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For sufferers of hypochondria, “worried sick” is not just an expression. As new research is revealed and a landmark book on the condition is published, Elle Hunt investigates the causes… and costs.
For five years, cancer was Sarah Drage’s constant companion. She could be enjoying a summer barbecue, or a day out with her husband and two young daughters, and she’d think, “My life is perfect.” Then, in the next instant, her happiness would be punctured by another thought: “Remember, you’ve got cancer.” The thing is, Sarah, now 34, didn’t have cancer. In fact, she tells me one Friday from her peaceful, neutral-toned home in Kent, “I was the epitome of perfect health. That’s the ironic thing.”
Those five years were a constant, all-consuming battle – “the worst of my life”, she recalls. When she was pregnant with her second child, she became convinced she had esophageal cancer and, though sceptical, her doctor referred her for an endoscopy. Being pregnant, she was not permitted sedation – she winces recalling the pain of the procedure. The results were negative but, as ever, Drage’s relief was short-lived. She began checking her daughters for signs of lymphoma, becoming so hypervigilant for lumps and bumps that her eldest, then four, started looking for them herself. When her daughter complained of leg pain, Drage took her to the GP, convinced of leukaemia when the health service was still battling the pandemic. At the time, Drage herself was working in the NHS, in administration (she is now a marketing consultant in the charity sector). “It’s madness, isn’t it?” Drage says. “But I couldn’t help it.”
Sometimes her brain would produce the treacherous thought that it would be a relief to discover she really did have cancer. One day in September 2020, she was walking her dog along Greatstone beach, seeking to shake off her anxiety, when the idea of suicide crossed her mind. “I was doing meditation, taking antidepressants, getting therapy – doing everything everyone was telling me to do. I was trying.” Even now, Drage’s voice contracts with frustration. “Nothing was working. I was desperate.”
As far back as the fifth century BC we’ve had a word for Drage’s state: hypochondria. And for almost as long, hypochondriacs have been presented as self-indulgent and attention-seeking – or else played up for laughs. Just consider Molière’s 17th-century farce Le Malade Imaginaire or Mrs Bennet in Pride and Prejudice or, more recently, the comedy of Larry David. It’s hard to miss the sense that, if you’ve got time to be pursuing imaginary illnesses, you haven’t got enough real concerns.
“All of the hypochondriacs of popular culture, over centuries, are so performative and out-there,” says Caroline Crampton, the author of A Body Made of Glass: A History of Hypochondria, from her pigeon-patterned wallpapered office at home in the Wirral. In her new social history-cum-memoir, Crampton seeks to untangle centuries of thinking about this sense-defying condition to counter its pernicious mainstream misconceptions. Chief among them is the dual assumption that the hypochondriac’s ailments are not only “not real”, but that they exist in the absence of any identifiable health concerns. “My own experience is that in real life it’s completely the opposite,” continues Crampton, now 35. “That there’s so much shame and worry associated with this, you keep it all to yourself.”
A recognised psychiatric disorder, hypochondriasis is characterised by persistent preoccupation with (or fear of ) serious illness. In its “repetitive and excessive” body-checking, it may bear similarities to body dysmorphia or obsessive compulsive disorder and it is thought to affect three to four per cent of the global population. Yet it often eludes diagnosis as people seek help for imagined or overblown physical symptoms, instead of the real anxiety underpinning them – or else avoid doctors altogether, lest their worst fears become reality. Meanwhile, there is little mainstream understanding of hypochondriasis as a real source of suffering in and of itself – it is, by nature, shape-shifting, a disorder of the mind masquerading as one of the body, one that resists easy definition. As Crampton’s decade-plus experience goes to show, the lines between good health and poor health, body and mind, and even real and imaginary are far from clear-cut.
Her own descent into hypochondria started with a very real disease. At 17 years old, she was diagnosed with Hodgkin lymphoma. Although she was successfully treated with chemotherapy, the cancer returned a year later, announced by a lump she found in her neck. After yet more invasive treatment, and years of tests and monitoring, she was finally declared cancer-free at 22. Crampton, however, remained a prisoner of her experience.
Although she was now at no more risk of cancer than the general population, she had absorbed doctors’ instructions to pay close attention to her body. She fixated on finding another tumorous “intruder” in her neck and self-diagnosed herself with dozens of other illnesses besides. Her book opens with her frantic, ritualistic checking of her collarbone in her office toilets, searching for evidence of a lump, while a familiar argument circles through her head: “You know it’s not real… but this time it might be real.” (“You are allowed to think it,” she writes, addressing the reader. “I can hear you thinking it. I am a hypochondriac.”)
Having lost her hair before during chemotherapy, Crampton became “obsessed” with monitoring her hairbrush: “How much hair is in it? Is that more than usual? When did I last pull all the hair out?” At one point, she was sure that she had polycystic ovarian syndrome. Hair loss is a symptom – but, she adds, “That was also because somebody I knew had just been diagnosed with it, so I thought, ‘Well, me too.’”
If Crampton’s fears were without basis, that is not to say she was left with a clean bill of health – as has been revealed, hypochondriasis itself can take a considerable physical toll. One Norwegian study found that high levels of health anxiety increased chances of coronary heart disease by about 70 per cent. More recently, Swedish researchers found that people with the condition had an elevated risk of dying than those without. They also died younger, at an average 70 years old versus 75.
While the Swedish paper didn’t look at causes, the heightened risk of death likely reflects the chronic stress of living with the condition, says David Mataix-Cols, its lead author and a professor at the Karolinska Institutet. “The reality is, some of these patients might spend all their waking hours worrying about their health… It’s a very miserable existence.”
