Contact Us: illnessconcern@aol.com | 212-543-5542

Welcome to the Columbia University and NYS Psychiatric Institute Program for the study and treatment of Heightened Illness Concern, Health Anxiety, and Medically Unexplained Symptoms.


Frequently Asked Questions



What is heightened illness concern?
Heightened Illness concern (HIC) is a common problem that plagues 5-10% of the general population. People with HIC may worry whenever they have an unexplained physical symptom that it could be a sign of a serious disease. People who have a medical illness that is stable may also have HIC if they find themselves worrying too much about it. At times, this problem has been called “hypochondriasis”. The term hypochondriasis is an ancient one but not a good one because it has taken on negative connotations – some people make fun of hypochondriacs because they suspect that “hypochondriacs enjoy their symptoms”. That is far from the case. People with hypochondriasis are in fact in great despair – fearing that they are dying or could be dying from a dreaded disease. Because of the negative associations with the term “hypochondriasis”, we use the term “heightened illness concern (HIC)”. People with HIC worry about illness excessively. Some worry for short periods while others worry for months to years. A person with HIC worries that he or she has or might have a serious illness despite the doctor’s evaluation that has ruled out an underlying disease. The person often has a hard time letting go of the fear or conviction that a serious disease might be underlying the persistent symptoms. HIC is painful for the individual who suffers from it and is distressing for friends and loved ones who find themselves unable to provide enough reassurance to the patient to truly relieve that person’s fears. People with this problem struggle routinely with intense anxiety and fear, irritability with others who seem not to take their concerns seriously, poor concentration due to the intrusive thoughts or sensations, misunderstanding by friends and family, and either avoidance of medically-related anxiety triggers or compulsive checking for reassurance with loved ones, medical books, or health professionals.

What are Medically Unexplained Symptoms?
Medically Unexplained Symptoms (MUS) refer to symptoms that a patient may develop that cause distress or discomfort, which persist or come and go, and which do not have a clear medical cause. Typical examples might include pain syndromes (e.g., headaches, abdominal pain, back or joint pain, rectal pain, pain on urination, discomfort during sex intercourse), gastrointestinal symptoms (e.g., nausea, bloating, diarrhea), neurologic symptoms (e.g., dizziness, areas of numbness, balance problems, lightheadedness, trouble swallowing, hearing changes, lump in throat). Typically a patient with MUS has seen many physicians and has either not felt understood or has felt frustrated by the failure of even good doctors to provide symptom relief.

There are many possible reasons for MUS and our treatment programs are geared toward helping patients to find better ways to overcome the way in which MUS are ruling their lives.

What if I worry about illness but I don’t consider myself a hypochondriac?
You are not alone. The term “hypochondriac” is not very popular and it is not even correct for it means “under the ribs”… “hypo” for under and “chondros” for ribs. In the ancient world, the Greek physician Hippocrates (~5th century BC) used the term because it was then believed that most ailments stemmed from organs under the ribs, such as the liver, gallbladder and spleen. Because the term hypochondria is inaccurate and pejorative, we prefer to use the term “Heightened Illness Concern (HIC)”. Modern medicine recognizes that there are many people who are otherwise healthy individuals with stable lives and families who suffer from excessive worries and fears of illness. These worries and fears may have been triggered by stress or trauma or they may come out of the blue. Some patients might be very depressed due to their conviction of having a serious illness. Others might be extremely anxious – on some days they have good insight that their fears are irrational while on other days they are riddled with anxiety that they might be dying. Current research suggests that it is an interplay of genetic vulnerability and environmental influences that determine who will develop excessive illness fears.

What if I do have an illness but I worry too much about it?
The mind and the body are intertwined. What affects the body will affect the mind. If a person is sick with a medical disease, such as diabetes or arthritis or a neurologic disorder, there will often be psychological effects as well, including depression and anxiety. Some people however can’t let go of the fear and despair that attacks them – and this happens even when their medical or neurologic illness is under good control. These people too may benefit from our treatment programs because their lives are far too burdened by their fear of illness and of the future.

Are there treatment studies I can participate in?
Yes, there are. The good news is that these disorders are treatable and we have a nationally recognized research program that focuses on identifying the most effective treatments to help people with illness fears and unexplained somatic symptoms. Experts at Columbia University and Harvard University have now teamed up to conduct a NIH-funded study to help patients with heightened illness concern. In the context of this research study, we offer specialized, expert treatment that is not widely available elsewhere at no financial cost to the client. Our treatment study is being conducted both in New York City under the direction of Dr. Brian Fallon and in Boston under the direction of Dr. Arthur Barsky at the Brigham Women’s Hospital. For more information about this study, please click here.

