March 30, 2004
A New Era in Treating Imaginary Ills
By MARY DUENWALD
very doctor recognizes them.
The man who discovers a bruise on his thigh and becomes
convinced that it is leukemia. The woman who examines her
breasts so frequently that she makes them tender, then
decides that the soreness means she has cancer. The man
who has suffered from heartburn all his life but after reading
about esophageal cancer has no question that he has it.
They make frequent doctors' appointments, demand
unnecessary tests and can drive their friends and relatives —
not to mention their physicians — to distraction with a
seemingly endless search for reassurance. By some
estimates, they may be responsible for 10 to 20 percent of
the nation's staggering annual health care costs.
Yet how to deal with hypochondria, a disorder that afflicts
one of every 20 Americans who visit doctors, has been one
of the most stubborn puzzles in medicine. Where the patient
sees physical illness, the doctor sees a psychological
problem, and frustration rules on both sides of the
Recently, however, there has been a break in the impasse.
New treatment strategies are offering the first hope since the
ancient Greeks recognized hypochondria 24 centuries ago. Cognitive therapy, researchers
reported last week, helps hypochondriacal patients evaluate and change their distorted
thoughts about illness. After six 90-minute therapy sessions, the study found, 55 percent
of the 102 participants were better able to do errands, drive and engage in social
activities. Antidepressant medications, other studies indicate, are also proving effective.
"The hope is that with effective treatments, a diagnosis of hypochondriasis will become a
more acceptable diagnosis and less a laughing matter or a cause for embarrassment," said
Dr. Arthur J. Barsky, director of psychiatric research at Brigham and Women's Hospital in
Boston and the lead author of the study on cognitive therapy, which appeared in the
March 24 issue of The Journal of the American Medical Association.
Almost everyone has inexplicable physical symptoms from time to time, and many
people experience a moment of worry that their odd rashes, bumps or pains are signs of
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