Learning how to trust your immune system
June 23, 2010 1:24 PM   Subscribe

How do you cure a hypochondriac?

A close relative of mine is a hypochondriac. Every itch on her leg must be a blood clot. Every pain in her gut must be appendicitis. Every mole or freckle must be skin cancer. Seems like she's in some sort of pain nearly all the time, and I honestly believe that usually, it's because she's looking for it that she finds it (it's psychosomatic). Sometimes she has phantom pain that moves from place to place, which suggests to me it's all in her mind. Of course, I'm not her so I can't be sure. I trust her but she is a chronic worrier and that frequently clouds her judgment.

Whenever she starts feeling bad she demands that we drop whatever we're doing and look it up online. I can't blame her for wanting answers but it seems like doing this only makes her more paranoid. She finds some rare, obscure disease that matches her vague symptoms and convinces herself that she has it. She can't relax until she's found some sort of assurance online that she's fine. I feel that this behavior itself is the most unhealthy thing about her (and the constant worrying may in fact be shortening her lifespan), plus I'm annoyed at constantly pulling up WebMD at all hours of the day and night.

The funny thing is, when she gets really worked up she decides she has to go to the E.R... but she's deathly afraid of doctors and refuses to make the trip. Then she gets locked into a cycle of fear, where she believes she must choose between dying a horrible death, and getting stuck by needles (a fate worse than death).

How can I help her relax? What should I do when I try to calm her down and tell her she's fine, and she accuses me of not caring or taking her health seriously? I am in a position of caretaker for this family member; I'm responsible for her wellbeing.

Also, is my "don't worry, be happy" approach too nonchalant? When I personally get hurt I tough it out and wait for my body to heal itself. If I've been sick for several days and still show no signs of improvement, then I'll go to the doctor, but not before then. I shrug off every unusual thing my body does, like it's nothing, and I'm usually right. I seem to have great metabolism, a strong immune system, and I bounce back from things quickly. But maybe I'm projecting those traits onto others who are not so resilient. I tend to think my relative overreacts to every little sneeze, but she thinks I UNDERreact. Maybe she's right. There are diseases out there that kill in just 24 hours and my approach wouldn't do anything until it was too late. My relative is deathly afraid that she'll be the victim of one because of my negligence, and I guess on some level I have the same fear (though statistics say there's probably nothing to be worried about). What should I do, for both of us?
posted by anonymous to Health & Fitness (14 answers total) 5 users marked this as a favorite
She needs a therapist; you cannot cure her anxiety disorder any more than you could cure cancer (if she had it).
posted by desjardins at 1:28 PM on June 23, 2010 [8 favorites]

Whenever she starts feeling bad she demands that we drop whatever we're doing and look it up online.

"I'm sorry, I can't help you with that any more." Every time you look up one of her imaginary ailments for her you're giving her the attention she desperately craves. The only medical research you should be doing on her behalf is looking for the names and numbers of therapists who can treat her mental illness.
posted by deadmessenger at 1:35 PM on June 23, 2010

Stop looking stuff up online. There's a reason doctors go to medical school and don't just read Google: patients with certain diseases present in a certain time period, with a certain history. Things like WebMD are for patient information, NOT to make a self-diagnosis. There is a big difference between these two things.

There are diseases out there that kill in just 24 hours and my approach wouldn't do anything until it was too late. My relative is deathly afraid that she'll be the victim of one because of my negligence, and I guess on some level I have the same fear (though statistics say there's probably nothing to be worried about).

Yes, and these are quite rare, and with most of them you're severely ill. You're not helping her well-being by allowing her to look things up online at all hours of the day and night. Sounds like she needs therapy.
posted by gramcracker at 1:39 PM on June 23, 2010 [4 favorites]

Hypochondria is notoriously difficult to treat, let alone cure. Exposure therapy and cognitive behavioral therapy probably have the best track records.

