Hyperchondriasis - a "New Age" Somatoform Disorder

Modern medicine's technological advances now allow more people to live long enough to develop chronic diseases where the mortality is low but the morbidity high. Hyperchondriacs are acutely aware of this, and perceive great threats in their aging and the future. Hyperchondriacs have similar attributes to hypochondrial patients even as they lack the attendant "symptoms" of a physiologic illness.

“Quit worrying about your health. It’ll go away.”

--Robert Orben

Consider temporally, somatizers live in the present, afraid their symptoms are the first sign of a developing disorder. Hypochondriacs live in the past, fearful of diseases they think they have already acquired. Those who have been healthy in the past and remain so in the present, but hold somatic fears and disease phobias for what the future may bring, represent a "New Age" somatoform disorder.

These patients may be found among clients of holistic medical practitioners, "ecological allergists," megavitamin therapists, food faddists, and other fringe healers. The word "hypochondria" is from the Greek, hypochondrion, the soft body part below the rib cage and above the navel (hypo, under and chonaros, cartilage). Depression and anxiety over one’s health was supposed to have been seated in this region.

A new word, "Hyperchondria," is needed to describe those with futuristic worries. The hyper prefix, meaning above, moves the seat of this melancholia upwards to the head, where it properly belongs.

Modern medicine’s technological advances now allow more people to live long enough to develop chronic diseases where the mortality is low but the morbidity high. Hyperchondriacs are acutely aware of this, and perceive great threats in their aging and the future. Hyperchondriacs have similar attributes to hypochondrial patients even as they lack the attendant "symptoms" of a physiologic illness.

Being sick means always having to say you’re sorry -- sorry you can’t succeed, take charge, be responsible, help others, or attend to all the financial and social obligations that full participation in society requires. Somatizing and hypochondrial patients refuse to give up their illnesses. To do so means releasing others from their dependency and, in turn, rising to meet their own responsibilities.

Hyperchondriacs also avoid modern social stressors and expected obligations. They remain very busy -- keeping well pursuing physical and mind-body connections, kitchen alchemy and healing therapeutics. As a culture we cherish health over wealth and acknowledged the idealized supremacy of the mind in harmony with the universe and itself. If we can't be rich or famous there is always transcendental peace and eternal youth. This is a remarkable adaptation - socially sanctioned and culturally in vogue.

Hyperchondriacs are worried about the ecological future and their aging. Today's exogenous insults are tomorrow's endogenous disorders. They pay strict attention to food origins, believe in preventive dietary supplements, and accept unproven therapeutics under the assumption that science will validate them in the future. An example of their “primary threat” is cancer.

In the continuum of subjective health, hyperchondriasis lies at the end where the worried well plan for their future afflictions.

Every disease model uses popular belief models to further its methodology. The "20th-century diseases" - allergies and environmental toxins - are engines of many of today's alternative practices. The vitamin and natural foods industry, both as therapies and businesses, were created by these concerns and it continues a familiar medical pattern. ("Spinal irritation" saw the birth of spas and manipulative therapies at the close of the 19th century. “Neurathenia” drove patent medicine’s greatest popularity (1870 to1930) with demands for “nerve tonics.”)

Social isolation, a late 20th-century American lifestyle, derives from relationships that are more tenuous than ever before. These weak bonds are evidenced in high divorce rates, single-parent household, nuclear families, and our elderly living away from their children. This gives impetus to the modern phenomena of "self actualization" with personal growth replacing community objectives. Such loneliness is also the link to the rise in narcissistic inspired somatic complaints and the increased need for "healing".

However, there is one valid argument made by Hyperchondriacs. As summarized by comedian Jackie Mason:

“It’s no longer a question of staying healthy. It’s a question of finding a sickness you like.”

alan berkenwald, md