In the 11th edition of the International Classification of Diseases (ICD-11), a hypochondria is described as "constantly thinking that one or more serious, or even life-threatening, illnesses may be developed," accompanied by repeated medical visits, examinations, searches for information related to the disease, or avoidance of physical discomfort.
Some scholars and medical practitioners prefer to use the term "disease anxiety disorder" to refer to the disease in order to eliminate the pejorative connotations.
Some doctors feel that in recent years, especially after the emergence of the new crown epidemic, such patients are increasing.
Yang Lei began to go to the hospital frequently to "report" again.
He was an undergraduate student at a university in Suzhou, and in the month after last year's National Day holiday, he hung up 39 numbers at a hospital near the school, an average of 1.3 per day.
At first, Yang Lei did not have any symptoms, but suddenly thought of his father who died of leukemia, planning to seek peace of mind. As a result, one of the indicators of the blood routine deviated slightly from the normal range, and from then on, he could not stop.
He began to repeatedly verify the fact that he did not have a blood disease.
During that time, he was interning, originally only hanging up the number of the weekend, and then evolved into a weekday leave to see, and finally the leave was not invited, during the lunch break, he took a taxi directly to the hospital, and then came back after two or three hours.
The blood routine was checked four or five times, and more than once a whole body B ultrasound was done to examine the lymph nodes in various parts. He showed the report to different experts and said there was nothing wrong with it. Walking out of the clinic, the anxiety seemed to subside, but it did not take a few days to make a comeback.
Yang Lei's blood reports showed no abnormalities, and he has had several similar tests in recent months
Image source: Courtesy of respondents
This state yang lei is not unfamiliar. Over the past 5 years, he has fallen into similar situations several times, but the diseases he is worried about are not the same.
In 2020, he was diagnosed with disease anxiety disorder. People may be more familiar with another name for it – hypochondriasis. Some scholars and medical practitioners prefer to use the former to eliminate the pejorative connotations in the appellation.
The 11th edition of the International Classification of Diseases (ICD-11), which came into force earlier this year, describes the disease as "constantly thinking that you may have one or more serious, even life-threatening, disease-threatening diseases," accompanied by repeated medical visits, examinations, searches for information related to the disease, or avoidance of physical discomfort.
Due to changes in diagnostic criteria, it is difficult to know the exact incidence of it. At present, the widely cited prevalence rate in China is 5 ‰, but this is already the data of 1982. The intuitive feeling of some doctors is that in recent years, especially after the emergence of the new crown epidemic, such patients are increasing.
Put yourself in 1%.
Yang Lei described his initial suspicious behavior as "a transfer of stress."
In the autumn of his junior year of high school, he began to pay special attention to his body. The initial focus was on the digestive system, and later he was suspicious of the lymphoid tissue in the neck, and once or twice a week, he would touch the neck of the male classmate to compare whether it was different. Even three or four times, when the teacher was lecturing, he ran straight out of the classroom and "went to the hospital near the school to check."
After the Spring Festival, the fear of stomach cancer has not yet subsided. His mother had heard enough of his nagging and promised to take him to the gastroscope. Everything turned out to be normal, not even superficial gastritis. The familiar doctor complained, "Why should such a young child, just 17 years old, take him to do a gastroscope of general anesthesia?"
Yang Lei analyzed that at that time, the academic pressure was relatively large, and emotional management was not very successful. "It might be an escape." It was as if a voice was saying to itself, "I'm not feeling well right now, so I'm not going to face these things."
College experience seems to corroborate this view, with frequent visits to the emergency room before important exams, "which is particularly evident."
Source: Station Cool Helo
Li Jianling, deputy chief physician of the Mental Health Center of Xiangya Hospital of Central South University, told us that among the teenagers she received, a large proportion of them were in the college entrance examination. These children are often accompanied by emotional problems while suspecting the disease.
She introduced that external stress and negative emotions are predisposing factors for disease anxiety disorders. Some people feel that "it is incompetent and faceless to not be able to bear the pressure", and the expression of negative emotions is blocked, at which point the complaint of physical discomfort becomes a "legitimate" way.
