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Hypochondria - fear of illness
Hypochondriac sufferers are overly worrying that they are or may become seriously ill. You may not have any physical symptoms or believe that mild symptoms are signs of a serious illness, even if a thorough medical examination does not reveal any serious illnesses. Hypochondria is a reaction to various complaints and a common symptom of emotional stress.
hypochondriac are not simulants that deliberately fake an illness. They are also not psychosomatically ill, so they do not express physical pressure with them. Rather, those concerned deal with mental or physical illnesses so intensely that they restrict their own lives.
They revolve around health and illness throughout their lives without becoming permanent patients in psychiatry. Most hypochondriacs can function in everyday capitalist life, which gives a key to their disorder.
Sometimes people are frightened when they think of diseases that could affect them. We think of lung cancer when smoking or dream of having a heart attack. Such fears often arise from sudden pain. A woman's chest hurts, and she jerks through: "Breast cancer".
These fears disappear in most people, but hypochondriacs are constantly afraid of possible diseases.
Artists and doctors, generals and actors suffered from imaginary diseases. Charles Darwin was particularly famous as a hypochondriac among scientists. Since the first pregnancy of his wife Emma, the discoverer of evolution in nature has been ill.
One reason for this "being sick" probably lies in the contradiction between character and discovery. The theory of evolution turned the then Christian worldview upside down - a revolution of the spirit. But the conflict-shy scholar was anything but a revolutionary and was afraid of snubbing colleagues whom he valued with his theory. That is why he postponed the publication of natural selection for a long time.
His children also became hypochondriac by habit. Emma Darwin was the "nurse" of the family and was constantly looking after her protégés. One granddaughter wrote: "Everyone else (children) used poor health as an accepted method of ensuring the living care of the mother (later the wife - and men)."
The granddaughter explains a little mockingly: "Henrietta spent her whole life in defense against an illness that obviously never appeared, George worked under the constant strain of" attacked health ", Francis was clearly depressed, Leonard retired at forty-five due to undiagnosed health problems and only died at ninety-three. "
Explanations for hypochondria
The simplest explanation is that hypochondriacs convert social strains into images of diseases: the alienated factory work becomes a rampant tumor.
It's not that easy. Hypochondria suffer from very different people with diverse motives. Hypochondria is not only a question of medicine, but also of psychology, sociology, philosophy, literature and history.
Health care is an unconscious strategy to avoid stress.
A research approach considers “feeling sick” as an early childhood disorder. Accordingly, a child becomes a hypochondriac because it cannot integrate the conflicts between its needs, the wishes of the parents and the constraints of society.
Hypochondriacs are said to suffer from an overmother complex. Overprotective mothers therefore ensure that a small child does not learn to differentiate itself from others. The hypochondriac therefore grows up feeling that he cannot survive alone.
He feels dependent on a parent figure and at the same time existentially insecure. The child believes that it cannot be independent.
Circling around your own illnesses expresses the helplessness of feeling like someone that others have to take care of. The hypochondriac is not aware of this, mind you.
The dependent inner child in the body of an adult thinks that they cannot make their own decisions, and when they are pending, they feel sick. Being sick means that others care.
Being ill excuses helplessness and at the same time punishes the provider for depriving the child of age.
The hypochondriac projects like people with anxiety disorders. He suffers from feelings of addiction, anger and guilt and focuses on his body. In doing so, he denies his lack of self-respect.
He rationalizes his lack of independence. The disease is to blame, without which it would be autonomous.
Some doctors also suspect a neuronal cause of hypochondria. Hypochondriacs, who suffer from mania and psychosis at the same time, may be hypersensitive, which means that they are flooded with stimuli and their nervous system perceives stress stimuli more intensely than “normal” ones.
Sociologists assume that hypochondriacs are overwhelmed by social conditions. So they fail to adapt to a society that denies them psychological stability, developed identities and love.
So they are not sick in the clinical sense, but they cannot get well in the sense of finding their socio-psychological balance.
In an elbow society, where people with mental health problems are considered "wimps", they take refuge in physical ailments.
