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People whose sickness is that they think they are sick are, well, sick. Hypochondriasis, the medical term for hypochondria, is a medical condition with a concise definition in the USA, where these things are listed in a manual known as the DSM 5.

A person who has hypochondria may have an "illness anxiety disorder" or a Somatic symptom disorder. Someone with an illness anxiety disorder:

  • Is preoccupied with having or being diagnosed with a serious illness.
  • Has only mild symptoms, and is inappropriately concerned about their getting worse.
  • Has a high level of alarm about health.
  • Has been preoccupied with a particular illness for at least six months.
  • Either avoids diagnosis and treatment or is overly invested in diagnosis and treatment.
  • Doesn't have another mental health disorder that better explains behavior, such as body dysphoric disorder, depression, delusional disorder, obsessive-compulsive disorder, paranoid personality disorder, or generalized anxiety disorder.

People who have an illness anxiety disorder tend to be "picky" (they may describe it as "conscientious") about their treatment. They tend both to seek medical attention and to avoid actually getting treated. They often go from doctor to doctor until some doctor pronounces them with the illness they "need" to have. 

People who have a Somatic symptom disorder:

  • Aren't faking their symptoms. Their symptoms are real.
  • But allow their symptoms to interfere with their lives. This doesn't mean they don't need help with pain, shortness of breath, or mobility issues, just that they become confined by their symptoms unnecessarily.

Someone who has a Somatic symptom disorder is less likely to "need to be sick." They just are, and they develop a negative attitude about their lives, not without reason.

More people have Somatic symptom disorders than illness anxiety disorders. While both conditions are "in their heads," there probably are physical reasons someone can develop these conditions. People who have illness anxiety disorders often have a distinctive EEG (brain wave) pattern, with the P wave more "dispersed"  (greater distance between highs and lows) than normal. Since the antidepressant drugs known as selective serotonin reuptake inhibitors are helpful in many cases of "hypochondria," it's possible that there is some kind of neurochemical imbalance that causes illness anxiety disorder and Somatic symptom disorders, along with the obsessive compulsive disorder, body dysphoric disorder, Tourette's syndrome, anorexia nervosa, gambling disorder, impulse control disorder, or trichotillomania (hair pulling) that may go along with it. 

Also important in these disorders are kinship and culture. Some families ignore children except when they are sick. Children find ways to get attention by being sick, and these habits carry over into adulthood. Some jobs are lenient with sick leave and rehab programs. People who don't like their jobs find ways to use their sick leave. And in some relationships, people shirk their responsibilities by "greasing the skids" toward illness.

But the bottom line is, if you present yourself as sick all the time, one possibility is that you have a serious, treatable psychiatric illness. For effective treatment, it's essential that:

  • The person complaining of illness sticks with the same primary care provider. Going from doctor to doctor without ever getting treated just perpetuates the mental illness.
  • Illness can't be allowed as an excuse for withdrawing from work or social life. It may actually be difficult, but it is necessary to stay involved in activities that don't revolve around illness.
  • Psychotherapy can be helpful--as long as it doesn't create another illness to be used as an excuse for getting involved in life.

One of the ironies of illness anxiety disorders and Somatic symptom disorders is that "imaginary" illnesses have a way of becoming real, physical illnesses. People who depend on being sick to get their way often actually get sick. When you can't control how sick you are, your real adaptive skills have a chance to develop. There's nothing wrong with ruling out or ruling in illnesses that have a variety of symptoms, like Lyme disease or migraine, but whether they are "real" or not, the same life challenges loom. Either way, treatment is required. Illness can't ever be a reason to check out of living fully.

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