Health Anxiety: Cyberchondria
The term “cyberchondria” is used to describe a condition that no medical or psychiatric reference book recognizes, yet the phenomenon is rampant and can be very debilitating. You may know it as Health Anxiety. “Cyberchondria” was first used in 2000 to describe “the deluded belief you suffer from all the diseases featured on the internet.” The term defines the threshold at which access to medical health information via the internet becomes part of a mental health problem, rather than a solution.
The origin of the term "hypochondria"
Medicine in general, Psychiatry in particular, has a long history of terms and diagnoses used to describe the interplay between one's mental or emotional states, and bodily or somatic symptoms. In fact, one of Freud’s earliest and most well-known case studies was of “Dora” who lost her voice as a result of what was termed "hysteria". Freud was not the first to use the diagnosis of hysteria -- the concept dates back to at least the sixth century BCE when it was used to describe a range of physical, behavioral, and emotional and symptoms primarily exhibited in females, and believed to be caused by the wandering of the uterus within the body cavity.
Though diagnosed only in women and attributed to the female reproductive anatomy, this "hysteria" was not some precursor to what we now know colloquially as PMS; it was a diagnosis given when a female exhibited any abnormal or just socially unacceptable behavior. As Victorian women did more and more “crazy” things (like demand access to higher education), the disorder became so all-encompassing that it finally became too vague to be taken seriously. (Plus there was no evidence that the uterus wandered!)
During that same era, there existed a parallel diagnosis, whose origins also dated back hundreds of centuries, which was thought to only afflict men and which was attributed to a disturbance of the stomach – "hypochondria". Men who had vague physical complaints of no known medical origin were thought to suffer from a weak constitution. The symptoms were attributed to "physical disease caused by imbalances in the region that was below your rib cage."
Current Diagnostic Nomenclature
Over the last hundred years, our diagnostic understanding has evolved so that the diagnosis of hypochondria is no longer considered a valid diagnosis. The term "cyberchondria" is also not a psychiatric diagnosis but describes a pattern of excessively searching the internet for health care information. This behavior may be part of a diagnosis of (health related) anxiety ; or considered a specific type of (disease) phobia; or could also considered a type of behavioral addiction (like gambling.)
In cyberchondria, internet searches are done under the guise of information seeking, but are really an attempt to get reassurance and soothe one's overwhelming anxiety which is driven by the fear of having some (particular) disease. But because of the seemingly endless sources of information, any information found seems never enough and only leads to further questions, doubts, fears, and more anxiety. This vicious cycle of internet searches results in the use of the internet becoming problematic in the same way that alcohol becomes problematic for alcoholics: it is addictively used for a purpose which no longer resembles the initial intended use and results in negative consequences in one’s daily functioning.
Treatment
While treatment via abstinence is essential in both (all) types of addictions, treating the cyberchondria as an anxiety disorder is more beneficial.
Because of the anxiety underlying the internet searches, there is a hypersensitivity to any perceived danger and a focus on negative thinking. As a result, rather than providing objective facts or reassurance, the information is interpreted in the most negative of ways so as to torment rather than soothe. Rather than quelling anxiety, information gathered only becomes more anxiety provoking.
Though medical and physical concerns are the seen as the primary issue by the sufferer, treatment for cyberchondria is primarily psychological. The treatment addresses the fear, distorted beliefs and the other maladaptive behaviors, not the particular physical symptoms. Cognitive-Behavioral therapy is the treatment of choice and has been shown to be highly effective in getting the anxiety symptoms under control, which then diminishes the intense focus on bodily complaints.
The cognitive portion of the therapy involves educating the patient about normal bodily sensations associated with anxiety and the physiological mechanisms which underlie them. They are reminded that almost any symptom perceived as indicative of an undiagnosed medical problem can usually be attributed to the feedback loop or cycle that is set in motion when fear leads to increased activity within the autonomic nervous system.
Cognitive therapy also involves making the cyberchondriac aware of thinking styles that perpetuate or maintain anxiety such as a selective negative focus, all-or-nothing thinking and catastrophizing. Those with cyberchondria are prone to flaws in reasoning. They personalize, overgeneralize, and jump to conclusions. Techniques used to challenge mistaken beliefs are taught and reinforced.
The behavioral interventions involve exposure to the anxiety and worry and concurrent abatement of the compulsive behaviors which are engaged in as an effort to reduce the fears. The patient is instructed to stop internet searches, stop self-exams and stop any other reassurance seeking behaviors. They are reminded that these efforts only result in more, not less anxiety.
Behavioral techniques used to help the individual tolerate and confront the fear of their yet undiagnosed condition can also include intentional exposure to worrisome thoughts or other triggers such as reading about having the dreaded disease. Behavioral interventions can also involve desensitization to the perceived sensations via exercises which induce pseudo symptoms.
Having family members and medical providers who are fully informed and supportive of the treatment protocol is crucial. Not relying on the media as a barometer for concern is also important.
Having an understanding of some basic facts about internet searches can also be helpful. Web surfers should be aware, for instance, that the algorithm that creates the list of search results is not based on the best match, likelihood, or relevance. Results are not listed or ranked by reliability, nor are they personalized to any one person’s own unique medical history. Because internet search results are based on frequency of keywords, each search becomes a self-fulfilling prophecy.
In addition to abstinence, the treatment for someone with cybercondria must rely heavily on the CBT techniques of desensitization and mindfulness. Those in treatment are instructed that symptoms and anxiety are to be noticed and tolerated, not reacted to. Abstinence can be maintained more successfully when the person understands their thoughts and feelings and the way in which their behavior is ultimately not helpful.