Many mental disorders are also products of their society. Whether hypochondriacs are sick depends on how society defines them as sick, and in capitalism sickness means uselessness tolerated.
In contrast to "healthy" unemployed people, if others take care of the sick, they are considered respected - but with reservations.
In the performance society, maturity means being mentally and physically on top. The patient is not despised, but he is not fully recognized either.
Illness thus appears, temporarily, as a time-out in which it is allowed to evade the obligation to work. However, the patient does not increase his success.
The hypochondriac adapts to society to the extent that he has a recognized reason not to utilize himself completely. It only breaks the rules of the system in that the point of rest in capitalism is to go back to work with full force afterwards.
With the hypochondriac, however, “signs of the disease” keep coming back. Although he narrowly escapes the accusation of being a lazy fool, he nevertheless draws the mistrust of the "creators". So hypochondriacs may be hidden rebels who maintain their own integrity.
Those who tackle stressful conditions aggressively wear out their strength and make themselves vulnerable. On the other hand, those who are sick remain “in reserve”, practice escapism and withdraw.
Those who suffer have different forms of expressing themselves. He can numb himself with drugs or break out in anger. However, anyone who is ill suffers without resolving the conflict openly.
He also maintains self-respect on the outside. Among neoliberal "winners" who admit neither weakness nor doubt, it is easier to say "I feel (physically) uncomfortable" than: "I am afraid." The disease says indirectly: "I am unhappy."
The message is clear, but without being able to pin down those affected. Everyone knows what is meant in the closest environment, namely "take care of me", but if the relatives said "take care of yourself", that would be connected with the guilty conscience of abandoning a sick person.
The hidden manipulation in western societies presumably promotes hypochondria. Authoritarian regimes with an open obligation to work, on the other hand, are more likely to trigger simulation in which people “play sick” but know that they are healthy.
The game runs in liberal capitalism: "We only want your best if you go to work." The counter-manipulation is: "I want to work, but unfortunately I'm sick."
The intermediate world
To see the hypochondriac as a simulator is still wrong. To tell the truth truthfully requires inner strength that most people who are not hypochondriacs do not have.
If hypochondria arises precisely from a child's dependence in conflict with society, this direct communication is impossible for him. He has just not taken a clear position to represent, but feels in an intermediate state.
A child who doesn't dare to go to school because older boys steal his pocket money probably says to his mother "I have a stomachache". This is not just shame, it is often not clear that the abdominal pain comes from the fact that the big boys are lurking.
Anyone who, as a hypochondriac, develops this discomfort into the structure of life no longer knows what he wants and what he rejects. Then he could say: "My problem is not an imaginary illness in my body, but my perceived dependency that I don't want to live that way, that I can't stand this work." If he could express it so clearly, he would no longer be a hypochondriac.
Most people sometimes practice similar strategies. If we are invited to a party but are no longer in close contact with the host, it is easier for us to say "I have a headache" than to say "I do not want to meet you". So much the better if we actually have complaints that give the rejection a real core.
But if our favorite band is playing, the headache would be a minor matter, and even with a full-blown cold we would rub ourselves with mint oil day and night rather than miss the concert. So there is a wide spectrum between lies and truth, and in this intermediate world the hypochondriac sets himself up unconsciously.
Lack of personal maturity and the inability to articulate problems offer disease as a perspective to express yourself. The more insecure a person is, the more he tries to express himself through body language. He expresses his needs indirectly, without running the risk of being rejected directly.
The headache can mean "I'm not going there with you today", the sleeping fits "you get on my nerves", the nausea "when you are there, I feel like ...". The "sick person" only takes responsibility for the part "I feel bad".
Hypochondriacs can also develop if the parents do not understand the instructions of the small child correctly. For example, if a child says "I'm lonely," and the mother says, "This is how many feel, don't act like that," then bedwetting or "being sick" at night may be the last way to articulate the need. If the child grows up not to be taken seriously with its clearly expressed needs, it stores this "being sick" to communicate, perhaps as an unconscious strategy, and the lonely child becomes a hypochondriac.
Hypochondria in children
Children often suffer from hypochondria or subconsciously use illness to communicate. Unexplained abdominal pain is the most common, followed by headache and chest pain.
