The Crippling Case of Cyberchondria

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The Crippling Case of Cyberchondria

This article is not meant to diagnose or provide medical advice—that responsibility lies with physicians.

One of the interesting things about the medical field is how frequently doctors have to come up with a term to describe a previously unknown phenomenon. Enter “cyberchondria”—the specific form of hypochondriasis (more than six months of life-interfering obsession with perceived medical symptoms despite a clean bill of health) that centers on repeated internet searches for health information. The constant Googling exacerbates the anxiety, leading to even more difficulty with relationships and concentrating on work, and disabling fear.

Before anyone self-diagnoses themself with cyberchondria, know that a quick search for “burning while you pee” when a patient has a real symptom signifies nothing but curiosity, literacy and the level of financial privilege to own a computer and have access to Wi-Fi. People without cyberchondria can process the information (“maybe I should call my doctor” or “looks like it’s probably nothing”) and quickly move on to other aspects of life. Cyberchondriacs might end up diagnosing themselves with a whole list of severe medical problems, then be so worried about their impending doom that they call in sick to work.

With the increased availability of internet access through mobile phones and the burgeoning amount of health information on the internet, it is not a surprise that 80 percent of Internet users have searched for health-related topics online. While most of those people do not suffer from cyberchrondria, it may be a growing problem.

Psychologists have even created a scale to scientifically assess people for the condition. Called the CSS, or Cyberchondria Severity Scale, it consists of 33 questions like “do you feel more anxious after searching for health information?” The information can help psychiatrists and psychologists determine whether the patient should be treated. Patients who do not score high enough for cyberchondria, but who report significant anxiety, might be diagnosed with health anxiety, a term now in use by mental health professionals because of the stigma of “hypochondriac” in society.

Are there risk factors for cyberchondria? One study determined that an “intolerance for uncertainty” and “anxiety sensitivity”—in other words, how damaging anxiety is to the person’s daily life—correlated with cyberchondria. The authors did exclude anyone with preexisting diagnoses, to ensure the reason the subject was obsessing about aches and pains was not hypothyroidism, for example.

Because no official medical body has come out with recommendations for treating cyberchondria, most patients will be referred to cognitive behavioral psychotherapy. Because of the link to obsessive-compulsive disorder (OCD) some psychiatrists might try medications designed for that condition. OCD features an obsession (with something like disease) that is temporarily relieved by a compulsion (like doing yet another internet search). In OCD, patients are usually treated with serotonin reuptake inhibitor medications, since dysregulation of serotonin, a neurotransmitter, is thought to be the cause of OCD, with genetics as a contributing factor.

Many doctors believe that the availability of the internet has improved patients’ engagement and health education. It could be saving them time; I can refer patients to a lengthy online list of things to avoid in the preconception phase, for example, instead of committing every last herb to memory. Younger physicians can sometimes be more understanding of all the Googling, since they themselves trained in an era with search available to anyone. But Dr. Google can convince patients of the wrong diagnosis and cause them to self-treat and make the problem worse. And, when cyberchondria is unrecognized, the interference with employment, relationships and caring for children or other dependents can be worse than the consequences of the perceived illness.

What’s an educated, feverish internet searcher to do? First, patients should be aware that searching symptoms has a lukewarm track record; as The New York Times pointed out, apps, websites and even online symptom-checkers are often wrong. One physician blogger has a list of tips to corral the anxiety around health information searching, including keeping a list of sites visited. This can help in those situations when a patient is wondering, “did it say I could have … giant cell arteritis, ankylosing spondylitis or both?” In an article for Psychology Today, Joni Johnston Psy.D, noted that the internet should be used to screen, not diagnose, and that while some information, like rating scales for bipolar disorder, can be very helpful, too many patients get tripped by not heeding when articles are outdated or posted on dubious websites.

Thankfully, Google’s first result for certain conditions will now be more reliable, thanks to a 2015 initiative to show accurate information for a variety of conditions. Researching online can be a good first “triage” step for any patient. However, if health articles and searches are interfering with daily life or are causing repetitive anxiety or worry, booking an appointment with a psychologist or psychiatrist is a reasonable next step. And if you are really worried about a condition, just call the damn doctor.

Dr. Monya De is an internal medicine physician, former ABC News reporter in the Medical News unit and the co-author of Minerals, The Forgotten Nutrient.