Strange Paradox: Hypochondriacs are at greater risk of death

A recent study in Sweden found that people who worry more about their health die earlier than those who don’t.

It seems odd that hypochondriacs, who by definition worry yet 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 offensive. Instead, we encourage medical professionals to use the term anxiety disorder (IAD). So, in order to avoid triggering our more sensitive readers, we must use this term.

We can define IAD as a mental health condition characterized by excessive anxiety about health, often with the unfounded belief that a serious medical condition exists. This may involve frequent visits to the doctor, or it may involve avoiding them altogether on the basis that a true and potentially fatal condition can be diagnosed.

The latter seems more logical to me. A hospital is a dangerous place and you can die there.

IAD can be very debilitating. A person with the condition spends a lot of time worrying and visiting clinics and hospitals. It is expensive for health systems because of the time and diagnostic resources used and is highly invasive.

Busy healthcare professionals will spend a lot of time treating people with “real conditions” and can often be very disengaged. So can the general public.

Now, about this study

Swedish researchers followed about 42,000 people (of whom 1,000 had IAD) over two decades. During this period, people who are infected have an increased risk of dying. (On average, worriers died five years less than those with less anxiety.)

In addition, the risk of death from both natural and unnatural causes is increased. Maybe people with IAD have something wrong with them.

People who die of IAD from natural causes have an increased rate of death from cardiovascular causes, respiratory causes, and unknown causes. Interestingly, they did not have an increased mortality from cancer. This seems strange because cancer anxiety is widespread in this population.

The leading cause of unnatural death in the IAD group was suicide, at least a fourfold increase compared to those without IAD.

So how do we explain these strange findings?

IAD has a strong association with psychiatric disorders. As the risk of suicide increases due to mental illness, this finding seems very reasonable. If we add to the fact that people with IAD may feel stigmatized and isolated, it follows that this may contribute to anxiety and depression, eventually leading to suicide in some cases.

The increase in mortality due to natural causes seems less easy. May be lifestyles. Alcohol, smoking and drug use are more common in people with anxiety and mental disorders. It is known that such malformations can limit a person’s longevity and therefore they can contribute to increased mortality from IAD.

IAD is more common in people who have a family member with a serious illness. Since many serious diseases have a genetic component, there may be good underlying reasons for this increase in mortality: life span is shortened by “faulty” genes.

What can we learn?

Doctors should be aware of the underlying health problems of patients and should listen carefully. When we dismiss our patients, we often get caught badly. People with IAD may have a hidden underlying disorder, an unpopular conclusion, I agree.

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

During his lifetime, he complained of many stomach symptoms such as fullness, bloating and vomiting, yet his medical attendants could find little fault. In fact, what he described is consistent with gastroparesis.

This is a condition in which the motility of the stomach is reduced and it empties more slowly than it should, leading to overfilling. This can cause inflammation and there is a risk of inhaling the inflammation leading to aspiration pneumonia and Proust is known to have died of complications from pneumonia.

Finally, a word of caution: writing about IAD can be very dangerous. French playwright Moliere wrote Le Malad Imaginaire (The Imaginary Invalid), a play about a hypochondriac named Organ who tries to get his daughter married to a doctor to reduce his medical bills.

For Moliere, he died in the fourth act of his work. Kidding hypochondriacs at your peril.

Stephen HughesSenior Lecturer in Medicine, Anglia Ruskin University

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

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