Small children express themselves primarily in diffuse fears and rough attempts to manipulate the parents; Older children and teenagers, for example, complain of abdominal pain or chronic cough. Boys express their problems particularly in "accidents" or in delinquent behavior.
It is difficult to draw the line between whether a 13-year-old deliberately lay down on his bike before doing math and sprained his ankle or "really" had an accident, since the teenagers themselves are often unclear where this line runs.
Between 16 and 19 years, suddenly occurring illnesses are linked to panic attacks.
On the one hand, children show acute hypochondria in response to crises, for example when the grandmother dies, and on the other hand they develop chronic hypochondria.
There are also representative hypochondriacs, i.e. children in whom one of the parents suffers from hypochondria and believes that the child is suffering from a serious illness. The reason for this projection can be to find an excuse to ask for help yourself.
Some children of hypochondriacs become hypochondriacs themselves because they copy the behavior of their parents, because parents and children misinterpret medical information, or - as a system - to support an unstable family.
In parent-child relationships, hypochondria is often the result of an unexplained bond. The parent has an unconscious wish to keep the growing child as a child, that is, as a dependent, and the child unconsciously obeys this wish by becoming ill.
The parental threat is unspoken: "If you are not sick, then I do not love you."
New studies show that a sickly childhood promotes hypochondria, but it is unclear whether the impetus lies in the disease itself, the treatment or the constitution.
However, cases of hypochondria show the following profile: An adult who was often or chronically ill as a child, whom the parents therefore protected, and who spent a lot of time in clinics, gets used to being "sick" as a normal state, like other children outside play.
Such children develop a justified fear of getting sick, and at the same time they later have problems with situations in which nobody cares about them permanently - they have not trained this independence.
Visits to the doctor and helplessness therefore become familiar patterns that his unconscious will later produce when crises arise.
In addition, there are sometimes incorrect medical assessments due to a lack of education: children then feel existentially threatened because an illness has to be treated, regardless of whether the illness is really serious, and this feeling of extreme helplessness remains.
Childhood trauma can promote hypochondria. The pain in the intensive care unit then burns itself into the unconscious, and the person affected later even feels the pain deposited as a memory. The trauma forms as an unconscious pattern that the brain keeps recalling. As with other traumatized people, it is equally important whether the objective situation looks completely different.
Once children are sensitized to diseases, they take on the role of the sick very imaginatively.
Several factors come together: First, a child imitates a chronically ill parent who also has a distorted idea of illness, second, it learns how the disease game works and what advantages such as control or well-being bring, third, the imitation develops for the cultivation of Conflicts as a pattern of life. The child sees signs of illness clearly in others and interprets them inappropriately.
However, psychiatrist Esther Richards found that while hypochondriacal children learn from role models how to replace other difficulties with illness, these patterns can also be reversed if they are discovered early.
All but one of their 20 adolescent patients stopped their hypochondriacal behavior after therapy.
However, since hypochondria is a behavioral pattern that takes the place of open arguments and constructive handling of conflicts, it is not completely “curable”.
Hypochondria in families
Through ambiguities, hypochondriacs build a network of interdependent relationships. The disease is a substitute for deeper conflicts and at the same time a way to punish yourself, your partner and your relatives and at the same time to deny personal guilt.
The most complex form of hypochondria is hypochondria as a family system. One or more children are given the role of "sickly" and they take on this role.
In every family, everyone has to play a fixed role and keep them together, and consequently the "sickly" are not encouraged to overcome their intended "weakness".
It becomes dramatic for a child when one parent suffers from strong negative emotions, but hides them outside under a facade of excessive care. The “sick child” enables the parent to do both: on the one hand, the mother / father presents himself as particularly caring and, on the other hand, he can live out his addiction to control and control without restriction. The "sick" is the underage. It is like a caged animal that depends on the hand that feeds it.
Such parents often choose social professions, as therapists or carers, in which they essentially fulfill their narcissistic needs at the patient's expense. They make healthy people sick and sick people even sicker, so that they can then "care" for them. They greedily look for people in their circle of acquaintances who have an alcohol problem or are mentally unstable and push themselves into the role of the caring for mother / father.