To a certain extent, this is also related to the socio-cultural environment. In some areas, the direct expression of emotions is considered shameful. In this atmosphere, patients will disguise, deny or even feel their emotional experience, and selectively pay attention to their own body.
Li Jianling was impressed by a middle-aged male patient. "His wife is very profitable. He originally had a decent job, but after the collective reform, he lost his job. Find a normal job, and you can't pull down." Before going to the psychiatric department, he was idle at home all day, feeling that he had no sense of existence, and then he had suspicious behavior.
On the other hand, patients with disease anxiety disorders tend to be sensitive, suspicious, cautious, and demanding.
We see such characteristics in Yang Lei. He repeatedly stressed in the conversation that he was very worried about small probability events. Only a "gold standard check" can reassure him, such as cutting off part of the tissue for a biopsy, but such a request will not be granted.
"That's why I do imaging tests repeatedly, and it's not 100 percent detectable. Even if 99% of the time it's okay, I'll put myself in the 1%."
Yang Lei tried to explore the source of this way of thinking. Looking back at his childhood, he did not get sick many times, and he never had a serious illness. But he considered himself "at least frail", "very short and thin" as a child, most of his junior high school, and was asked if he was in elementary school.
He felt that his anxiety about the disease may have a subtle influence on his family. Yang Lei was born prematurely, seven and a half months ago, weighing less than 4 pounds at the time. The family occasionally mentioned this past, and when they listened to it, they didn't feel anything, but looking back now, they still more or less buried hidden worries in the boy's heart.
"In the past, I felt that illness and death were far away from me. My dad said that our family's genes are very good, my great-grandparents have lived to be more than 90 years old, and my grandmother is still alive and 100 years old." In his freshman year, Yang Lei's grandfather died of lymphoma, and in the years since, several relatives and friends have died. "It's too concentrated, and that's probably a factor too."
Ding Ruoshui, a psychologist who has been in the industry for 4 years, told us that people with disease anxiety have a heavier sense of vulnerability, and its source may be the overprotective of the main caregiver in childhood, or the death of a loved one very early, "maybe the understanding of death at that time was not so direct, but the experience of fear was strong."
These experiences have led them to form certain fixed beliefs, such as "Getting sick is terrible" and "if something is uncomfortable, it means I have a terminal illness". Usually, these beliefs are latent. After certain critical events occur, vague physical discomfort activates them.
"Can't stop it"
Yang Lei's toughest days were in the summer of 2020.
The trigger is a one-time act, "actually a protective measure", and there is no need to worry. But he was still afraid of getting sick and began frantically drawing blood for tests, two or three times a week.
Each time the result was negative, "but it was still in the window period, and it can't be said that it was definitely fine". So I continued to run to the hospital, and then the dermatologist said, "You come to work with us every day."
A month and a half later, the window period of common STDs had passed, and all the tests were still negative, and Yang Lei gradually believed that he was indeed not infected.
However, the suspicion did not stop there. "It's like stepping on the accelerator and can't stop."
From lung and nasopharyngeal cancer to Parkinson's, in just one month, he suspected he was suffering from a serious illness several times. Now that I think about it, maybe it was just the discomfort of wearing a mask for a long time, and the slight shaking of the hands that had always existed.
He remains a regular visitor to the hospital. When inspections are at their most intensive, the positive effects can only last for a few hours.
"Reflect on how much medical resources I have wasted!" Every time I repeat the check, I take advantage of a person who really needs to be checked." But Yang Lei at that time could not think of these. "Fear has long since overridden, can you still consider others?"
Image source: IC photo
Researchers in Saudi Arabia have reported an extreme case that fully demonstrates the burden that patients with disease anxiety disorders place on healthcare institutions:
The male patient suspected cancer from the age of 48 and lasted 25 years. During this period, he sought medical treatment several times a week, and did a total of 18 abdominal CT, 11 chest CT, 7 head CT, 6 lumbar MRI and 4 chest MRI, and even persuaded many doctors to perform kidney, prostate and stomach biopsies. His family was modest, but he spent $178,000 on it.
