When illness is imaginary, it's a different case

By Shari Roan
Los Angeles Times

Psychosomatic illnesses shouldn't be confused with imagined conditions. Helping people who imagine or fake illness is more complicated than treating psychosomatic illness, said Dr. Marc Feldman, a nationally known expert in psychosomatic medicine.

"We're probably more advanced right now in understanding the brain-body connection," he said. "But when you talk about the mind and the role of fantasy, we're a long way off."

Hypochondria can be especially vexing to treat. Studies show that about 9 percent of people who seek care at medical offices are "card-carrying" hypochondriacs, as Feldman puts it. They complain of pain and vague symptoms, but doctors can't find any cause. Unexplained medical conditions account for about $20 billion in healthcare costs in the United States each year, he said.

"These people are not psychotic," he said. "They are just illness-obsessed."

Because the patient is convinced of being sick, it can be difficult for doctors to distinguish an imagined from a real illness. Even when every biological cause is ruled out, patients often reject the idea that they are imagining their ailments.

"It's enormously hard to treat hypochondriasis," Feldman said, because "these patients aren't deliberately deceiving the doctor. They believe what they're saying."

No one understands what causes hypochondria, but research suggests these people are more sensitive to normal body sensations and more preoccupied with their health.

People with so-called factitious disorders, however, are fakers. They include malingerers, who make up illnesses for gain (such as to collect disability payments), and those with the psychiatric disorder Munchausen's syndrome, in which people make themselves or a loved one ill (such as by poisoning) to get attention. Treatment of Munchausen's requires intense psychiatric therapy.

Hypochondriacs sometimes can be treated successfully with therapy and brief regular visits to a physician, Feldman said. Therapy can help uncover faulty ideas, such as, "if my head aches, I must have a brain tumor." Regular visits to the doctor, meanwhile, can assure patients that any physical problem will be discovered.

Feldman said he also has learned to embrace "innocuous" alternative therapies such as herbs, because people sometimes feel better if they believe a treatment is working — a basic tenet of mind-body medicine.