An extreme case was a nurse who entered into a “love affair” with a patient with advanced muscle wasting who depended entirely on her as a partner. She strictly made sure that no drafts came into the room, the "partner" was given a macrobiotic diet that she prescribed, she reprimanded the other supervisors if they bought the "wrong food" or did not give him the scarf while walking in the park Tie "right". The abused home was a paradise for her control addiction, and even when she talked, she constantly discovered new "diseases" in the victim.
Children of such mothers are exposed to a double bind at puberty at the latest. The mother herself believes that she is doing the best for her “sick child” and cannot let go so as not to lose power.
Later she reproaches the young adult for being unemployed, but at the same time suggests that "you have to stay at home because you cannot live alone".
The child sees himself in the situation of not being able to make a decision based on his own will, because moving out or staying at home would mean fulfilling the mother's suggestions. When at the same time it learns that illness means relative psychological integrity before maternal abuse, the body reacts easily with somatic symptoms so that it does not choose one or the other. The mother-child conflict is therefore not resolved, but is held in a pending armistice by the "disease".
If the family suppresses child aggression, hypochondria appears to be a plausible strategy to deal with others.
Families in particular where disputes are not openly held are at risk of establishing hypochondria as a system. If the problems come to the table, the father withdraws with a headache, if the pubescent daughter wants to sleep with her boyfriend instead of at home, the mother gets cramps in the lower abdomen, and if the 16-year-old son wants to party with his friends, she gets it Mother has a fit of weakness and he urgently needs to go to the emergency pharmacy.
Such families often emphasize externally what kind of civilized culture they would have developed to deal with conflicts, for example the parents proudly say "we have never fought". The children sometimes hate this way of not dealing with conflicts, but learned early on to “control themselves”; they adopt this behavior and additionally hate each other for it.
For example, Beatrice grew up with parents who never argued loudly, but her father told her at fourteen that she and her brother were the only reason that the parents did not divorce. They still hadn't divorced twenty years later. Beatrice's brother was four years older than her, and the father lived his life through him.
Everything Stefan did was great. Stefan completed his Abitur with Ach and Krach, canceled several studies, the parents took out loans so that Prince Son could finance his life. Whenever Stefan had screened one of his grandiose projects again, the father believed in the "final victory".
Beatrice was in the shadow. Stefan didn't respect her limits, he stole her pocket money, when she had her own car, he drove it around without paying fuel, and when she suffered from bulimia in her puberty, the brother said "that would be a fad".
At 17 she had a boyfriend who looked after her very much. At school she was considered a fairy tale aunt because she always talked about primary school. Your friend listened to everything well. He was 20, had a car and wanted to take her to the nearby big city to the disco at the weekend. Once she came with her, but afterwards she suffered from mysterious sleep attacks. Whenever the decision was made to drive into the city at night, she got so tired that her boyfriend had to take her home, and the evening was over for him too.
Beatrice Freund played along for a few months, but he felt mysterious about the sleep attacks and suffered from feeling like a father putting his child to bed. An acquaintance, who also had iron deficiency, said that she sometimes felt weak, but did not have to go to bed with tablets at 9:00 p.m.
One evening, Beatrice had gone to bed "dead tired", her partner asked what was actually going on. She replied: "You see, now I am so weak that I have to sleep and put out the light." He switched on the light again and said: "If you have problems in our relationship, say that." She asked the lights out again and said, "It's nothing. I'm tired and have to sleep now. ”A week later she broke up and said:“ You didn't think about my iron deficiency anyway. ”
Hypochondria are not isolated in families. The symptoms of the hypochondriac usually interweave with at least one relative who takes on the role of the "nurse". At the latest in a love relationship outside the family, the partner must develop tactics that simultaneously keep and promote the symptoms of the hypochondriac - a relationship is not possible otherwise.
For example, a father moaned about his unsatisfactory position, and then he got sick and disappeared into his darkened room for a week.
His daughter copied this behavior in order to "buy" the protection of the mother and to escape unpleasant situations.
