In a new study published in JAMA Network Open, a team of scientists have discovered that individuals diagnosed with hypochondriasis, commonly known as health anxiety disorder, face a significantly higher risk of death compared to those without the condition. This study, the first of its kind, indicates an increased likelihood of both natural and unnatural causes of death, particularly suicide, among so-called “hypochondriacs.”
The study was motivated by the challenges and complexities surrounding hypochondriasis. Characterized by an excessive preoccupation with having one or more serious illnesses, this condition often leads to a catastrophic interpretation of bodily symptoms, resulting in excessive health-related anxiety.
Despite its prevalence, hypochondriasis is frequently underdiagnosed. Many health professionals either overlook or misunderstand the condition, and the stigma attached to the diagnosis further complicates recognition and treatment. The researchers embarked on this study to shed light on the real-world implications of hypochondriasis, particularly its impact on mortality rates, a largely unexplored aspect until now.
“There was a clear gap in the literature,” explained study author David Mataix-Cols, a professor at the Centre for Psychiatric Research at Karolinska Institutet. “While the risk of death amongst psychiatric patients in general is well known, there were no previous studies in hypochondriasis. Some old studies had even suggested that the risk of suicide may be lower in individuals with hypochondriasis, compared to unaffected individuals, as they have no desire to die. Our hunch, based on clinical experience, was that this would be incorrect.”
The study was conducted in Sweden, where researchers harnessed the power of several national registers to compile a comprehensive dataset. They identified 13,534,945 individuals living in Sweden from January 1, 1997, to December 31, 2020. From this pool, 4,129 individuals diagnosed with hypochondriasis were matched with 41,290 individuals without the condition. The matching was based on sex, birth year, and county of residence at the time of diagnosis.
This methodical approach allowed the researchers to compare the mortality rates of those with hypochondriasis to those without, accounting for factors like age and geographic location. Crucial information, including sociodemographic data, medical diagnoses, and death records, was meticulously extracted from these registers. The researchers followed the individuals in the study until death, emigration from Sweden, or the study’s end in 2020, whichever came first.
The researchers found that individuals with hypochondriasis had an 84% higher risk of dying from any cause compared to those without the disorder. This increased risk extended to both natural causes, such as diseases of the circulatory system, and unnatural causes, particularly suicide. The study also found that individuals with hypochondriasis tended to die at a younger age (average 70 years) compared to those without the condition (average 75 years).
“Despite their pervasive fears of illness and death and frequent medical consultations, individuals with hypochondriasis have an increased risk of death, both from natural and unnatural causes, compared to individuals from the general population,” Mataix-Cols told PsyPost. “Most deaths could be classified as preventable.”
Further insights emerged when considering psychiatric comorbidities. Many individuals with hypochondriasis had other psychiatric diagnoses, primarily anxiety-related and depressive disorders. When these comorbidities were factored into the analysis, the risk of death from suicide, while still elevated, was no longer statistically significant. This suggests that the risk of suicide may not be directly attributable to hypochondriasis alone.
“The results may surprise some readers who are not familiar with the disorder,” Mataix-Cols said. “Superficially, one might think that because they frequently consult with doctors, individuals with hypochondriasis may have lower risk of death. However, clinicians working with this patient group know that many individuals experience considerable suffering and hopelessness, which could explain the elevated risk of suicide we describe in the paper. Experiencing high levels of stress during many years is also known to be associated with increased risk of death.”
While this study offers vital insights, it also has its limitations. One significant issue is the underdiagnosis of hypochondriasis in Sweden, meaning that the study’s findings might only represent a fraction of the actual scenario. The researchers also acknowledged the absence of primary care data, which could have provided a more comprehensive understanding, as most people with hypochondriasis first seek help in primary care settings.
“Probably the main limitation is that the disorder is markedly underdiagnosed by clinicians, which means that despite having the entire population of Swedish cases, we are still missing quite a few,” Mataix-Cols said. “It is likely that our cohort includes the most severe cases, and the results should be interpreted in this light.”
Given these limitations, future research should focus on including data from primary care and exploring other potential factors influencing mortality in individuals with hypochondriasis. Studies could also benefit from a broader international scope to see if these findings hold true in different healthcare systems and cultural contexts.
“Taken together, these findings illustrate a paradox, whereby individuals with hypochondriasis have an increased risk of death despite their pervasive fears of illness and death. In this study, most deaths could be classified as potentially preventable. Dismissing these individuals’ somatic symptoms as imaginary may have dire consequences,” the researchers concluded in their study.
“More should be done to reduce stigma and improve detection, diagnosis, and appropriate integrated (ie, psychiatric and somatic) care for these individuals. Evidence-based psychological treatments for hypochondriasis exist and, in some countries, are even available as low- threshold, guided self-help via the internet, substantially increasing access to treatment. The hope is that increased detection and access to evidence-based treatment will reduce somatic morbidity, suicidality, and mortality in this group.”
The study, “All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis“, was authored by David Mataix-Cols, Kayoko Isomura, Anna Sidorchuk, Daniel Rautio, Volen Z. Ivanov, Christian Rück, Susanna Österman, Paul Lichtenstein, Henrik Larsson,Ralf Kuja-Halkola, Zheng Chang, Isabell Brickell, Erik Hedman-Lagerlöf, and Lorena Fernández de la Cruz.
