Unveiling the Red Flags: Identifying Hypochondriasis in Patients
As a doctor of smooth supple skin, muscle tissue, and the soft contours of the human body—and the mind—I know with a sixth sense what kind of person lies beneath. The one that raises my eyebrows are the ones who remain silent as I work my hands on their body. How may I please them, when I fear for what I may discover?
Their secrets and shame lie hidden in their body, but only with their willingness can I uncover them. I have nightmares over the things confessed on the pads of my massage table. Yet, I pretend there is nothing but a baby before me, as I get too deep into the thick of things.
The Pattern of Thinking: A Path to Obsessive-Compulsive Disorder
A certain pattern of thinking, a consequence of three internally contradictory beliefs, may lead to obsessive-compulsive disorder. These beliefs are:
To always believe the worst to avoid disappointment.
To be a high achiever or never be loved.
To believe in themselves no matter what.
Such children struggle to form healthy relationships, whether at home or at work, as they are too dogmatic to agree with others. Any contradiction to their beliefs is met with the belief that the real world is wrong and everyone is suspiciously out to get them. They isolate themselves, strive to over-achieve in a futile bid for respect, and become engrossed in the ritual pessimism, making their expectation of failure self-fulfilling.
Hypochondriasis: A Serious Mental Illness
One of the sinister symptoms is hypochondriasis, a mental illness affecting doctors and patients alike. Contrary to popular belief, it is a serious and disabling illness that often leads to excessive and irrational worries about their health. A good family doctor takes it very seriously. If they investigate it as a physical illness, they will never cure it. Indeed, if they engage in ritual pessimism, they are convinced it’s something fatal, making the belief unshakable. Many delay consulting a doctor, hoping negativity is enough protection, and suffer months of anxiety—a feedback loop of fear and anxiety.
What the Doctor Can Do: A Two-Pronged Approach
For every patient with genuine hypochondriasis that is missed, there are probably ten whose genuine physical illnesses are dismissed as hypochondriac. This is not necessarily because the doctor is lazy or incompetent but because they are overworked to the brink of the brain’s capacity, leaving them unable to provide thorough investigations. Therefore, some investigation is necessary for safety-netting, but such tests are more to satisfy the doctor that nothing is being missed than to actually reassure the patient.
Once the physical investigations are complete, the real work of psychotherapy starts. To understand the patient’s past and find where the doom and gloom originated, is essential. The traditional family doctor, armed with the knowledge of community and family background, can handle this. But in today’s overstretched healthcare services, psychosocial support is often the first to be cut when funds are short, leading to a regression to over-investigating instead of treating.
The NHS internal market structure encourages this inefficiency, as trusts invest in lucrative imaging services rather than therapies. However, the good news is that such services are still available and are a crucial part of the healthcare system. If we can address the financial and structural issues that lead to over-investigating, we can improve the overall quality of care.