How long have I got, doctor?

Hypochondriacs are figures of fun, but their suffering is real. After six years of seeing death around every corner, Clint Witchalls decided to seek treatment for his obsessive health anxiety

People who have a cold but call it the flu are often labelled hypochondriacs. I have suffered from hypochondria for about six years, and I've never mistaken a cold for the flu. A cold is just a cold and you soon get over it. But when my heart skips a beat, my body goes into full alert. I know that the Holter monitor test showed that my heart arrhythmia are a benign condition known as ectopic heartbeats, but what if the diagnosis was wrong? What if they're really atrial fibrillations? What if there's a giant blood clot building up in my heart as I type this?

A hypochondriac's symptoms are always real: they really do have swollen glands, chest pains and night sweats. The difference between us and "normal people" is how we interpret these symptoms. A chest pain is never just heartburn, it's always a heart attack. Itchy skin? Must be Hodgkin's disease. A hypochondriac will inevitably choose the most serious but often least probable explanation for their symptoms. At the time, though, it always seems perfectly rational.

Hypochondria has no specific cause. It belongs to a group of disorders known as somatoform disorders, in which the medical test results don't explain the person's symptoms. Typical hypochondriac symptoms include headaches, stomachache, food intolerance, breathlessness, palpitations and muscular fasciculations (twitching muscles). All of these symptoms can have difficult-to-detect causes.

My father died of motor neurone disease, so when I first developed muscular fasciculations, I rushed to my doctor's surgery (muscle twitching being one of the early symptoms of MND). My GP listened patiently to my litany of symptoms, which by now included wobbly legs and trembling hands (surely a sign of wasting muscles?), then calmly said: "First off, motor neurone disease is not hereditary..." Alarm bells! In one fell swoop, I'd lost faith in my doctor. I know for a fact that in 10 per cent of MND cases, the causes are hereditary. Was he being patronising or was he simply ill-informed? Either way, at that point I stopped listening. I just wanted the referral to a "real" expert. Sure enough, my GP referred me to a neurologist, but only to reassure me, he said.

The long NHS wait to see the neurologist was hell. I thought I'd be dead before I saw him, but see him I did. After some nasty tests involving long needles and electrical currents, the muscular fasciculations were declared benign. "But if things change, come back and see me," said the neurologist, kindly. "But if things change" echoed in my head for months after. I would repeat some of the simple tests, such as heel-and-toe walking, to see if things had changed. I became obsessive. Any slight wobble in my gait or blurring of vision and I wanted to run back to the neurologist. It took colossal willpower not to do so.

Dr Paul Salkovskis, a leading light on hypochondriasis (or "health anxiety" as he prefers to call it), doesn't believe that referring patients to experts is the way to alleviate anxiety. "How easy is it to prove the absence of an insidious neurological disease?" he asks. "At this point in time, I have no idea whether or not I have motor neurone disease. I can't be sure that I don't have cancer, multiple sclerosis or heart disease either, because you can't prove the absence of any of these things. But you shouldn't be asking yourself what you haven't got. Instead, you should be asking yourself what you have got, which is a tendency to worry about your health."

I realised that my problem was more psyche than soma when I reflected on the past six years. I can see that if I really had had prostate cancer, atrial fibrillation and motor neurone disease, odds are I'd be dead by now. What I actually had was prostatitis, ectopic heartbeats and benign muscular fasciculations. I had wasted huge tracts of beautiful life fretting over fairly innocuous symptoms. Not only was I wasting my life, I was also wasting scarce NHS resources. I wondered whether the Department of Health had any statistics on health anxiety and what it cost the NHS. To my surprise, they said no. Dr Joe Neary, of the Royal College of General Practitioners, on the other hand, isn't surprised at all. "I would be deeply suspicious of any statistics that were trotted out," he said. "While on the one hand you've got people who are anxious who don't have any terribly good reason to be, on the other hand you have people with significant medical problems who also have substantial health anxiety. And people with moderate health problems have a range of anxieties, so it gets very difficult to draw clear lines between where appropriate anxiety finishes and inappropriate health anxiety begins."

