Published: 5 January 2024 at 15:00
VIEWPOINT: ARU expert looks into IAD and what might explain this health paradox
By Stephen Hughes, Anglia Ruskin University
People who worry excessively about their health tend to die earlier than those who don’t, a recent study from Sweden has found. It seems strange that hypochondriacs who, by definition, worry yet have nothing wrong with them, should enjoy shorter lifespans than the rest of us. Let’s find out more.
First, a word about terminology. The term “hypochondriac” is fast becoming pejorative. Instead, we medical professionals are encouraged to use the term illness anxiety disorder (IAD).
We can define IAD as a mental health condition characterised by excessive worry about health, often with an unfounded belief that a serious medical condition is present. It may be associated with frequent visits to a doctor, or it may involve avoiding them altogether on the grounds that a real and quite possibly fatal condition might be diagnosed.
The latter variant strikes me as quite rational. A hospital is a dangerous place and you can die in a place like that.
IAD can be quite debilitating. A person with the condition will spend a lot of time worrying and visiting clinics and hospitals. It is costly to health systems because of time and diagnostic resources used and is quite stigmatising.
The Swedish researchers tracked around 42,000 people (of whom 1,000 had IAD) over two decades. During that period, people with the disorder had an increased risk of death. (On average, worriers died five years younger than those who worried less.) Furthermore, the risk of death was increased from both natural and unnatural causes. Perhaps people with IAD have something wrong with them after all.
People with IAD dying of natural causes had increased mortality from cardiovascular causes, respiratory causes and unknown causes. Interestingly, they did not have an increased mortality from cancer. This seems odd because cancer anxiety is rife in this population. The principal cause of unnatural death in the IAD cohort was from suicide, with at least a fourfold increase over those without IAD.
So how do we explain these curious findings?
IAD is known to have a strong association with psychiatric disorders. As suicide risk is increased by psychiatric illness, then this finding seems quite reasonable. If we add in the fact that people with IAD may feel stigmatised and dismissed, then it follows that this may contribute to anxiety and depression, leading ultimately to suicide in some cases.
The increased risk of death from natural causes seems less easy to explain. There may be lifestyle factors. Alcohol, smoking and drug use are more common in anxious people and those with a psychiatric disorder. It is known that such vices can limit one’s longevity and so they may contribute to the increased mortality from IAD.
IAD is known to be more common in those who have had a family member with a serious illness. Since many serious illnesses have a genetic component, there may be good constitutional causes for this increase in mortality: lifespan is shortened by “faulty” genes.
Doctors need to be alert to the underlying health problems of patients and must listen with greater care. When we are dismissive of our patients, we can often be badly caught out. People with IAD may well have a hidden underlying disorder – an unpopular conclusion, I accept.
Perhaps we can illustrate this point with the case of the French novelist, Marcel Proust. Proust is often described by his biographers as a hypochondriac, yet he died in 1922 at the age of 51 at a time when the life expectancy of a Frenchman was 63.
During his life, he complained of numerous gastrointestinal symptoms such as fullness, bloating and vomiting, yet his medical attendants could find little wrong. In fact, what he described is consistent with gastroparesis.
This is a condition in which motility of the stomach is reduced and it empties more slowly than it should, causing it to overfill. This can lead to vomiting and with that comes a risk of inhaling vomit, leading to aspiration pneumonia and Proust is known to have died of complications of pneumonia.
Finally, a word of caution: writing about IAD can be quite risky. The French playwright Molière wrote Le Malade Imaginaire (The Imaginary Invalid), a play about a hypochondriac called Argan who tries to get his daughter to marry a doctor in order to reduce his medical bills. As for Molière, he died at the fourth performance of his work. Mock hypochondriacs at your peril.
Stephen Hughes, Senior Lecturer in Medicine, Anglia Ruskin University
The opinions expressed in VIEWPOINT articles are those of the author(s) and do not necessarily reflect the views of ARU.