With the father, the strange exhaustion explained why he could not find a satisfactory job, and the daughter's "racing heart" assured her that she was not an independent woman only because of her illness.
This contradiction also applies to hypochondria in families. "Being sick" obviously disturbs family life, but it also stabilizes it. If the families are burdened with problems (and they are almost always, otherwise there would be no hypochondriacs), "playing ill" reduces these problems into a single feedback loop: sick and nursing.
Esther Richards found that hypochondriacs always had a chronic complainer with her parents and one who took over the role of doctor.
The benefits of hypochondria
Unlike most other mentally disturbed people, hypochondriacs have the advantage of not being rebellious or crazy, and they create the illusion of a loving family. The hypochondriac is the institution that holds the family together.
In a harmful way, hypochondria ensures survival as a family. Families with hypochondriacs attract little attention externally - in their social environment, at work, in the extended family. The excesses and breaks, the ascents and descents that families with borderliners or bipolar people are familiar with are missing. Everyone is silent.
Certain hypochondria may even serve a therapeutic purpose by channeling underlying psychological conflicts. This is particularly evident in patients with other mental disorders who use hypochondrial strategies: Martina, for example, is diagnosed as a border liner and suffers in every social environment because she regularly destroys friendships through her emotional outbursts. She grew up with an overprotective mother and a lonely father who beat her and her siblings softly.
After her outbursts of emotion, she "withdraws into her cave," as she says. During these periods of rest she discovers symptoms of illnesses on her body which, in her belief, indicate a deep meaning. A scratchy spot on the leg, a bump on the back of the head, or the "migraine" that always occurs when she is ashamed of her previous behavior. The "migraine" also depresses the father. When he had "migraines" in Martina's young age, he retreated to his room and needed absolute rest - for the children this meant a respite in which he did not strike.
In their families, hypochondriacs are by no means only the oppressed. As in SM relationships, they can force the other family members to take care of the "sick" and thus sit on the web as a spider. It is no coincidence that the SM scene loves the role play physician and patient.
For example, a hypochondriac wife obliges her husband to take care of material matters: he buys, he takes the children to school, and he fills out the tax return. Susanne, for example, is actually a teacher, but only her husband, Richard, has worked as a teacher for 25 years.
Susanne, on the other hand, has always puzzled, just like the doctors, what disease she is suffering from. A doctor once diagnosed a tendency to schizoidity, which was just an expression for "I am at a loss". Susanne fights her recurrent “outbreaks of disease” with adult education courses on therapeutic painting or spa stays on the North Sea.
She never became "healthy", but Richard and the two children took care of her at home. Her son and daughter are both now successful medical professionals. Richard is considered an old school teacher and the “good soul of the village”. The system works.
Relationships with hypochondriacs don't always have to be destructive, especially between hypochondriacs. The brothers Edmond and Jules de Goncourt, two successful writers, became famous in the 19th century. Her father died early and suffered war injuries, the two brothers lived in a kind of symbiosis in the same house all their lives. Both "suffered" from illnesses. Edmond was in pain in the stomach and Jules was chronically hurting the liver. Both saw their "illnesses" as a source of their creativity. If one of the two had become "healthy", this would have destroyed the symbiosis and thus the literary life's work.
In a relationship, hypochondria can be a highly effective tool to bind the partner. For example, if a woman is looking for a strong partner who takes care of her, but also needs a strong position in the relationship so that he does not leave her, it is unwise to negotiate directly.
The partner would probably say: "Now what, please decide." However, if she uses hypochondria as a strategy, she can get sick to indicate helplessness, but at the same time bind her husband to herself.
Hypochondriacs who suffer from their disorder are more likely to be helped than those who enjoy their symptoms.
First of all, the doctor has to recognize that he is dealing with a hypochondriac, i.e. see through the trick that the patient claims emotional as physical problems. However, since hypochondriacs usually see doctors who treat physical illnesses and not psychologists, the doctor may first think of an illness that he cannot diagnose and refer the hypochondriac to a specialist. The game repeats itself.
Or the doctor recognizes that there is no disease and considers the hypochondriac to be a simulator, which it is not.