Many experts view hypochondria as having a lot in common with OCD, and I'm inclined to agree (I'm a person with hypochondria, by the way, not a mental health professional). Instead of seemingly stereotypical "ritual behaviors" (like hand-washing or having to turn light switches on and off a certain number of times), people with hypochondria compulsively seek reassurance, as you've experienced. Often this consists of doctor-seeking behavior and demanding medically unnecessary tests, but in your case the person in question is looking to you for reassurance.

The most important thing you can do is to break the cycle of reassurance-seeking behavior.

Refuse to do Internet research for her at all hours of the day. If you must taper down, do Internet research for her only briefly (one Wikipedia entry and that's it, for example). Tell her that if she truly believes she's sick, she needs to make an appointment with the doctor. Tell her that in all likelihood, it's nothing.

Other things that can help include medication (usually an SSRI anti-depressant and sometimes possibly a tranquilizer if the hypochondria symptoms include panic attacks) and therapy. It can also be extremely helpful, though difficult, to maintain an ongoing relationship with an understanding doctor who is willing to treat and test extremely conservatively.

But the most important thing you can do is to break the cycle of reassurance-seeking behavior. It's difficult, and it's unpleasant, but it's the only thing that will help, and even then there will be plenty of relapses. My condolences; hypochondria is no fun to have, and it's certainly no fun for those of you stuck dealing with a loved one who has it. Be firm, but be compassionate.
posted by infinitywaltz at 1:48 PM on June 23, 2010 [1 favorite]

Have her get checked for Fibromyalgia.

My mom was very similar to your relative (not so demanding though) and was finally diagnosed with Fibromyalgia. She is still in pain a lot of the time, but at least now she knows why and doesn't get so worried.

I was also called a hypochondriac, and it turns out I have Celiac Disease. I say don't be so quick to offer your own diagnosis.

Tell your relative that since they are in pain they really need to get checked out. Offer to go with them to the doctor if you need to. Try to be supportive and don't be dismissive to the doctor. There may actually be something wrong, but it may be hard to find.

(And yeah, stop looking stuff up online. It's a horror fest out there.)
posted by TooFewShoes at 1:49 PM on June 23, 2010 [2 favorites]

IANAD, but I do have experience with intense health anxiety, and know that for me needles and getting blood taken does seem like a fate worse than death.

This makes me think that part of your friend's problem may be vasovagal, meaning that certain stimuli cause her blood pressure to plummet and, basically, make her feel like she's dying.

It can be a terrible circle-- she starts to think she's slightly sick, thinks about going to the hospital, and immediately feels intense anxiety and far more sick then she felt at first.

Anything can trigger it, for me the sight of blood, getting blood pressure taken, and even glaucoma tests make me go out cold.

So she should look into being treated for an anxiety disorder and definitely ask her doctor if she may have vasovagal syncope.
posted by karminai at 2:00 PM on June 23, 2010

Oh, and to answer your question: no, you're probably not being too nonchalant in your own attitude. The approach you take with your own medical well-being is one she should emulate and also one I try to emulate myself.

However, your "don't worry, be happy" attitude may or may not be helping. A lot of people will tell you "Oh, don't worry about that, you don't have cancer" or whatever, but the problem with hypochondria is that it's irrational. Logically, you know you're probably not sick, but you keep asking yourself "What if?" over and over again. Don't brush off your relative's concerns as "nothing," but don't indulge them, either. Understand them as very real (to her) despite their irrationality.

It sounds like your relative doesn't at this point even understand that she has hypochondria, and that makes things more difficult as well. She's saying that you don't take her concerns seriously; the hope is that she'll get to the point where she'll say, "I know this concern is irrational and probably just my hypochondria, but..." and then from there, eventually, to the point where she isn't plagued by irrational concerns at all.
posted by infinitywaltz at 2:01 PM on June 23, 2010

(IANAD) Your question is not about hypochondria but about how to deal with a hypochondriac that you are responsible for. (I am assuming she's been diagnosed, although some lines in your question make me doubtful of this.)