Given my history of worrying about things that never come to pass, such as my own demise, I decided to ask my GP to refer me to a cognitive behavioural therapist. He said I'd be a good candidate for therapy. I didn't ask why. Perhaps he's tired of me weeping onto his desk twice a week.

Cognitive behavioural therapy (CBT) is very effective in treating health anxiety, and it is has a much lower drop-out rate (about five per cent) than other methods of treatment, such as dosing patients with SSRIs (selective serotonin reuptake inhibitors). Unless the pill-taking is combined with therapy, health anxiety tends to resume as soon as the prescription runs out.

Unlike most therapy, a course of CBT is brief, usually no more than 16 sessions. CBT works on the notion that our thoughts cause our behaviour and our feelings. Change your thoughts (from negative to positive, for example) and you can change the way you behave and feel. The therapist helps the client to think differently and to unlearn old assumptions. It sounds simple, but it's a lot harder than swallowing a capsule.

The therapist gets an understanding of the problem and how it affects your daily life through fairly detailed questioning and analysis. Because health anxiety can be linked to other psychological disorders (in what health professionals call "comorbidity"), the therapist will also determine whether you suffer from depression, panic attacks, obsessive-compulsive disorder or any other anxiety disorder. You then work together to develop an exact understanding of the problem, you set goals to overcome it (such as, in this case, lessening anxiety about symptoms), and you work out a method to achieve these goals (for me, for example, getting up and doing physical activity usually takes my mind off an errant twitch or pain). And you get homework - forms to fill out, new techniques to try.

I haven't yet completed the therapy, but I'm already more aware of what my mind is doing when a new symptom presents itself. I tend not to get caught in the tailspin of anxiety. I don't immediately type the symptoms into Google to find the most gruesome prognosis. That's not to say that I'm free from anxiety: there's always a nagging feeling that maybe this symptom is the one I should see my GP about. What if I develop a brain tumour but ignore the symptoms, telling myself, "it's just a headache"? I can't help having this vision of people standing round my grave saying, "If only he hadn't been cured of his hypochondria quite so thoroughly, he might be alive today." But then again, I'd rather live one year free from anxiety than 10 as a gibbering wreck.

LOG ON TO CYBERCHONDRIA

Hypochondria is as old as the hills, but the advent of unregulated health information on the Internet is blamed for recruiting more sufferers. Over the past few years cyberchondria, also called "internet print-out syndrome", has become endemic. This is hypochondria made worse by use of the internet. Sufferers look up medical information on the internet, and then self-diagnose using the information they find.

Many people will do this on an occasional basis, but those severely affected can spend up to five hours a day on the web, researching potential illnesses and fuelling their actual one.

Interactive sites are involved as well as information sites. A typical comment from an internet health chatroom runs: "I am sitting here at work behind my computer trying not to break down from fear. I have a doctor's appointment on Thursday to look at my leg and I am so afraid. I feel like I'll be dead by then. I was just scaring the crap out of myself, looking on the internet at pictures of bloodclots in the legs and things..."

Dr Paul Cundy, who chairs the British Medical Association's GP information technology sub-committee, says, "Hypochondriacs can be made worse by access to the internet, where there is so much more material available than ever before - and a lot of it is seriously wrong".

Far from making medical experts redundant, as was once mooted, all the information present on the web has simply altered their traditional role. Dr Cundy thinks that those who have "taken on board a whole load of information which they are not trained to handle now need their GP even more than before".

* It is estimated that health concerns are the second most popular topic of the net, second only to pornography.

* 10 to 15 per cent of patients are thought to have looked for their conditions on the web before visiting a doctor.

* It is estimated that up to 25 per cent of the content of medical web sites is inaccurate or misleading.

* The frequency with which diseases occur on the web is almost in inverse proportion to the frequency with which they occur in life. Google "cancer" and you get 25,400,000 hits. MS gets you 2,110,000. The common cold, which most of us will suffer in the coming months, only manages 677,000.

CATHERINE NIXEY

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