Picture this. You're nursing a nagging headache, feel nauseous and stress is like a monkey on your back. Maybe it's all due to an overload of work at the office. But then again, maybe not.
You want to know what your problem is but you don't really want to pick up the phone and make an appointment. Worse, make an appointment and then physically go to see the doc. In your current state of mind, all that seems too much of an effort.
You think of something simpler.
Like logging on to the internet. And before you can exhale, you are trawling through a pile of information on just about every medical condition known to man. You type in your symptoms and yikes! with a sinking feeling read on that it could be the sign of a brain tumour.
A brain tumour?
Suddenly, the room feels too hot, your palms are sweating and is that a fainting spell you are about to plummet into...?
You take a deep breath and type in more symptoms. Sweaty palms. Faint-headedness. Feeling hot ... Well, what do you know, you are being informed of another kind of illness ...
Welcome to the world of the cyberchondriac – or the hypochondriac perpetually online in pursuit of that the secret to the state of perfect health. He is constantly scouring for information to stay hale and hearty.
Why? Because he always suffers from imagined ill-health: if he has a migraine, he thinks it's probably due to a brain tumour.
If he has gas pains, he thinks he needs to call the ambulatory cardiac unit.
A Harris Poll conducted in 2002 reveals that 110 million adults in the USA go online checking on healthcare information, and a staggering 80 per cent of them are obsessive about it.
And psychologists in the UAE are claiming that cyberchondria has hit us too.
"Hypochondria is a very common condition here in the UAE, and although there are no definite studies conducted in relation to it, very many people definitely suffer from it," says Maya Fleifel Sidani, psychologist, Comprehensive Medical Center, Dubai.
"And now due to the easy access of information on the internet, the information which formerly people had to hunt for in books, libraries and from successive trips to doctors, is today so readily available (at the click of a mouse). Technology has made it easy for all of us to turn into cyberchrondriacs."
Cyberchondria occurs when people begin to interpret their symptoms and link them to a disease merely by reading about it on the net. They begin to be convinced that they are indeed suffering from the ailment.
This self-diagnosis has depressing consequences on their state of mind – it not only puts a damper on their outlook towards life, if taken too far, it also leads to needless despair, panic and an obssessive need to recheck every symptom again and again on the medical bulletin boards
on the net, without ever consulting a doctor.
So convinced are these cyberchondriacs of their illnesses that they eventually do go to a doctor and argue their case saying they have the correct information!
Log on to 'sickness'
There are any number sites you can log on to today which, depending on you you look at it, can help or hinder your search for the truth.
You just have to type in a few key words and the search engine will reveal several sites and chat rooms devoted to the specific complaint.
To check out the theory, I logged on to Google and typed in "medical symptoms".
Of the myriad sites that popped up, I logged on to "Medical Symptoms and Signs of Disease – Index". Up popped columns after columns of neat medical possibilities. Time to type in the symptoms – (in my case, a case of coughing that lasted for upto a week). Then I clicked on the 'diagnosis' box and waited for a few seconds to get the answer.
"Sjogren's syndrome – classically features a combination of dry eyes, dry mouth, and another disease of the connective tissues, most commonly rheumatoid arthritis," was the verdict.
Now that I think of it, I seem to be having those joint pains as well. The literature went on to state that while the cause of the syndrome remains unknown, there was no cure for it.
Easy enough to pass it off as 'quacknosis' (quack diagnosis) for someone with plenty of time to experiment with cyber info, but for the cyberchondriac, it can be a devastatingly depressing experience.
Not dissuading a hypochondriac from using the internet as the final diagnostic tool is a big problem. For him and his family. Maybe even for his friends.
Of course, searching the internet for medical information is not always a bad thing. There is plenty of good information available.
It's a rich resource to discover more about health updates, research findings, unusual or rare diseases and their case studies; in fact, if approached sensibly, the internet is an invaluable tool for seeking information of any kind.
Although there are no statistics to support the facts, local medical professionals say that a large percentage of the people in the UAE turn to the internet seeking information on medical conditions, mainly because seeking the same information from professionals involves high costs.
Other reasons could be a deep fear to see a medical professional, pure curiosity or simply to see if they can get information at the click of a button.
But don't confuse a healthy net search for medical information with cyberchondria. Just because you log on to the net for information on how to combat the common flu more than once or want to check on the more embarrassing symptoms you may have, you don't have to start doubting your intentions.
