New research shows that people who have high levels of anxiety about their health are more at risk of heart disease. Doctors may have to start taking hypochondriacs more seriously.
Doctors may have to start taking hypochondriacs more seriously, new research suggests.
There have been a number of scientific studies showing how stress and anxiety can increase the likelihood of your developing a heart condition. But focus in on "health anxiety" specifically and a conundrum emerges: if worrying about illness leads to illness, then isn't the initial anxiety justified? And, if so, how do you counter the anxiety?
Heart disease is the leading cause of death among men and women in Europe and the United States. Around 130,000 people in Germany die from the condition every year – the eighth highest rate of all OECD (Organization for Economic Co-operation and Development) countries.
A Norwegian study published last week in the "BMJ Open" journal links the most common form of heart disease, ischemic heart disease, to hypochondria.
Hypochondria is characterized by an excessive worrying about your health, often to the point of developing imaginary symptoms.
In the study, more than 7,000 people answered questions about their lifestyle, education and health. They each had a physical examination and participants with high levels of health anxiety were identified using the Whiteley Index, a recognized measure of hypochondria. Their health was then tracked over 12 years using national hospital data.
The researchers had predicted that people with health anxiety would be less at risk, because they are more likely to get symptoms checked out and make lifestyle choices in order to avoid getting ill.
But while participants with health anxiety did consume less alcohol than others, they also smoked more and spent fewer hours being physically active.
Mind over body
Lead researcher, Dr Line Iden Berge, says it appears the worrying itself leads to the increased risk of heart disease, rather than any associated lifestyle factors.
"We show that participants who self reported high levels of health anxiety had a 70 percent increased risk of ischemic heart disease, after adjustments for established risk factors," says Berge.
"General anxiety has a physiological effect on the heart, just like other stressors do," says cardiologist, Dr Thomas Klingenheben. "People with anxiety have a much higher resting heart rate than others - perhaps around 80 [beats per minute], when the average person might have a heart rate of around 60."
Klingenheben, who was not involved in the study, says this is caused by increased activity of the nervous system and, when anxiety triggers this overactivity, it may even cause vascular damage.
It raises the question of just how much mental health can influence the body.
"A range of studies have shown that depression is also associated with increased risk of ischemic heart disease," says Berge.
But is hypochondria a symptom of depression?
"As a clinical psychiatrist, I would say there is a strong connection between depression and health anxiety," says Berge. "In our study we also demonstrated a correlation between the two conditions."
Klingenheben says the study shows doctors will have to think carefully about how they deal with hypochondriacs.
"Of course these are the people doctors don't really want to see," he says. "I have patients like this myself, who come in two or three times a year because they believe there is something wrong with their heart. But I think doctors will have to take this illness more seriously and treat the health anxiety itself."
While he points out this is not a job for cardiologists, he says the patients should be referred to a neurologist or a specialist in psychosomatic medicine.
"This new evidence of negative consequences over time underlines the importance of proper diagnosis and treatment for health anxiety," says Berge, adding that doctors should encourage patients suffering from hypochondria to seek treatment, such as a cognitive behavior therapy.