Hypochondria and the medical profession

[karimcha]

Hi there,

 

Can one with hypochondria go to med school?

[medaholic]

Yes you would be able to. In fact, a lot of medical students suffer from hypochondia too. It's just called "medical student syndrome"

 

The NYTimes had an interesting article on cyberchondria today that you might be interested in reading

[The Law]

I think it would be a great idea to talk to a doctor about this issue. It's really easy for hypochondria to begin to develop into more issues. I definitely think you can overcome this though and become a physician.

[0T6]

I wrote a paper for my psych rotation on just this. Here it is:

 

Fatigue? Sometimes. Weakness and tingling? There was that one time 3 months ago. Tremor? The other day, post-call. Optic neuritis? Blurry vision if I haven’t slept in 48 hours. I must have multiple sclerosis!

This happens countless numbers of times to students studying medicine – we learn about a disease and we’re convinced we must have it. Does this make most medical students hypochondriacs? Does the intensity of medical training increase the likelihood of hypochondriasis?

Hypochondriasis is a psychiatric disorder where patients are preoccupied that they have a certain medical condition based on the misinterpretation of symptoms. This preoccupation is refractory to medical consultation and investigation, causes functional impairment, and continues for greater than 6 months [1]. As most medical students can attest to – thoughts of being stricken by a rare disease do occur, but are often fleeting and don’t impair function. In fact, of medical students referred to psychiatry because of their fears, a diagnosis of hypochondriasis was only made in 1% of cases [2], less than the prevalence in the general population (4-9%) [3].

With such a questionable diagnosis in such a specific population, the research available isn’t abundant, but it is present. The first studies into hypochondriasis in medical students dates back to the 1960s and suggested that about 70% of medical students develop unreasonable fears about medical illness [4]. Hunter suggests this anxiety might be due to the fact that for the first time in their lives, medical students are encouraged to obsess about medical diseases, and indeed to master them. Reading about diseases and seeing patients with those diseases may lead to displacement [5], where a medical student sees the possibility that maybe they too have that disease. This phenomenon is seen commonly in doctors who become new parents – they may think their child has a rare disease they saw in a child during their training. The prevalence of medical concerns does decrease over the course of medical training, suggesting that students lose their anxious reactions over time [6].

An interesting correlate to medical student hypochondriasis is the possibility that the intensity of medical education may predispose students to minor depression and anxiety, leading to excessive worry about their health. Sleep deprivation is often seen as a badge of honour in medical school – a sign of commitment to the profession and to patients. Insomnia, night time arousal, less than 7 hours of sleep, and daytime sleepiness are all common in medical students and have been shown to be linked to minor psychiatric disorders with a risk ratio of 4.5 [7]. While this is impressive, the results need to be looked at with some skepticism as the investigators did not comment on the fact that sleep disturbances are often manifestations of underlying psychiatric illness – forcing us to ask if it was the chicken or the egg that came first. Future studies may want to compare sleep prior to admission into medical school, and during medical school, and correlation to mental illness.

While medical students often have unfounded fears about their health, these are often short-lived and lead to no significant impairment. This review of relevant literature was interesting, but more importantly, relieving, as it settled my concerns about being a hypochondriac.

 

References

1. Diagnostic and statistical manual of mental disorders (fourth edition). Washington: American Psychiatric Association. 1994.

2. Howes, OD. Health anxiety in medical students. Lancet. 1998; 351(9112):1332

3. Psychiatry – Current Clinical Strategies. Hahn, Rhoda K. Current Clinic Strategies Publishing. 2006.

4. Hunter, RCA., Lohrenz JG., Schwartzman AE. Nosophobia and hypochonrdiasis in medical students. The Journal of Nervous and Mental Disease. 1964;130:147-152

5. La Cour, P. Psychological Defenses of Danish Medical Students. The Journal of Nervous and Mental Disease. 2002; 190(1):22-26

6. Kellner, R., Wiggins RG., Pathak D. Hypochondriacal fears and beliefs in medical and law students. 1985; 43(5).

7. Hidalgo, MP., Caumo, W. Sleep disturbances associated with minor psychiatric disorders in medical students. Neurological science. 2002; 22:35-39

[Zygor]

From what I hear, it happens a lot in Psychology programs(understandably), considering you research Psychopathology with symptoms capable of broad interpretation.