The real pain of hypochondria

Back in the days when doctors were more managers of disease than curers, hypochondria was a common diagnosis with little stigma attached to it.

Besides offering a handy label for the vast areas of malady not understood by science, there was a general conviction that some individuals were constitutionally unable to approach concerns about their health with balance or reason. Such people were to be treated with empathy and kindness and afforded whatever comfort medicine could offer at the time. Figures as accomplished as Charles Darwin and Florence Nightingale led lives ruled by fear of non-existent illness.

Nowadays, hypochondria is more likely to be the punch line of a joke. Doctors are wonder workers able to diagnosis and cure all manner of conditions with scientific precision. The unfortunate few whose imaginations produce symptoms resistant to such treatment are to be shunned or laughed at, like Redd Foxx thrashing through another one of his convenient heart attacks in "Sanford and Son."

Yet hypochondria is serious stuff by just about any measure. Various studies suggest that mentally-originated symptoms accounted for more than 5 percent of visits to primary-care physicians in the United States and up to 10 percent of the more than $2.5 trillion Americans spend on health care every year. Even modest success in alleviating hypochondriacal behavior could have a major impact on our medical spending crisis.

Hypochondria exacts a terrible cost in personal suffering, too. While the illnesses hypochondriacs self-diagnose are imaginary, the symptoms behind them are very real, no less so for being mental in origin.

For those who are friends or family with hypochondriacs, relationships become strained and frustrating, with imaginary illnesses crowding out all other social concerns. Medical and mental-health practitioners who deal with hypochondriacs routinely describe family and friendship ties strained or broken by the all-consuming quest for the "right" diagnosis.

As a student of the mental arts and someone with personal experience dealing with hypochondria, I've been study this poorly understood condition over the past few years. In a continuing series of Hubs, I'd like to share what I've learned about:

• Why hypochondria is so seldom diagnosed by modern practitioners and the ongoing debate among mental health professionals over the structure and nature of the disorder.
• The causes of hypochondria, which is often rooted in childhood experience.
• The functions hypochondria serves for the sufferer, including its role as a shield for self-image and the communicative aspects of physical symptoms.
• The medical profession's uneasy relationship with hypochondria, especially in the days of managed health care.
• The slowly expanding options for treating hypochondria.
• Some famous examples of hypochondria in action.
• What you can do to have a more functional relationship with a hypochondriac.

I hope some of this will be helpful to those who relationships have been strained or worse by this puzzling but fascinating condition.