For many patients, the same can not stop is the online verification.
In the summer of 2020, Yang Lei was so anxious that he couldn't sleep, talking to different doctors in the consultation app, "looking for a dozen." Even if he had to go to the hospital early the next morning, he couldn't wait. At the end of the consultation, I also have to look through the previous records of these doctors to try to find a "case with the same symptoms as myself and eventually fine."
Yiyi, a high school student in Shanghai, has also been mired in the mire. In March last year, she put herself in a seat with the news of "squeezing through acne and causing intracranial infection", went to the emergency department with a panic attack, and has since embarked on the road of suspicion.
She was once obsessed with searching for "symptoms" and "diagnosing herself with thrombocytosis," chronic fatigue syndrome, myocarditis, and more. The feeling was so bad that "every time I told myself I would never search again, and the next time I couldn't help it."
She will also look for "patients" to share on social platforms, and every time she reads an article, she feels that the corresponding parts begin to be uncomfortable. The more you watch, the more the platform pushes, and over time, all the accounts are full of disease-related content. She once blocked keywords such as "leukemia" and "cancer" and asked the platform not to recommend, which did alleviate it for a while, but in the end it was a failure.
Yi yi once tried to block keywords such as "leukemia" to reduce the chance of seeing serious illness content
Is it harder to admit that there is a psychological problem?
In the 4th year of suspected illness, for the first time, a doctor explicitly prompted Yang Lei to see a psychiatrist.
Before the start of his senior year, his suspicions reached the extreme. At that time, I suspected frostbite, first feeling that my calves were getting thinner, and then I was aware of the meat jumping. One of the symptoms associated with frostbite is a tremor in the muscle bundle, and fear strikes instantly.
"It's over, sure enough."
The more you observe, the more places to jump. When I returned to school, I already had the feeling that my eyebrows were discharging from my feet to my feet. Originally, there were still three or four exams at the beginning of the school, and Yang Lei could not review them at all. "The whole person is very irritable and fidgety."
He made three or four phone calls to a doctor in West China Hospital who was good at frostbite, the kind that cost him hundreds of yuan in 8 minutes. The other party reassured several times, and Yang Lei was still not at ease. "He hasn't seen me real, and I haven't done an electromyography, so how can I tell if it's?"
Later, Yang Lei directly abandoned the exam.
That night, he called the doctor again. The other person said, "I suggest you go to the psychiatric department, and the sooner the better."
In the autumn and winter of 2021, Yang Lei once frequently consulted online
Regarding disease anxiety disorders, it is often mentioned that patients will first appear in cardiology, neurology, gastroenterology and other departments, and travel for a long time before going to the psychiatric department.
Li Jianling told us that when she came into contact with patients, it was often more than a year since the other party had suspicious behavior, and it might be five or six years.
"No one will come to the psychiatric department anytime soon, and even if they do, the doctor will not make a diagnosis." Because one of the diagnostic criteria is to exclude various organic problems, and the disease has an evolutionary process, some are not easy to find in the early stage, a symptom will correspond to a variety of diseases, and it is not easy to confirm that there are no organic problems in a short period of time.
After excluding other factors, whether the patient can seek help from the psychiatric department earlier depends on the advice of the non-psychiatrist on the one hand, and on the other hand, on the other hand, on the willingness of the patient and family to accept such prompts.
Yang Lei has long known the concept of hypochondriasis, but if it were not so serious that he would abandon the examination, he would still "first deny the psychological problem, and habitually think that it is a physical problem."
In the second month of her frequent visits, an emergency doctor suggested that she see a psychiatrist. But she and her parents didn't think it was necessary, "I felt normal, just a little nervous."
As the situation got worse, she offered to "take me over." Parents always promised to do it, but never acted.
They are not ignorant of disease anxiety. On the contrary, they have been troubled.
The first time Yi Yi heard this concept was with her mother. She revealed that in her twenties, she was terrified of cancer in her biological sister and repeatedly suspected stomach cancer, so she saw a counselor for several years. As for Yiyi's father, he was afraid of AIDS for no reason, for more than twenty years.
