Wellness Anxiety: A Stressor on Public Health

Hypochondria, also known as wellness anxiety or health anxiety, can be defined as an excess of concern for a person’s own physical health combined with a belief that the person is or will become ill.  Generally, no clinically identifiable disease will be present in the individual at all.  This non-existent condition—the object of the patient’s anxiety— might be the product of personal research, in which the sufferer perceives himself as having various symptoms and tries desperately to find a common root cause. The object of the anxiety may also have vague origins.  During my time as an EMT in a small-town hospital, I had the opportunity of observing a number of individuals who might have been suffering from wellness anxiety.  I say “might” because it is very difficult to distinguish patients who have psychosomatic symptoms from those who might actually be ill.  The fact remains that hypochondria places a burden on public health by causing actual health problems, dividing the attention of dedicated healthcare professionals, providing an easy fix for the less dedicated, and generating financial burdens.

Wellness anxiety, as with any form of anxiety, can put stress on the human body.  It can contribute to problems such as hypertension (high blood pressure) and malnutrition.  The patient might actually forget to eat because they are so worried about being ill, and that ends up making them sick.  Another major problem among many hypochondriacs is a propensity to self-medicate.   A doctor at my old hospital once described a case where an apparently healthy 27-year-old man had collapsed and vomited blood.  The cause of this was a perforated ulcer; the patient nearly bled to death into his stomach before the perforation could be repaired.   After taking a complete medical history, it was found that the patient had been taking daily doses of aspirin since high school.  His grandfather had died of a heart attack when he was younger, and when he learned that heart disease ran in the family, he became convinced that he would get it too.  The subsequent anxiety led to self-medicating with aspirin (to thin the blood), which likely caused the bleeding.  A less specific and potentially more disastrous instance of self-medication is the abuse of antibiotics.  This can be seen in the case of women in northeastern Thailand in the 1990s. Many of these women, excessively concerned about poorly understood risks to reproductive health, would, according to Nichter, “engage in inappropriate self-medication with antibiotics for a wide range of symptoms in an attempt to reduce their risk of cancer” (32).  This use of antibiotics by hypochondriacs as a means of treatment for non-existent bacterial infections and other inappropriate ailments can have far reaching consequences, including the emergence of antibiotic resistant strains that could potentially kill thousands.  In less developed nations, misuse of antibiotics also reduces the supply available for fighting legitimate infections.  These are just a few examples of how wellness anxiety can, like a self-fulfilling prophecy, have an adverse effect on health in a biomedical context. 

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                  Whenever I have the opportunity to observe an ER doctor at work on a particularly busy shift, it calls to mind an image similar to the one above.  It is of a professional juggling the responsibilities of his chosen profession, seemingly without effort.  Of course, the more balls you throw in the mix, the harder it is to keep them all in the air.  Consider this scenario: An ER doctor has six patients, three with severe lacerations and three complaining of stomach pain.  Two of the bellyachers are hypochondriacs with mild indigestion and the third has appendicitis.  Long story short, the last man’s appendix bursts and kills him before the doctor has a chance to make a thorough examination, in large part because the ER is too crowded for a Tuesday night.  It may be unfair to blame the two patients with wellness anxiety for the death of the last man.  After all, they are suffering from a potentially debilitating anxiety disorder.  Nevertheless, the fact that their disorder was not recognized long ago and referred to a psychiatrist did put an extra strain on the ER staff, which may have led to mistakes being made.  Caution must be exercised in this line of thinking, however; it can be a double-edged sword.

                  Joseph Heller wrote in Catch-22, “Just because you're paranoid doesn't mean they aren't after you.”  Applied to this context, “they” is referring to a wide range of physical diseases.  If a person is convinced they have a disease, they actually might have one.  Unfortunately, issues like hypochondria, anxiety, and stress have become crutches for indolent diagnosticians everywhere.  What they really mean when they diagnose a person as stressed after a just few minutes is, “I don’t know what’s wrong you, and I’m too lazy/cheap to find out.” Most people, including myself, have heard more than a few stories about this exact phenomenon.  Among those anecdotes are the confirmed second-opinion diagnoses of West Nile virus, mono, and bacterial meningitis.  Some practitioners have the habit of diagnosing “stress” and “exaggeration” after a single visit from a patient.  That is a disturbing trend.  A patient should be thoroughly vetted before such assumptions are made.  This will oftentimes require repeat visits.

                  Repeated medical appointments, numerous ER visits, and insistence on unnecessary tests can be both costly and time consuming.  The time lost can translate into lost income and loss of health coverage.  This places a burden on individuals suffering from a mental condition, one that might have been treated in therapy for a fraction of the cost of an MRI, a biopsy, or whatever tests the patient insisted on.   When the wellness anxiety becomes unmanageable and the patient can no longer pay their bills, a burden is placed on the healthcare institution.  This could, in an ideal capitalist system, increase the cost of healthcare for everybody else.  Whether or not that is the case, there can be no arguing that expensive habits of any kind have adverse effects on both society and the individual.

                  The real question is how to address the problem of wellness anxiety and reduce its negative consequences.  Aside from raising awareness of hypochondria as a mental disorder and encouraging those affected to seek therapy, I believe a more thorough understanding of the condition and its influencing factors would be beneficial.  To solve this and other practical problems, it might be helpful to further bridge the divide between medical anthropology and current healthcare practitioners.

Sources

Nichter, Mark (2008). Global health: why cultural perceptions, social representations, and biopolitics matter. Tucson: University of Arizona Press. Pp 23-132.

Heller, Joseph (1961). Catch-22. New York: Simon and Schuster.