August 29, 1988 12:00 PM

From halitosis to heart disease, the range of phobias and ailments that torment hypochondriacs is limited only by the imagination. Evolutionist Charles Darwin suffered from chronic, though apparently psychosomatic, intestinal disorders, perhaps rooted in the guilt he felt about toppling religious totems. Biographer James Boswell would watch public hangings to divert himself from an obsessive fear of venereal disease. The poet Sara Teasdale was crippled by a constellation of imaginary infirmities until her death by suicide. A malady that afflicts millions, hypochondria is an elusive disorder in which emotional problems masquerade as physical ailments.

“It may well be the most common symptom of distress,” says author Susan Baur, 48, who devoted four years to her research and writing of Hypochondria: Woeful Imaginings (University of California Press, $19.95). “I know what it’s like to be afraid of disease,” she says. “In college I was very afraid of cancer. I remember reading about a lung removal in great detail and feeling breathless for a week.” Baur earned her master’s in psychology at Harvard in 1987 and is completing her Ph.D. in counseling psychology at Boston College. “I wanted to write a compassionate book that would make hypochondriacs feel that they are not losers,” says Baur. “I see them as scrappers, and I respect their difficulties.” She spoke about her findings with Senior Writer Kristin McMurran.

How would you define hypochondria?

A person can be said to be a hypochondriac when his or her preoccupation with health or disease is so intense that it disrupts normal living habits and is disproportionate to any medical problems that actually exist. Hypochondriacs use a concern for their health as a way of coping with stress.

Are all hypochondriacs alike?

Hypochondriacs fall into three categories. First, there are those who are convinced that they have a particular disease and organize their lives around that illness. Then there are the disease phobics, high-strung suggestible types with a chronic fear of illness. These people are preoccupied with danger—”What’s going to happen to me?” Finally, there is a larger group of hypochondriacs who are preoccupied with symptoms—”What’s wrong with me?” They’re tired, they fret about insomnia or anemia. They are often complaining or indisposed.

Do hypochondriacs know they are hypochondriacs?

Hypochondriacs in the first category have no insight. Telling them they are hypochondriacs is like a slap in the face. The other types suspect that they have some control over what is happening. Take the case of a man who was convinced that he would die of a heart attack. When he developed palpitations on the golf course, he invented a minor excuse for slowing down and insisted that his companions go on ahead. He did not ask for help because he suspected that his fears were unfounded and didn’t want to make a fool of himself.

Are such people just faking it?

No. A person who pretends to be sick is a malingerer. True hypochondriacs really believe that they are ill or about to be ill. A genuine hypochondriac is miserable a good bit of the time.

What causes hypochondria?

As with many emotional problems, there are usually a handful of interacting factors. One of them, alone, is not going to trigger hypochondria. Children who grow up with a hypochondriacal parent may learn to use illness as a strategy for getting through the tough parts of life. An overprotective mother may prevent a child from developing a strong sense of self and teach the child to subconsciously feel he cannot survive on his own. Some sociologists believe that people who are deprived of physical security, self-respect or love may develop symptoms as a way of expressing distress.

What is at the root of the problem with hypochondriacs?

They are people who perceive themselves as powerless in a dangerous world. Hypochondria is really a plea for a special advantage. Poor me, I only have one leg, let me go first. Being sick is one way of unconsciously agreeing to be helpless. Hypochondriacs create impediments or exaggerate problems in order to excuse poor performance. They desperately maintain their belief that they would be strong, independent and lovable if only they were not sick.

How exactly do hypochondriacs benefit from their imaginary illnesses?

People who are sick get a special set of rules in our society. You don’t have to work as hard or be as pleasant. Take a woman who is not in a very good marriage. She’d like to say, “I’ve had it. I do everything for you and the children, and you ignore me,” but subconsciously she worries that if she divorces her husband she will fall apart. So instead of confronting him directly, she develops a peculiar kind of arthritis. She can’t clean or load the dishwasher. Now she gets special attention. Getting better would mean going back to the old way.

What are the most common fears afflicting hypochondriacs?

Cancer is number one on the hypochondriac’s hit parade. Heart disease is second. Headaches and dizziness are the most common symptoms, followed by gastrointestinal complaints. Among the unusual cases I discovered were a fear of halitosis and a profound fear of becoming a hypochondriac. One 17th-century medical treatise described a man in Italy who was afraid to urinate because he would drown his village. His physician, an imaginative fellow, had the village bells rung and told his patient the town was on fire, whereupon the man relieved himself and was cured.

What sort of people are most likely to become hypochondriacs?

It’s not an elitist disorder. It is common in societies where it is more acceptable to be sick than crazy. The working class, for example, views mental illness as a sign of weakness, but sanctions back pains and headaches as normal problems. Persons lacking in power are the most susceptible—welfare mothers, insecure wives, minorities living away from their people, men who lose their jobs, elderly people who lack money or social supports.

What do hypochondriacs really want?

The impossible. They want a head start in every game of life without being thought of as weak people who need a head start. They are saying, “Help me, help me, but treat me as if I don’t need any help.” They really are fighting at cross-purposes with themselves. The problem is that they don’t seem to want to get well. No amount of care or reassurance is enough.

Do doctors tend to tolerate or play along with hypochondriacal patients?

Unofficially, many physicians hate them. Doctors spend years being taught to cure, and that’s what they want to do. A hypochondriac never lets them feel effective. The symptoms come back, the symptoms change, the hypochondriac begins to criticize the doctor. Also, doctors like being treated with respect and they know that however wonderful a relationship with a hypochondriacal patient seems in the beginning, it is going to deteriorate into ambivalence or rage.

Is the condition curable?

There are no guaranteed cures. Hypochondriacs with personality disorders that keep them severely dependent or socially isolated are not likely to change, and neither are people who accept chronic invalidism without feeling a lot of emotional discomfort. The reactive hypochondriac—for example, someone who develops a fear of heart disease after losing a spouse to a heart attack—is the easiest to treat. The anxious type who is miserable from waking up in a sweat thinking, “I was wrong in the past, but this time I know I have breast cancer,” may also seek help. Similarly, the depressed person who develops chronic back pain after losing a job is often miserable enough to want to change.

What treatments are available?

Clinicians who believe that most hypochondriacs are suffering from depression will overlook bodily complaints and focus on the depression itself. If the depression can be alleviated, often the physical problems will begin to disappear. One-half to two-thirds of the hypochondriacs in psychotherapy improve. Behaviorists believe that hypochondria is a learned response to stress and that patients can be taught to unlearn their bad habits.

How would you deal with a hypochondriacal friend?

First I would try reassurance—but that’s not going to work with a true hypochondriac. If the affliction is recent I would try to identify any stress that might be triggering the hypochondriacal fears. If, on the other hand, you have a friend who has complained about illness for years, be realistic. Friends rarely cure their friends who have chronic problems.

Can hypochondriacs actually worry themselves into a real illness?

Worrying needlessly is not the healthiest way to live. However, the myth that if you worry about skin cancer you will contract it is just that, a myth.

What becomes of hypochondriacs?

For some, the sickness habit is so deeply entrenched that they remain hypochondriacs all their lives. For others, getting better takes a long time. To unearth true feelings and express them in honest actions is a difficult task. It is heartening to remember that the drive to get better goes on whether we sabotage it or not. Like our bodies, our minds are meant to survive.

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