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Old 03-30-2005, 08:06 AM   #1
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rIcHrD HB User

Just to pick at a few agile minds and see what you think of this.

Hypochondriasis can be defined as: concern about own health, interest in own health, myriad of symptoms having no obvious commonality/similarity, worry, not being completely and entirely satisfied by the generic "there is nothing wrong with you" reassurance from a doctor and proceeding to seek other opinions, reading up about health problems, diagnoses and solutions.

Do you agree that the above definition could be applied to almost everyone with a CFS complaint or CFS-like experience in this forum and elsewhere? Would it not also apply more generally to everyone who posts on this forum or forums of healthboards with a complaint of some sort and interest in its aetiology? If so, then the answer is simple. If you fit most/all of the above profile, you are a hypochondriac and have no real problems.

Personally, I find the definition of hypochondriasis contentious, its existence presumptuous and its supposed manifestation too generalised to be useful. Surely almost all people who visit their GP more than once to arrive at a diagnosis/understanding of their problem is by definition a hypochondriac. Indeed, the status of hypochondriasis can only be lost by correct, specific diagnosis. Although I am not personally of the opinion that CFS is a psychosomatic illness (i.e. imagined), I think the following analysis illustrates the problem.

CFS is (unless you are fortunate enough to meet a skilled researching physician interested in your condition and truly believing your claims) by definition a diagnosis of exclusion. "I don't know what is wrong with you, and I have carried out a few routine tests and arrived at no statistically significant findings, therefore as far as I am concerned, you are physically well". A doctor arriving at such a conclusion will invariably diagnose CFS to all persons that have pushed their patience/interest. It is like "fine, you have CFS if that is what it takes to relieve me of this burden of your persistent questioning/visits" at a psychological level. Indeed, it is my opinion that CFS is too vague and generic to have applicability in clinical practice. The concept of a disease characterised by fatigue/tiredness is nonsensical to me. All bacterial and viral infections produce this experience, so do hormone disorders, neurodegeneration and even the (much loathed but nonetheless frequently considered) psychiatric disorders. Thus to be diagnosed with CFS would only be meaningful if all other possibilities had been rigorously considered and excluded. I have sincered doubts whether even one person exists that has been tested for every single possible cause of persistent fatigue, and thus think it unlikely that many or probably most people diagnosed with CFS are actually suffering from the same condition.

So to conclude, most CFS sufferers fit the definition of hypochondriasis, and as CFS is a diagnosis of exclusion, as well as hypochondriasis, it can be inferred that both diagnoses have equal weight. Further more, it logically can be extended to encompass many ill people who have yet to be diagnosed with a specific condition.

After all, who, if they felt ill would not show even the slightest concern/worry, seek help/advice over the issue, take interest in the cause of their experience, consider with an open mind an array of possibilities as to the cause of their experience (this means an array of possible illnesses in practice) and depending on the degree to which their experience disturbs them, have uncertainties about whether the statement "there is nothing physically wrong with you" is entirely correct. Yes I do realise there is a distinct problem with the subcategory of people who believe that most new experiences are symptoms of distinct and different life-threatening illness and who go on random searches on their body for anything that could in anyway be construed to be atypical. But I do not think this subcategory should be in anyway confused with the majority of those who fall into the main definition, who retain the distinct possibility that they are ill, are not hyperanxious and have concerns that have not been addressed but do affect their general life independent of whether they 'ignore it' or not.

Hope it's been an interesting read.

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Old 03-30-2005, 10:50 AM   #2
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Re: Hypochondriasis?

Yep, very interesting. Hypochondriasis eh? In the medical terminology used in GP surgeries, CFS is classified under 'Neurasthenia', which encompassing as it does lassitude, irritability, lack of concentration, worry and oh, hypochondria, seems to make more and more sense... to anyone who has not been diagnosed with CFS.

I have to say that I've never believed I have 'Chronic Fatigue Syndrome' and don't even believe that it exists as an illness. I think it's several as yet unidentified illnesses which are conviently grouped under the umbrella title of CFS. I know I'm not a hypochondriac as I have only seen my GP four times since I got ill - the first time a whole two months after it started as I thought it would 'go away'. I haven't seen my GP since November and have no plans in the near future to go back. The GP makes me feel like a hypochondriac-depressive patient and actually makes me feel quite a bit worse than I do on a regular basis. I leave her well alone now.

I don't believe that CFS would ever be meaningful, even if all possible tests were run. If every single test that you could possibly carry out on a patient (that includes psychiatric tests for depression etc.) and everything said the patient was "normal" then I would consider that patient to be a hypochondriac - i.e. not suffering with any disease. Whereas I believe most people grouped under "CFS" are actually ill - whether it be glandular fever/mono, hypothyroidism, sleep apnoea, depression and so on.

Working in a doctor's surgery, I see patients who would fall under the term hypochondriac. They see the doctor on a weekly basis. They make demands for sick notes when there's little more wrong with them than a sore throat. They pester the doctor for unnecessary referrals. On the whole, those with CFS get tired of listening to a silly doctor telling them it's all in their head and prescribing them antidepressants. They don't visit the doctor very often (and perhaps not at all after the first few consultations). This is the sign of someone who is ill - someone who's a hypochondriac wants attention, wants something to be wrong with them. CFS patients just want to be well again and give up on stupid doctors who offer no help.

Next Thursday I'm seeing a general physician. I haven't seen a doctor in a while and am not looking forward to it. I have to say if one more doctor tells me it's CFS without doing any bloodwork or other investigations, I'm going to give up with the medical profession. What use are they when they sit there shrugging their shoulders, calling us mental health cases just because they don't understand what's truly wrong?


Old 03-30-2005, 11:28 AM   #3
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rIcHrD HB User
Re: Hypochondriasis?

I guess maybe that's part of the difference I was trying, but could not think how to say. A 'true hypochondriac' is generally more interested in getting their illness acknowledged/declared non-severe, whereas the ill are generally more interested in getting better. I.e., giving a CFS suffer a name for their condition without any treatment is next to useless, because their complaint is that they feel unwell, not that "am I dying of so and so?".

What I find surprising is how difficult it seems for the person giving the hypochondriasis argument to consider the possibility (and likelihood) that much of what hypochondriasis is, could as well be a reaction to being unwell as to being psychologically unbalanced. It's like if a doctor (or indeed anybody) is entrained on such thought pattern, it is pointless to continue conversing.

I'm happy though that more and more doctors are suffering from CFS-like/non-specific conditions and enjoying the fun of knowing something isn't right, but being dismissed as a maniacal idiot. I sincerely hope that anyone (and if I had my way, everyone) with the ideology that hypochondriasis explains most such ailments suffers from a severe and debilitating form of CFS or the likes and is fobbed off at every single attempt they make to resolve/understand the issue. As evil as that is, that would bring a smile to my face, if only for the irony of it.

In the end, it does not matter whether indeed the cause of such conditions is psychological, or has a psychological component (like some subconscious process that's later elucidated). What matters is that it is not a matter of choice - i.e. unlike the persistent complainer at the GP with the monthly sorethroat, the sufferer doesnt choose to be unwell, or choose to exaggerate their experience, or exploit their mild ailment for all its benefits, or demand the sympathy of the world for their experience, or try and exaggerate it by focusing their attention on it, it affects them and they cannot help it.

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