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To describe the destructive effects of intense health anxiety to his young doctors in training at Columbia University Irving Medical Center in New York City, psychiatrist Brian Fallon likes to quote 19th-century English psychiatrist Henry Maudsley: “The sorrow which has no vent in tears may make other organs weep.”

That weeping from other parts of the body may come in the form of a headache that, in the mind of its sufferer, is flagging a brain tumor. It may be a rapid heartbeat a person wrongly interprets as a brewing heart attack. The fast beats may be driven by overwhelming, incapacitating anxiety.

Hal Rosenbluth, a businessman in the Philadelphia area, says he used to seek medical care for the slightest symptom. In his recent book Hypochondria, he describes chest pains, breathing difficulties, and vertigo that came on after he switched from a daily diabetes drug to a weekly one. He ended up going to the hospital by ambulance for blood tests, multiple electrocardiograms, a chest x-

ray, a cardiac catheterization, and an endoscopy, all of which were normal. Rosenbluth’s worries about glucose levels had led him to push for the new diabetes drug, and its side effects were responsible for many of his cardiac symptoms. His own extreme anxiety had induced doctors to order the extra care.

Recent medical research has shown that hypochondria is as much a real illness as depression and post-traumatic stress disorder.

Hypochondria can, in extreme cases, leave people unable to hold down a job or make it impossible for them to leave the house, cook meals, or care for themselves and their families. Recent medical research has shown that hypochondria is as much a real illness as depression and post-traumatic stress

This work, scientists hope, will convince doctors who believed the disorder was some kind of character flaw that their patients are truly ill—and in danger. A study published just last year showed that people with hypochondria have higher death rates than similar but nonafflicted people, and the leading nonnatural cause of death was suicide. It was relatively rare, but the heightened risk was clear.

The research has also shown that the condition is actually two syndromes. One is illness anxiety disorder, Fallon says, in which the general idea of a sickness prompts excessive fear and preoccupation. The second syndrome is somatic symptom disorder, in which people worry about actual symptoms—a rapid heartbeat, say, or high blood pressure. The leading psychiatry handbook, the Diagnostic and Statistical Manual of Mental Disorders, now uses these two more specific diagnoses. (When referring to aspects that both conditions have in common, I use the word “hypochondria,” which is widely used by doctors and many patients, or the phrase “intense health anxiety.”) In addition, a new feature of hypochondria has garnered attention: cyberchondria, in which people spend an inordinate amount of time on the web researching medical conditions they think they might be suffering from.

Studies have also pointed to more effective treatments. Short-term cognitive-behavioral therapy (CBT) provides people with techniques to more rigorously evaluate the causes of their concerns—particular physical responses, in the case of somatic symptom disorder, or general fears about contracting a disease, for illness anxiety—and quell their spiraling sense of terror. Antidepressant drugs also help. Dismissing a patient with comments such as “it’s all in your head,” however, only makes things worse.Estimates of hypochondria’s frequency range from as high as 8.5 percent to as low as 0.03 percent in medical settings. The COVID pandemic, which combined a real health scare with isolation and more time to ruminate, may have pushed the incidence up. In Australia, it jumped from 3.4 percent before the emergency to 21.1 percent during it.

The ancient Greeks thought hypochondria originated in a region of the body just under the rib cage that produced “black bile,” an ill-defined substance that caused a variety of physical ailments. Eventually, hypochondria came to be associated with the nervous system, and in the early 20th century Sigmund Freud termed it an “actual” neurosis. He tied it, as he did many things, to feelings of guilt and sexual repression. It wasn’t until the 1990s, after clinical treatment studies with talk therapy and drugs, that psychiatrists stopped linking hypochondria to guilt about sexual and aggressive feelings.

Despite the pain and anguish it causes, “for centuries, hypochondria was deemed a fashionable, even a desirable disorder,” perhaps as a sign of an intellectual, thoughtful disposition, according to hypochondria reference material from the Wellcome Collection.

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