Wikipedia suggests CBT and SSRIs as effective treatment options (hopefully others with experience will chime in), but there is more to this than just finding "a cure". You seem to be conflating her personality with her symptoms - which, given your position as caregiver, is understandable but it's helping neither your relative nor you. Hypochondria means that there is a strong pathological/obsessive element to her worry. In which case, you need to be a little more sensitive, if not to your relative, then at least to the necessity for treating her as a person and not just her symptoms.

Hypochondria is a lot about anxiety and the need for control. But it's a disorder, which means you can't just convince her out of it, and a lot of your own annoyance with her seems to be rooted in the assumption that she's just not listening to reason. It can be very difficult to be responsible for such a person, I say this from experience in dealing on a daily basis with a depressed elder who refuses to get help. However, expecting her to just snap out of it, get convinced with reason or comparing yourself to her (even in your own head) is totally counterproductive. The fact that this approach is not working may be what's making you so impatient - in which case, the solution (or the first step towards it) is to change your outlook.

If she's a hypochondriac, she doesn't just "think" she's unwell, she is. The problem is that she's misplacing it in specific physical symptoms, so as a caregiver your responsibility is to remember what the real illness / issue is. You can clearly see that her perceived symptoms are "not real", but to her they very much are. She is in a lot more mental anguish than you, and caring for her means you don't get to put yourself or your own reactions first. So correcting her or dismissing her concerns, even though it's what you want to do or what you think is right, is not the way to go about it.

Yes, you are in a difficult situation. No, you don't get to blame your relative or get upset at her for being unwell. It's hard, but please try, because with psychological problems the important thing is to build and maintain trust. So start with kindness and with treating her with care. Educate yourself about hypochondria. Talk to a doctor yourself even if she doesn't go. Maybe there are online groups, or the doctor can refer you to other caregivers more experienced in this area. Try to get her to the point where she is ready to accept medical help. Try not to lose patience. Try not to judge.

And take breaks from your responsibility - because you need to care for your own emotional health as well. Good luck.
posted by mondaygreens at 2:03 PM on June 23, 2010

Phobias are by definition irrational, so it is very hard to reason your way out of them.

I would agree with the others who said that the first step is therapy. But you don't want to suggest it in a confrontational way that suggests that she is crazy. Say something like "hey, I've noticed that worrying about your health is really bothering you. I feel like I'm not doing a very good job myself of making you feel better. I think you should talk to someone about it." and be ready with the name of a recommended and trusted therapist.

Another thing you could do is try to arrange a trip to the doctor for a routine checkup. Since she is afraid of needles, you just go for the visit but promise that no blood work will be done up front. This gives her a chance to talk to the doctor about some of her fears and be reassured. She gets a full history and physical and a clean bill of health. Once she becomes comfortable with the idea of going to the doctor/has a good relationship with the doctor, and is not associating it with needles every time, you try to take the next step and get routine blood work with cholesterol testing etc. done.

I also agree that you are playing into the game by using WebMD with her. I think you need to find some firm but kind way to say "I think looking things up on the internet is just getting you more upset, and I don't want to do that. If you think you are really sick, we should go to the doctor. You can refuse to get blood work drawn, but at least then we can talk about it with a health professional." After a couple of rounds of this she will probably get sick of going to the doctor's so much. Figuring out whether you are really sick or not is not rocket science, it is more common sense. Pain that is severe or lasts a long time should be checked out. You may need to go to the emergency department for things like shortness of breath, chest pain, abdominal pain, severe headaches, loss of function of a body part, etc. You can most likely go to or call your primary care doctor for rashes, mild to moderate pains and discomforts, colds and flus, stomach bugs, or cancer screening. You can *always* call your primary care doctor for an opinion on whether your symptoms are serious or not (many people don't realize that primary care doctors have someone on call 24-7, not just during office hours). IANYD. I deal with a lot of hypochondriacs, and I understand how you feel. I hope you can get this issue resolved.
posted by treehorn+bunny at 2:29 PM on June 23, 2010 [2 favorites]

I would suggest using an approach similar to the communication pattern suggested for talking to people with Borderline Personality Disorder -- although she probably doesn't have BPD, I find that it's a good way to assert boundaries while supporting someone emotionally (my mother did have BPD and OCD and a serious cancer phobia).

