doctor, i'm dying again

THE HUMAN CONDITION Britain is now a nation of hypochondriacs and, yes, we're getting worse all the time. But experts hold out some hope for a cure, reports Eleanor Bailey

You will be pleased to know that I'm not a hypochondriac," said Ronnie Corbett, poised in his raconteur's chair. "That's the one disease I haven't got."

No matter that nine out of 10 investigations for cancer prove to be nothing, or that your chance of growing a brain tumour is almost nil; your chances of suspecting a brain tumour next time you get a bad headache are very high indeed. For hypochondria is a national pastime. We have colds that miraculously transform into mystery viruses, we can feel irregular heart beats getting out of bed in the morning and we know we have a dodgy liver because no one else has hangovers like this. And we're getting worse. "We're not speaking from hard data, but it would appear that our levels of hypochondria are moving upwards," says Dr Paul Salkovskyis, an expert on hypochondria at the department of psychology at the Warneford Hospital, Oxford.

A survey in the new issue of Men's Health magazine showed that men worry a lot about their health. Fifty per cent feared going bald and growing old and 75 per cent were worried about the shape of their bodies. Women are even more concerned about their health and more likely to go to the doctor. Not surprisingly, perhaps, that spending on stomach upset remedies and sleeping and calming products were up last year by 8.5 and 15 per cent respectively.

We are increasingly bombarded by health information, much of it alarming: genetic testing, the dangers of processed foods, the cow row. It's enough to make even the most rational individual worry.

"Last weekend alone," says 28-year-old Janette Marks, "I discovered a malignant melanoma on my thigh, found a breast lump and worried that a pain in my knee might be damaged cartilage. I have an ongoing belief that I have something terrible that no one has picked up and that one day soon my whole system will collapse. But my biggest fear is that worrying about it will make cancer more likely. That really scares me."

Fortunately there is no scientific evidence that worrying increases the risk of cancer. In fact, says Dr Salkovskyis, worriers tend to live longer than non-worriers, if only because they are less likely to race cars at 80 miles an hour with a fag hanging out of their mouths.

Janette Marks has a manageable form of hypochondria. She gets uncomfortably anxious sometimes. Constant possibilities flit through her mind but she dismisses most of them. "The thing that stops me taking my fears too seriously is the embarrassment. I think, I can't go to the doctor again, she'll laugh at me. Also, I have a sensible side that tells me not to be so ridiculous.'

Hypochondria, which was identified back in Ancient Greece, affects the majority of people to some degree. For a small percentage of sufferers - about half a per cent of the population - the worry ruins their life. These are people who find accommodation near casualty departments in case of a heart attack, who won't go on holiday, who give up jobs. Sixty per cent of hypochondriacs suffer from panic attacks, which of course provide them with symptomatic evidence. It even drives some to suicide (they are convinced that they are about to die in agony anyway). Andrew Wood (not his real name), 33, was convinced that he had a growing, incurable brain tumour, 'When my father died suddenly of a tumour, there were so many questions that nobody seemed able to answer: why did it happen to him and how could he have prevented it? The only answer that I got was 'these things happen'. And so I started thinking, well, it could happen to me.

"I started having these terrible headaches; to me, they were evidence that my worst fears had been realised. I took a lot of time off work and became very depressed. Eventually my GP agreed to send me for tests. Then I had to wait several weeks. I couldn't sleep. I had cold sweats. I was forever droning on to my girlfriend about it. When the tests came back negative, I insisted on a second opinion. The GP wasn't keen - he wanted to put me on anti-depressants instead. I'd taken so much time off by now that my employers and I agreed that I ought to leave. I ended up in a mental hospital for three months.

"That was three years ago now and I think of myself as 'better' in that I can no longer understand my behaviour at that time. It is an enormously difficult problem to deal with because until you really reach rock bottom, you don't want to be cured of hypochondria, you want some one to deal with the 'real' problem. It is not a disease that people can really understand or sympathise with - particularly doctors. It's the medical equivalent of wasting police time." Recent research has given encouraging results that this most intractable of conditions does in fact respond to a form of cognitive behavioural therapy. Dr Salkovskyis's study, soon to be published in the British Journal of Psychiatry, showed that there was a better than 70 per cent chance of improvement.

"We get the patients to change their behaviour - so that they no longer seek constant reassurance from doctors and friends. We show them evidence that, if a person has 10 tests, it is quite likely that in three of them some abnormality will show up whether or not the person has anything wrong. So constant testing is not likely to be helpful." Hypochondriacs also often create evidence of illness unwittingly. "For example," says Dr Salkovskyis, "if a person checks their lymph nodes repeatedly over the course of an hour it can cause lumps which will become painful through the checking. We get patients to do this deliberately to show them the effect. We also get them to see for themselves how worry can trigger palpitations."

Hypochondria is affected by fashion. Syphilis left the hypochondriac Top 10 when it became curable. It was replaced by Aids. (The Sun once ran a column called "10 Signs that you need an Aids test" beginning with, "You're feeling more tired lately". If you had five or more "symptoms" you were said to be at risk - and when the column was presented at a medical conference on hypochondria, everybody in the room had at least the first three.) These days there are a lot of self-diagnosed sufferers of CJD on the basis that one of the first signs is forgetfulness; and it is feared that genetic testing will make hypochondria even more prevalent and severe.

Urban myth is fuel to the hypochondriac's fire. In reality there are probably only about three cases where someone went to the doctor with a headache, were told it was nothing and then dropped dead three weeks later. But this phenomenon seems to happen constantly. No one says at a dinner party: "My neighbour went to the doctor with a strange lump and the doctor said it was nothing and, guess what, it turned out it was nothing" - unless they don't want to go to any more dinner parties.

Also people have experiences that make them believe that doctors habitually keep back the grim truth. "The doctor didn't say you had a brain tumour," protests Woody Allen's secretary in Hannah and her Sisters. "Of course not," retorts Woody, patron saint of hypochondriacs, "because the weaker ones will panic."

When being given the all clear after tests, hypochondriacs, according to Dr Salkovskyis, "will remember the time that the doctor pulled them aside and said, "No need to tell Aunty Jeanie that she only has a few weeks to live." They then reason that if the doctor lied to Aunty Jeanie, why not to them?"

The majority of us worry more than we need to, but this is natural, indeed part of our survival instinct. A little hypochondria, under control is not unhealthy. "People who don't worry at all," concludes Dr Salkovskyis firmly, "are mad."

PARADISE SYNDROME

The latest hypochondriac to come out of the closet is rock star Dave Stewart. He admits to having had his appendix out for no reason in Bangkok; to forcing film director Mike Nichols to rush him to hospital when he felt a little off colour in New York and to mistaking a strained muscle for a heart attack. Stewart labels his condition as "Paradise Syndrome". It's because his life is so good, he says. "There has to be a catch."

SELF DIAGNOSIS

A HYPOCHONDRIAC'S GUIDE TO SYMPTOMS:

Headache? Brain tumour.

Heartburn, tingling in fingers or

palpitations? Heart attack

Earache? Always meningitis

Pain in the side? Appendicitis

Excessive thirst? Diabetes

Joint pain? Arthritis

Tiredness/unusual scabs? Aids

Involuntary jerks? Motor Neurone

disease.

Back pain? Kidney failure