Although there were similar experiences, Yiyi did not feel more understanding. Fathers, in particular, always instilled their own views in her harshly, sometimes for two or three hours, giving people a great sense of oppression. Once, he saw Yiyi searching for the illness again, and he was so angry that he grabbed the phone and fell on the floor.
He said that he knew that it was very uncomfortable, so he did not want Yiyi to continue this state at such a young age. "But he felt that as long as he didn't read the online statements, the suspected illness could be stopped immediately." It's not something I can control."
Yi Yi speculated that parents still have some shame about mental illness.
Liu Chang, an Anhui girl, was deeply troubled by her father's "stubbornness". He began to suspect illness at the beginning of last year, and still believes that he has organic problems.
Very early, an internist consulted and prescribed him anti-anxiety drugs, he felt that he was not anxious, and secretly stopped taking the medicine for a few days. His family took him to the psychiatric hospital in a neighboring city, and he didn't think so, and privately told Liu Chang, "That doctor can't do it at all."
In September last year, Liu Chang and his mother took him to Shanghai, first to a hospital with a high ranking in gastroenterology and then to a mental health center.
On the way to the first hospital, he changed his previous decadence, full of energy and brisk steps. It seems that he finally has another chance to prove that he is right -- "This time the doctor is a little stronger, and he will definitely be able to find out the organic problem."
The doctor once again told him that it was disease anxiety. "When he came out of the hospital, he was so depressed that he couldn't move his feet and was about to cry."
For the 58-year-old man, acknowledging that he has psychological problems seems to be much harder than admitting that he has physical problems.
Accept anxiety
In the psychiatric clinic, the doctor prescribed Escitalopram to Yang Lei. It is an antidepressant that is a serotonin reuptake inhibitor whose efficacy in disease anxiety disorders has been confirmed by multiple randomized controlled studies.
Before starting to take the medicine, Yang Lei was holding some doubts. He was willing to believe what the doctor said, it was a psychological problem, but he always muttered, is it really not found out?
In the first week of taking the drug, he found that it seemed that the frequency of meat jumping decreased, and by the second week, some of the symptoms disappeared. He increasingly recognized the doctor's diagnosis that "psychotropic drugs are effective, which verifies that this is indeed a problem."
The drug prescribed by the psychiatrist to Yang Lei
Li Jianling stressed that for patients with disease anxiety disorders, it is necessary to give priority to drugs with small side reactions and pay attention to the adjustment of doses.
These patients are already very sensitive to changes in the body, and if the medication is taken violently and there is a side reaction, they may think that a new somatic symptom has emerged, which will aggravate anxiety and reduce adherence to treatment.
Liu Chang's father is a typical example. He went through 3 dressing changes, one of which was secretly stopped for a month before being discovered, and once when he threatened to throw it away after only two days of eating, because he was a bit sick to his stomach after eating, and cancer of the digestive system was originally one of the diseases he suspected.
Taking medication intermittently made his condition more and more serious. "Later, there was already a bit of depression, I didn't like to talk, I ate less and less, and I lost almost 20 pounds of weight."
Liu Chang recalled the scene he saw every time he went back to his parents' house during that time: his father sat on the sofa, talked to him, as if he hadn't heard, and only glanced up at him in the middle of the night. "Watch TV and ask him which is the bad guy, I don't know."
"His eyes are gone."
Studies have confirmed that patients with disease anxiety disorders are more likely to try psychotherapy than drug therapy.
Ding Ruoshui has been in contact with some patients with disease anxiety. In her opinion, it is more important to convince the client that even if they do not repeatedly seek verification, the anxiety will pass.
"When the urge to verify comes, do nothing, don't give in to it, just wait for it to leave on its own." It's an exposure exercise that allows clients to try to endure the uncertainty of not being able to tell if physical sensations are real symptoms.
The first attempt can take a long time, "as short as 20 minutes, as long as one or two hours". But after going through enough practice, they will realize that the pain is temporary, not as terrible as they think, which will help them overcome their fear and thus resist the urge to verify.
