How is it possible that hypochondriacs have a shorter lifespan? – The Irish Times

“Dúirt me leat go raibh me breoite” is the epitaph on Spike Milligan’s grave in an English cemetery. The unexpected use of the Gaelic version of ‘I told you I was sick’ reportedly came about because the church authority disapproved of the Irish comedian’s use of humour, leading to a neat linguistic circumvention by his family.

Milligan’s postmortem swipe at hypochondria reflected the stigma associated with the term until recently. Defined as a mental illness characterized by the persistent and unfounded belief or fear that one has a serious illness, it has become a pejorative term both within and outside of medicine.

In an effort to distance itself from the previous baggage associated with hypochondria, the World Health Organization prefers to use “health anxiety” to describe the phenomenon. And “illness anxiety disorder” (IAD) has become the accepted term in medicine.

While the figure of the hypochondriac in popular culture is a perfectly healthy person who is convinced that he or she is ill, Caroline Crampton’s excellent book on the history of hypochondriasis, A Body Made of Glass, illustrates how health fears coexist with real disease can exist. When she was diagnosed with lymphoma as a teenager but treated successfully, she describes how: “I could never quite shake the fear that this could happen again, that some serious disease could take over my body without my knowing it. . As I got further away from being an active cancer patient, this hypervigilance and constant awareness of every little ache and tingle turned into fear for my health.”

A recent Swedish study shows that people who worry excessively about their health die sooner than people who don’t. How can it be that hypochondriacs, who by definition worry and yet are not wrong, have a shorter lifespan than the rest of us?

The Swedish researchers followed approximately 42,000 people (1,000 of whom had IAD) for twenty years. During that period, people with the condition had an increased risk of death. Those who worried died five years younger than those who worried less.

( A Body of Glass: Unflinching Interrogation of Hypochondria )

People with IAD who died of natural causes had increased mortality from cardiovascular and respiratory causes. But they had no increased mortality from cancer (which seems strange because fear of cancer is a problem for many people with hypochondria). The leading cause of unnatural death in the IAD cohort was suicide, with at least a fourfold increase compared to those without IAD.

In The Conversation, Dr Stephen Hughes, senior lecturer in medicine at Anglia Ruskin University, attempts to explain this unusual association between illness anxiety and premature death. “IAD is known to have a strong association with psychiatric disorders. Since suicide risk increases with psychiatric conditions, this finding seems reasonable. If we add to this that people with IAD can feel stigmatized and rejected, it follows that this can contribute to anxiety and depression, which in some cases can ultimately lead to suicide, says Dr. Hughes.

However, the increased risk of death from natural causes is less easy to explain.

Dr. Hughes points out the possible role of lifestyle factors: “Alcohol, smoking and drug use are more common in anxious people and people with a psychiatric disorder. It is known that such vices can limit a person’s lifespan and thus they may contribute to the increased mortality from IAD.”

( The anxiety hangover: Recovering from a panic attack takes time )

Although IAD is known to be more common in people who have had a family member with a serious illness, I am afraid I find Dr. Hughes’ explanation for this difficult to accept. “Since many serious diseases have a genetic component, there may be good constitutional causes for this increase in mortality: lifespan is shortened by ‘defective’ genes,” he writes.

While GPs treat patients with illness anxiety with gently challenging tactics and offer treatment with cognitive behavioral therapy (CBT), the Swedish research suggests there may be a need for closer health monitoring.

The inescapable truth is that, in the absence of immortality, everyone with IAD will ultimately be right.