Once hypochondria is identified, the doctor should first talk to the patient about physical, and then emotional and social problems.
He then tackles the invented symptoms and advises those affected to stop pondering which spot of the liver might be developing cancer or whether the buzzing in the ear is not a sign of an impending stroke.
Auto-suggestion and exercise help change the hypochondriac's focus.
If the hypochondrian's fantasies are not relieved, psychotherapy is necessary. In the United States alone there are over 50 different therapies to treat hypochondriacs, Freudian, systems theory, social psychology or design.
Behavioral therapy helps to get the symptoms under control. If hypochondriacs eat healthy, they improve their constitution and positively influence the biochemical balance in the central nervous system. Physically, they then feel less sick.
Body, soul and society belong together in hypochondria.
Viele Hypochonder milderten ihre Symptome, indem sie sich um wirklich Hilfsbedürftige kümmerten, um Suizidgefährdete, Arme und einsame Alte.
Das soziale Umfeld gehört zur Therapie: Empfängt der Betroffene Liebe und Anerkennung, ohne „krank“ zu sein? Kann er Zuneigung, Wut oder sexuelle Lust ausdrücken, ohne zurückgewiesen zu werden?
Ist das in der Familie nicht möglich, ist eine Familientherapie angesagt, oder sogar die Trennung von der Familie.
Verbessert sich die soziale und berufliche Umwelt, verlieren die Symptome ihren Sinn, ehrliche Handlungen können jetzt an die Stelle des Eskapismus treten.
Während Kinder und Jugendliche hypochondrisches Verhalten relativ schnell ändern, wenn sie es erkennen und Alternativen probieren, lassen sich erwachsene Hypochonder selten in Gänze heilen.
Mit Hilfe von Verhaltens- und Psychotherapie gewinnen sie jedoch erstens einen besseren Zugang zu ihren realen seelischen Problemen und gehen zum anderen den Alltag konstruktiver an.
Bisweilen zeigt sich der reflektierte Zugang zu den tiefer liegenden seelischen Konflikten darin, dass die körperlichen Symptome von innen nach außen wandern und sich abmildern: Eine Frau, die panische Angst vor Darm-, Uterus- oder Leberkrebs hatte, wandelte ihre befürchteten Krankheiten zum Beispiel in Gelenkschmerzen und Angst vor Arthritis.
Für alle anderen, die keine klinischen Hypochonder sind, aber gerne vorschieben, eine Erkältung zu haben oder unerklärliche Kopfschmerzen, weil sie sich nicht trauen, zu sagen: „Ich will nicht“, gilt: Aufrichtigkeit befreit, gibt innere Stärke, bringt Sicherheit und beruhigt. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Susan Baur: Die Welt der Hypochonder. Über die älteste Krankheit der Menschen. Zürich 1991
- Berufsverbände und Fachgesellschaften für Psychiatrie, Kinder- und Jugendpsychiatrie, Psychotherapie, Psychosomatik, Nervenheilkunde und Neurologie aus Deutschland und der Schweiz: Hypochonder sind keine Simulanten - Sie haben große Ängste (Abruf: 22.08.2019), neurologen-und-psychiater-im-netz.org
- Bunmi O. Olatunji, Brooke Y. Kauffman, Sari Meltzer, u.a.: Cognitive-behavioral therapy for hypochondriasis/health anxiety: A meta-analysis of treatment outcome and moderators Author links open overlay panel, Behaviour Research and Therapy, Volume 58, 2014, sciencedirect.com
- Berufsverband Deutscher Internisten e.V.: Hypochondrie (Abruf: 22.08.2019), internisten-im-netz.de
- Marion Sonnenmoser: Krankheitsangst: Keine Bagatelle, Deutsches Ärzteblatt, 2010, aerzteblatt.de
- Mayo Clinic: Illness anxiety disorder (Abruf: 22.08.2019), mayoclinic.org
ICD-Codes für diese Krankheit:F45, F92ICD-Codes sind international gültige Verschlüsselungen für medizinische Diagnosen. You can find yourself e.g. in doctor's letters or on disability certificates.