If you wish to republish this article, please follow these guidelines: https://theconversation.com/uk/republishing-guidelines
"Kama ilivyoelezwa katika utafiti wa hivi karibuni wa ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" na ""IATA"" Ni ajabu kwamba watu wenye ugonjwa wa hypochondriac ambao kwa maana ya kawaida wana wasiwasi lakini hawana tatizo lolote, wanaishi maisha mafupi kuliko sisi wengine. Hebu tujue zaidi. Kwanza, neno kuhusu usemi. Neno "hypochondriac" linakuwa la kudharau haraka. "Kwa hivyo, wataalamu wa afya wanakubaliana na maoni ya kwamba ""ugonjwa wa wasiwasi"" ni tatizo la wasiwasi." IAD ni hali ya afya ya akili inayojulikana kwa wasiwasi wa kupita kiasi juu ya afya, mara nyingi na imani isiyo na msingi kwamba hali mbaya ya matibabu iko. Huenda ikawa ni kwa sababu ya kwenda mara kwa mara kwa daktari, au huenda ikawa kwa sababu ya kuepuka kwenda kwa sababu ya uwezekano wa kupatwa na ugonjwa wa kweli na wenye kuua. Tofauti ya mwisho inanivutia kama yenye busara kabisa. Hospitali ni mahali pa hatari na unaweza kufa katika mahali kama hapo. IAD inaweza kuwa dhaifu sana. Mtu mwenye hali hiyo atatumia wakati mwingi akihangaika na kutembelea kliniki na hospitali. Ni gharama kubwa kwa mifumo ya afya kwa sababu ya muda na rasilimali za utambuzi zinazotumiwa na ni stigmatizing sana. Watafiti wa Sweden walifuatilia watu karibu 42,000 (ambayo 1,000 walikuwa na IAD) kwa zaidi ya miongo miwili. Katika kipindi hicho, watu walio na ugonjwa huo walikuwa na hatari kubwa ya kufa. (Kwa wastani, watu waliofikiria sana walikufa wakiwa na umri mdogo kwa miaka mitano kuliko wale waliofikiria kidogo.) Isitoshe, hatari ya kufa iliongezeka kutokana na visababishi vya asili na visivyo vya asili. Labda watu wenye IAD wana kitu kibaya nao baada ya yote. Watu walio na IAD waliokufa kwa sababu za asili walikuwa na vifo vingi kutokana na sababu za moyo, sababu za kupumua na sababu zisizojulikana. Jambo la kupendeza ni kwamba hawakuwa na ongezeko la vifo vya kansa. Hii inaonekana ya ajabu kwa sababu wasiwasi wa kansa ni wa kawaida katika idadi hii ya watu. Kifo cha kawaida katika kundi la IAD kilitokana na kujiua, na kiliongezeka mara nne kuliko wale wasio na IAD. Kwa hiyo tunaelezaje matokeo haya ya kushangaza? IAD inajulikana kuwa na uhusiano mkubwa na matatizo ya kisaikolojia. Kwa kuwa hatari ya kujiua huongezeka kwa sababu ya ugonjwa wa akili, basi matokeo hayo yaonekana kuwa yenye kusadikisha. "Ikiwa tunaongeza ukweli kwamba watu walio na IAD wanaweza kuhisi kuwa wamechukuliwa na kufukuzwa, basi inafuata kwamba hii inaweza kuchangia wasiwasi na unyogovu, na kuongoza mwishowe kwa kujiua katika baadhi ya kesi. """ Hatari iliyoongezeka ya kifo kwa sababu za asili haionekani kuwa rahisi kueleza. Huenda ikawa kuna mambo yanayohusiana na mtindo wa maisha. Kunywa pombe, kuvuta sigara, na kutumia dawa za kulevya ni jambo la kawaida kwa watu wenye wasiwasi na wale walio na ugonjwa wa akili. Inajulikana kwamba maovu kama hayo yanaweza kupunguza maisha ya mtu na hivyo yanaweza kuchangia kuongezeka kwa vifo kutokana na IAD. IAD ni kawaida kwa wale ambao wamekuwa na mwanachama wa familia na ugonjwa mbaya. Kwa kuwa magonjwa mengi mazito yana sehemu ya urithi, huenda kukawa na visababishi vyema vya kuongezeka kwa vifo: muda wa maisha hupunguzwa na chembe za urithi "zisizo na ubora". Madaktari wanapaswa kuwa macho kwa matatizo ya msingi ya afya ya wagonjwa na wanapaswa kusikiliza kwa uangalifu zaidi. Tunapowashutumu wagonjwa wetu, mara nyingi tunaweza kugunduliwa vibaya. Watu wenye IAD wanaweza kuwa na ugonjwa uliofichwa <unk> hitimisho lisilo la kawaida, ninakubali. Labda twaweza kuonyesha jambo hilo kwa mfano wa mwandishi Mfaransa, Marcel Proust. "Mwanzoni mwa karne ya 20, Proust aliitwa ""hypochondriac,"" lakini alikufa mwaka 1922 akiwa na umri wa miaka 51 na wakati huo watu wa Ufaransa walikuwa na umri wa miaka 63 tu." Alipokuwa hai, alilalamika juu ya dalili nyingi za tumbo kama vile kujaa, kuvimba na kutapika, lakini wahudumu wake wa matibabu hawakuweza kupata kitu kibaya. Kwa kweli, yale aliyoeleza yanapatana na ugonjwa wa gastroparesis. Hii ni hali ambayo motility ya tumbo hupunguzwa na hutolewa polepole kuliko inapaswa, na kusababisha kujaza kupita kiasi. Hii inaweza kusababisha kutapika na kwa hiyo inakuja hatari ya kupumua kutapika, na kusababisha pneumonia ya aspiration na Proust inajulikana kuwa alikufa kutokana na matatizo ya pneumonia. Mwishowe, neno la tahadhari: kuandika juu ya IAD inaweza kuwa hatari sana. Mholier, mwandishi wa michezo ya kuigiza wa Ufaransa, aliandika Le Malade Imaginary (Mtu asiye na uwezo wa kufikiri), mchezo kuhusu mtu mwenye ugonjwa wa akili anayeitwa Argan ambaye anajaribu kumfanya binti yake aolewe na daktari ili kupunguza gharama zake za matibabu. Kuhusu Molière, alikufa wakati wa maonyesho ya nne ya kazi yake. Mock hypochondriacs kwa hatari yako. Stephen Hughes, Mwalimu Mkuu wa Tiba, Chuo Kikuu cha Anglia Ruskin Maoni yaliyoonyeshwa katika makala za VIEWPOINT ni ya mwandishi (s) na hayaonyeshi maoni ya ARU. Ikiwa unataka kuchapisha tena makala hii, tafadhali fuata miongozo hii: https: theconversation.com uk republishing guidelines