where therapists encouraged patients to stop habits that worsened their symptoms, including seeking disease information on the Internet and reading newspaper obituaries. Patients were taught how to understand symptoms better and also learned distraction techniques.

"With a condition that is such a difficult one ... any improvement that is statistically significant - we'll take it," said Emanuel Maidenberg, an assistant psychiatry professor at UCLA.

By Lindsey Tanner