Another focus is to help them adjust for cognitive bias. This is not easy, because "people with disease anxiety have some obsessive-compulsive qualities to a greater or lesser extent". ICD-11 is the first to classify the disease under the category of "obsessive-compulsive or related disorders."
"When you try to lead such a client to replace some of their thoughts, they may have an antagonistic mindset, like a very stubborn voice inside saying, 'My thoughts are true.'" That makes it harder to change."
At this time, she chooses to first let the client accept her suspicious thoughts, and then separate the thoughts from the facts. This is cognitive dissociation in acceptance and commitment therapy.
An easy way to do this is to prefix the expression with "I have an idea." For example, ask the client to say "I will get cancer" and "I have an idea, I will get cancer" to experience the different feelings brought by these two sentences.
At the same time, it is also recommended that the family of patients with conditions can participate in the consultation earlier in order to give appropriate support.
Some patients will often ask their families to confirm their "symptoms", and if they are blindly satisfied, they will rely too much on this repeated way of verification, "feeling that this method is enough, thus losing the opportunity to try more self-help methods". Of course, ta's feelings cannot be completely denied. The most appropriate response is to point out this behavior - "You are asking for verification again and again!"
"I'm getting better"
On the day he met Yang Lei, he came from the cancer hospital. He had just returned to Beijing from Suzhou the day before, and he couldn't wait to get the report of the previous lymph node examination to the "more authoritative doctor."
"In a way, before I pushed open the door of the clinic, I already knew the doctor would say the same thing. But I want that." Toward the end of the interview, he told us, somewhat self-deprecatingly, that he had made an appointment with Hospital 301 the next day.
He hadn't been tested for a full year before Last September.
For a while he was in good shape, he was 100% committed to the matter at hand, and he would not be distracted by suspicious thoughts. Even if you are uncomfortable, you can take the initiative to distinguish whether it is caused by emotions or living habits.
Yang Lei once endured major changes. Early last year, his father was taken to life by leukemia, from the onset of symptoms to his death, just fifty days.
We envisioned that he would soon regain his anxiety, but instead he wanted to say, "When the disease comes, you can't stop it, just lie flat." In April, he even successfully stopped taking the medication with the help of a doctor.
It was not until the autumn that he was once again caught in the vortex of doubt. He said he had "returned to God" and that for nearly a year he had bothered to build up the ability to "put himself in a high probability event" because those closest to him were "crushed" when they encountered a small probability event.
Fortunately, compared to the past few years, he already knows how to seek professional help.
"The first time I went to the hematologist in October was for no reason, there was no discomfort at all. I realized this and went to see a psychiatrist."
The doctor told Yang Lei that it was not enough to take medicine. In recent weeks, he's been considering whether to ask a counselor.
Liu Chang's father finally admitted his anxiety, and there were too many doctors who said this. But he still insisted that he was anxious because he was "sick", rather than having disease anxiety in the first place, and gradually became aware of all kinds of pain.
Last month, he changed another medicine, and the effect was not bad. In the past half a year, his social interaction has been almost completely broken, and he has been bored at home, and he even offered to climb the mountain a few days ago.
He still has some doubts about cancer and has a colonoscopy this month. "But he himself said that as long as it didn't hurt, he could think of it and do something else."
Yi Yi relied more on self-help. She learned some ways to relieve anxiety from books, "when you feel like you're going to die, use abdominal breathing."
Changes in the environment can also help. This semester she moved into the school dormitory, and every time she suspected a disease, she would tell it in a joking way. The comfort of the roommates is appropriate, not preachy or overly nervous as the parents are. "And soon I'll talk about something else, so I don't think much about getting sick."
In the past two months, she has been able to completely control not to search for the disease. She regained a sense of control.
She was sure she was getting better. "My mom is better now, and I think I'll be okay in the end."
(In the text, Yang Lei, Yiyi, and Liu Chang are pseudonyms.) ）
This article was reviewed by Yirui Wang, a licensed clinical psychologist at the University of Queensland, Australia
Author: Chen Yihan Yuyan
Producer: Li Chen
First image source: Stand Cool Helo
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