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Unlocking a Mystery

If you answer yes to any of the questions below, you could be a hypochondriac. But take heart: Doctors are learning more about how to treat the illness.

July 03, 1996|SHARI ROAN | TIMES HEALTH WRITER

Mr. A was the kind of patient no doctor wanted to deal with.

A few years ago, he showed up in the office of Dr. Brian A. Fallon, complaining of nonstop headaches, which he was sure meant a brain tumor.

Tests showed nothing in the 52-year-old stockbroker's head other than a normal-looking brain. And it was clear to Fallon--at the time a young psychiatric resident at Columbia University--that Mr. A had hypochondria.

Mr. A, however, was not convinced, says Fallon, who recalled their first meeting.

"I feel I have a serious medical illness, but the doctors won't tell me what it is," Mr. A ranted. "You are a psychiatrist. I don't want to talk about my problems. I don't care how well-trained you are, you can't help me. I have a physical problem, not a mental one!"

What Fallon did next, however, not only convinced Mr. A that he did have hypochondria, it also convinced both doctor and patient that hypochondria is indeed "a serious medical illness."

On a hunch, Fallon prescribed Prozac--which is used for depression and obsessive-compulsive disorder--because he believed Mr. A's excessive fears mimicked the obsessive doubts and expectations of harm that people with OCD typically experience.

Within six weeks Mr. A was a new man. No headaches. No irrational fears. No obsession over dying.

Equally ecstatic was Fallon. To him, Prozac represented a key that unlocked a big, black box in psychiatry.

Until recently, hypochondriasis--unremitting fears about disease and a preoccupation with bodily symptoms despite reassurance from doctors--was considered one of the mental disorders most unyielding to psychotherapy. Medications were not considered useful.

Now, however, the picture is brightening for hypochondriacs and the exhausted retinue of doctors who try in vain to treat them for everything but hypochondria.

"It's almost like a disorder coming out of the closet," says Fallon, an assistant professor of clinical psychiatry at Columbia University.

Adding greatly to the new understanding of hypochondria is a New Jersey journalist named Carla Cantor, whose new book on hypochondria details her ordeal with the disorder. "Phantom Illness: Shattering the Myth of Hypochondria" (Houghton Mifflin) contains a forward by Fallon.

The progress in understanding hypochondria reflects the mind-body movement in medicine, in which emotions and thoughts are accepted as having a large effect on physical health.

Moreover, the promising use of Prozac for hypochondria suggests that the brain's serotonin neurotransmitters may be highly influential in "mediating" this disorder, Fallon says. "Patients experience their bodily symptoms more intensely and experience a catastrophic reaction to those symptoms."

*

"Catastrophic" is a word Cantor can relate to. The first emotional bomb to fall in her life occurred when she was 17. Driving to a ski outing with a friend, Cantor's car collided with a tractor-trailer. Cantor, now 41, walked away. Her friend was killed.

Morose and shaken, she developed an eating disorder in college and became preoccupied with the fear that she, too, would soon become ill or die. Cantor underwent years of psychotherapy, but the therapy never fully explored the idea that her emotional state might be a factor.

"We need to know what the psychological underpinnings are for each patient," says UCLA psychologist Marc Schoen, an expert in mind-body medicine.

While some people may have a predisposition toward worrying, hypochondria seems to emerge to fill a need in someone's life, he says.

For example, hypochondria can be used to seek attention or to punish oneself, to withdraw from personal responsibilities or because some traumatic event has led to a feeling of being unsafe. (In his preliminary research, Fallon has found a high rate of early psychological trauma, such as sexual abuse, among hypochondriacs.)

"People who become obsessed about having AIDS"--a common fear among hypochondriacs--"don't feel real safe inside," Schoen says. "They are scared about the world. A traumatic event shakes their foundation, and it goes down to the bottom brick, which is our health. When people aren't safe, they focus on physical health."

Cantor believes her car accident "fell on fertile ground." But it was after the birth of her second child in 1990 that she developed a range of symptoms that convinced her she had lupus, another common fear among hypochondriacs. Repeated trips to doctors and a battery of tests showed nothing.

"I'm sure a lot of doctors, behind my back, rolled their eyes and couldn't stand me," Cantor says. "Hypochondriacs are begging the doctor to diagnose them and yet they are so frightened of having a disease that there is no pleasing them."

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