Could there be a physical problem underlying excessive illness fears that might be helped with medication?
This is a good question. Unfortunately, people who suffer with excessive illness worry may not initially recognize that they need psychological help. They believe that they have a serious physical disease underlying their symptoms. We too believe that these patients have a serious disease but we locate the serious disease in the neurochemistry of the brain. We believe that in some patients the neurochemistry is not functioning properly and that this malfunctioning causes the patients to have a heightened awareness of physical bodily sensations and an inability to let go of the intense worry about illness. Current research makes clear that this excessive worry can be helped by either appropriate medicine or targeted psychotherapy. We expect that because of the latter treatments, as the person gets better, the brain chemistry will readjust to the proper balance seen in healthy individuals. Such return to healthy brain blood flow and metabolism as a result of either medication treatment or psychologic treatment has been demonstrated in other obsessional disorders, such as obsessive compulsive disorder. This makes sense because all of our emotional experiences are processed through the nerve cells and neurochemical communications of the brain. When a person feels better, the brain neurochemistry is helping to shape the feeling. When brain chemistry isn’t working right, as a result perhaps of excessive stress or anxiety, the brain actually suffers. We can see this for example when we look at the effect of the neurotransmitter glutamate. In the right amount, glutamate allows nerve cells to work properly. In an excessive amount, such as may be occurring in certain anxiety disorders, glutamate excess causes too much excitation of the nerve and the brain’s nerve cells may start to shrink and eventually become non-functional. It is important therefore for the person afflicted with anxiety or excessive worry to get help – this will improve the person’s emotional well-being and it will reverse the harmful effect on the brain’s nerve cells of abnormally functioning neurochemistry.

Who gets hypochondria or medically unexplained symptoms– the young, the old, the famous?
Anyone at any age can develop these problems - from the child at age 10 to the senior citizen at age 75, from the deli cashier to the academic scientist, from the stay-at-home mom to the female C.E.O. The movies and television provide plentiful examples, from the neurotic characters in Woody Allen’s films to the obsessional Felix Unger in the Odd Couple. Often the hypochondriacal individual is the butt of jokes – jokes made by others and even by him or herself. The true nightmare of this disorder is not appreciated or adequately portrayed. The inner experience of the hypochondriac is one of daily terror and despair – relentless worry fills the day and night. Susan Baur in her book “Woeful Imaginings” lists a number of individuals in history thought to have hypochondriasis, including James Boswell (the distinguished biographer of Samuel Johnson in the late 1700s), the American poet Sara Teasdale, and the renowned philosopher Immanuel Kant (1724-1804). Kant, who promulgated the idea that the human mind is the active originator of experience rather than just a passive recipient of perception, also suffered from severe hypochondriasis at different point in his life. Baur details how Kant wrote about his own hypochondria and called it “hypochondria vaga” - a syndrome in which “the patient fancies himself afflicted with all manner of diseases” and feels an absolute inability to combat or control them. Kant apparently tried to reason this anxiety out of his head – sometimes successfully and sometimes not.

Unlike prior eras of history, we now have effective treatments to help people with hypochondriasis and excessive illness concerns. To learn more about these treatments, click here.

Can you explain why people with anxiety have lots of intrusive worries and lots of troubling bodily symptoms? Because these feel so real, how can they be from the mind?
Anxiety is associated with both cognitive symptoms and bodily symptoms. The cognitive symptoms stem from the worry that results when faced with uncertainty, fear, or harm. The bodily symptoms may include dizziness, abdominal discomfort, diarrhea, neck pain with shoulder tension, headaches, sensation of lump in the throat, an urge to urinate, a physical restlessness, fast heart beat, shortness of breath, trouble sleeping. How could it be then that an emotional state of anxiety causes or exacerbates physical symptoms? Many people are aware that anxiety and depression are mediated by problems with the neurotransmitters such as epinephrine and serotonin. Too much norepinephrine will result in severe panic attacks, with symptoms of fast heart beat, sweating, fear, shortness of breath. Too little serotonin can result in severe depressive states, accompanied by inability to sleep, poor appetite, severe fatigue, and heaviness in one’s body. Did you know that 90% of the body’s serotonin nerve cells are located in the gastrointestinal system? Therefore, it makes sense that when a person is anxious they might also have symptoms that affect the stomach or bowels. Medicines that readjust these brain chemicals are effective treatments for anxiety and depression and, in turn, these medications can help reduce troubling bodily symptoms. These medications may work on the norepinephrine or serotonin system of the brain. The serotonin reuptake inhibitors allow for more serotonin and include medicines such as fluoxetine (“Prozac”), fluvoxamine (“Luvox”), sertraline (“Zoloft”), and citalopram (“Celexa”). The symptoms that people with anxiety feel are indeed real bodily symptoms that are triggered by abnormally functioning bodily neurochemistry. Fixing the neurochemistry therefore should help to reduce the worry and reduce the intensity and frequency of the troubling physical symptoms. These treatments are not capable of hiding real medical problems – rather they bring the body back to a healthy balance.

 


Click on the image to learn more about the new NIH-funded Treatment studyof Heightened Illness Concern being conducted in Boston and New York