The pattern is Support, Empathy, Truth:

Support: Acknowledge their feelings through reflection: "I know you're really scared that you have a serious disease right now, and that you are really feeling pain." (Psychosomatic pain is REAL, only caused by the body-mind connection rather than any underlying disease).

Empathy: Empathize with their very real feelings: "I am really sorry that this is scary for you right now."

Truth: Assert what you know, assert boundaries: "There are many things that could be causing your pain. However, I am not a doctor and neither you nor I are qualified to diagnose you using the internet. I will, however, sit here while you make a doctor's appointment, so that you can find out what's really causing your pain." (This way, you address her fear while not feeding it through the Internet search, you assert your boundaries, and you acknowledge what you can safely provide for her.)

This might lead to further need for SET at some point:

"I know that you're worried that there's something seriously wrong with you that the doctors can't find. It must be uncomfortable being that worried. I think you would benefit from some coaching on how you can live with your concerns with less emotional pain. I know the name of a good person (therapist) who can help you find ways to cope until the doctors figure out what it is."
posted by lleachie at 2:33 PM on June 23, 2010 [6 favorites]

I love LOVE the advice everyone is giving here. Seriously great stuff! AskMe is the BEST.

I wanted to toss out an additional thing you can do, which is to work the problem backwards, if you follow me. Find a therapist you can talk to about these issues, someone who specializes in hypochondria, phobias, OCD, and other such complicated anxiety problems.

This will help in two ways. First, it gives you someone who understands, and who can give you the tools you need to cope with this situation. And second, it gives you first-hand info you can pass along to your relative.

I'm assuming, if she's like most people, that there are times when she sheepishly or off-handedly admits that she's a hypochondriac. The next time one of these moments of lucidity arises you can say, "I've been talking to Therapist Jane, and I think you might find it helpful to talk to Jane as well. She's really compassionate, and she knows a lot about this stuff, and she can help you out. Or if you like, she's also recommended Therapist Joe, who also specializes in these issues."
posted by ErikaB at 3:10 PM on June 23, 2010

I would teach her how to use the interweb herself, which will at least minimize your involvement day-to-day.
posted by pseudostrabismus at 3:27 PM on June 23, 2010

Homeopathy might do it.
posted by MuffinMan at 12:12 AM on June 24, 2010

"Heightened Illness Concern" is what you want to google.

I used to be a hypochondriac and it was "cured" by:

--excellent and compassionate medical care (I do have an auto-immune disorder that is very real as well as some minor heart weirdnesses that feel strange but aren't horrible)
--removal of other sources of emotional pain, stress, and anxiety
--treatment of my ADHD (it really led me to obsess about EXCITING STUFF! but now I know better and entertain myself in healtheir ways)
--the acceptance of my own mortality
--a husband who just doesn't give a shit about me being sick unless I'm bleeding (annoying but it helped remove a big source of positive reinforcement) but who does care for me very much in other ways

You'll notice that none of these things could have been done by someone else except removing the positive reinforcement.

I think that your responsibility for her as her caretaker are rather mysterious. Is she mentally competent, or does she have another mental illness that prevents her from taking care of herself? If so, that might be the first thing to treat. Is she physically well?

There is no reason you should be looking stuff up for her in the middle of the night. Ridiculous. You're not "don't worry, be happy", you're "this is important enough for you to bother me". If it's an emergency, she can go to the ER. If not, you need to be unavailable for her when you need time to yourself.
posted by internet fraud detective squad, station number 9 at 12:14 AM on June 24, 2010 [1 favorite]

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