Mataix-Cols’s hope is that his findings will encourage policymakers and health professionals to take hypochondriasis seriously, “as a bona fide, serious mental disorder, not just some amusing peculiarity”. Adapted forms of cognitive behavioural therapy have been shown to be highly effective, often within mere sessions. “What’s tragic is that we have good treatments,” he says. “People just need to get them.”
That said, hypochondriasis cases require careful handling that time-poor GPs aren’t necessarily equipped to give. Patients often feel attached to their self-diagnoses and sensitive to feeling dismissed. “As far as I was concerned,” recalls Drage, “I had cancer and nobody was listening to me. It’s almost like me saying to you, ‘The sky isn’t blue, it’s green.’”
For patients to be receptive to psychological treatment, they first need to feel heard – which, in the cash-strapped public health service, is increasingly not a given. The average GP consultation in the UK lasts 9.2 minutes and increasingly people don’t see the same doctor each time, making it difficult to establish patterns and quell concerns. “Knowing and trusting your GP has a more powerful effect than any drug we have in our armament,” says Gavin Francis, an Edinburgh-based GP and author of Recovery: The Lost Art of Convalescence. Although often considered a feminine concern (and historically thought to be linked to the womb as far back as ancient Egypt) hypochondriasis is in fact equally common in men and women. But structural bias within the medical profession means female patients, and those from ethnic minority backgrounds, in particular, struggle to be heard by doctors and may be more readily dismissed, delaying diagnosis and treatment.
Factor in medicine’s dismal track record of minimising or missing women’s pain, and public-health messaging emphasising the importance of monitoring your health, and it becomes hard to tell excessive or undue health anxiety from legitimate cause for concern. A 2021 study found that women’s pain is routinely underestimated compared to men’s; meanwhile serious gynaecological conditions are so chronically under-diagnosed that endometriosis is known as “the missed disease”.
It took Anita Guru, 42, three years after first presenting to her doctor with stomach pains to be finally diagnosed with advanced endometriosis. Early investigations focused on a digestive issue: “It was almost like they didn’t want to look at the gynaecological side,” she says, from her Surrey home. Between her diagnosis, in September 2014, and December 2018, Guru underwent five operations, alongside cycles of IVF and an ectopic pregnancy. Although her endometriosis was successfully removed, the ordeal left her constantly on edge. “Any twinge or symptom, I’d go straight to the doctor, like, ‘Check me, scan me – I’m scared it’s come back,’” she says.
Even the all-clear didn’t reassure Guru: “I know for a fact that scans don’t always pick it up.” She started doing acupuncture, making three-hour round trips for two-hour sessions, and cut gluten, sugar and dairy from her diet. It was expensive and unsustainable, Guru says. “But that’s how great the anxiety was – the feeling of needing to prevent it… If you tell yourself, ‘I’m sick’ and go to the worst-case scenario, it’s almost psychosomatic: you actually start experiencing those feelings.”
Guru’s mental health deteriorated to such a point that in 2017 she was admitted to a psychiatric hospital, where she was diagnosed with post-traumatic stress disorder, ascribed in part to her fertility struggles. “What I discovered on that journey is that trauma lives in your body and it will manifest in different ways,” she says.
Having now retrained as a life and “mind coach”, Guru remains alert to potential triggers of her health anxiety, such as Facebook support groups for endometriosis (which she has permanently muted) and times of life stress. She has also tried to harness that psychosomatic connection for good, learning meditation, breathwork and other strategies for catching her thoughts before they spiral. “I try to keep my mind as fit as possible, so that it doesn’t impact my body.”
What finally helped Drage break free from hypochondriasis was a form of hypnotherapy called rapid transformational therapy, which returned her to unprocessed memories from childhood. She then listened to a recording of the session every night for a month. “And it worked,” she says, with quiet awe.
A subsequent diagnosis of ADHD brought Drage further clarity. Now she draws a straight line between her turbulent childhood, marked by her beloved father’s alcoholism, and her innate tendency towards hypervigilance and anxiety, later coalescing around her health. Some of her doctors knew about her past traumas, but never joined the dots, Drage says.
Now a campaigner raising awareness of the issues faced by the adult children of alcoholics, she thinks that the response could have been more compassionate. “They’d roll their eyes and get visibly frustrated, like, ‘This has to stop, Sarah’ – but they could have perhaps asked more questions… When you stop researching your symptoms and start researching hypochondriasis, everything starts to make sense.” In the end, the most effective treatment Crampton received for her hypochondriasis is one that’s often dismissed as a pseudoscience: a once-experimental trauma treatment known as EMDR, or eye movement desensitisation and reprocessing. “I found it really helpful,” says Crampton. “Then I read all of the studies debunking it.”
It’s further proof of the permeable barrier between body and mind, and sickness and health. With her extensive medical history, Crampton’s “NHS pathway” is now so well greased that a flu jab and even a podiatrist’s appointment have seen her referred for further testing, both returning no cause for concern. This cycle has taught Crampton to resist her desire for diagnosis and sit with the ambiguities presented by her ever-changing body.
These days she is less troubled by the need for certainty – a real admission, Crampton says, laughing, for “a researcher and a worrier” who used to seek reassurance for her health anxieties from scientific papers. But not every illness can be identified with tests, she points out, while those that exist in the mind can take a demonstrable toll on the body. Even the constant questioning of a hypochondriac’s concerns as being either “real”, and able to be ascribed to a verifiable condition, or imagined is somewhat by the by: their psychological distress, at least, is undeniable. Crampton concludes: “I have come to the point of view that if you feel it, it’s real – I don’t think there’s any difference.”
This article was originally published on British Vogue.