Hardcore cyberchondriacs have a history of hypochondriacs in the family or are influenced by the environment, say experts. "Many people are victims of pathological internet use (PIU) syndrome or cyber addiction. Like hypochondriacs constantly imagining they have various illnesses, cyberchondriacs or victims of internet printout syndrome declare themselves outrageously sick after reading material on the Web," says Sidani.
"The internet is a great resource, but it leads people in many directions, some of which are good and some bad. For people who suffer from health fears, it can offer nightmarish scenarios. They type in a symptom and up comes the answer that points to many disease possibilities. You learn about more horrors. You go into a chat room and throw out your symptoms and people say you have lupus."
"People choose to self-diagnose for reassurance and control. But often reassurance is not enough for people who suffer from serious health anxiety. People who invest a lot of energy and time in medical research have underlying conditions of anxiety, obsessive compulsive disorder (OCD) or depression," adds Sidani.
The numerous chat rooms can also be very distressing for people with anxiety because it may suggest many disorders. "During chatting [on the internet] people start reporting symptoms they are experiencing and the associated diagnosis. So for anxious people, they might believe that they have the same disease as the participants if they are experiencing any of the symptoms mentioned, and this can be especially harrowing," says Sidani.
"Being a cyberchondriac might seem harmless enough at the beginning, but sufferers know it can shift from a quirky, neurotic character trait into a devastating obsession. Illness becomes a central part of the cyberchondriac's identity. They become disconnected with their families, they will stop everything in their lives to give in to the itchy sensation in their fingers to surf – just one last time – searching for answers. But sadly, with cyberchondriacs, as it is with hypochondriacs, that one last time never is the last."
"It's a vicious cycle," says Sidani, "Cyberchondriacs go on in life searching for answers to what might be a really trivial or imagined ailment."
As with hypochondria, cyberchondria is obsessive, compulsive and a disorder. This combination can practically ruin the individual's life as well as those of affected individuals' families, say doctors.
"With a cyberchondriac, the need to log on to the Internet right now is so powerful that they just cannot help it," says Sidani. And armed with all the information finds on the internet, he would often imagine that his common cold could be HIV, for instance.
Then he would seek for confirmation consulting doctor after doctor, requesting for all the possible tests, as though wanting to confirm his worst fears.
"As with any anxiety-related illness, cyberchondraics too just cannot relax. They complain about the stress the condition causes them, but at the same time, revel in that stress. In simple terms, they just don't want to relax, because they have the deep-rooted fear that if they did, they would lose the edge and will not be ready for 'it' when the 'catastrophe' strikes," explains Sidani.
Treating a cyberchondriac
In most cases, once doctors diagnose a case of cyberchondria in someone, he or she is recommended to see a psychologist, say the doctors.
As with any behavioural condition, treating a cyberchondriac is certainly no easy task. And the need to use the internet as part of daily routine – whether it's at work or for studying – doesn't help either.
"But cyberchondriacs have to be treated – and treated early on," says Sidani.
"We use cognitive-behavioural treatment, sometimes combined with medication for this condition. During the treatment, the patient registers the thoughts that go through his mind when he notices his physical symptoms."
"Hypochondriacs often choose the most serious, but often least probable, explanation. For instance, his headache is not migraine or stress but a brain tumour; chest pains are not caused by tense muscles but it is a heart attack coming on."
"These thoughts are then discussed and alternative explanations tested out. Often patients with hypochondria have beliefs like – 'It is normal to feel completely well all the time – a physical symptom is a sign that something is seriously wrong with my body'," says Sidani.
Going step by step
The first step for the patient then becomes recognising that his anxiety is not normal. But realising that you're blowing things out of proportion alone doesn't do the trick, and that's where the cognitive treatment comes into play.
"The cognitive treatment helps the patient to identify thought distortions and process them," says Sidani, "and this is often the difficult part."
"The treatment includes homework assignments which might be behavioural, like less checking of the body, limiting the use of the internet, or cognitive work like registration of situations, thoughts, feelings and behaviour, in which context did the anxious thought occur what event did triggered it, how did you interpret the event, and how much was your interpretation valid, what did you do about it, etc."
"The client is requested to evaluate his level of anxiety before processing these details and after," says Sidani.
Going through a series of stress relief techniques is equally important to tackle the situation. "Stress relief or relaxation techniques teach the person to get over his anxiety," says Sidani.
"And these effective techniques can take the shape of physical or mental exercises like Progressive Muscle Response (breathing, stretching and relaxing the muscles) or visualisation technique (breathing and mental visualisation) or thought stopping (a cognitive technique that works on the thought to help the person control his obsessive or negative thoughts), which all help in the way of limiting use of the internet and getting over his obsession of being sick."
Six million Americans seek online medical advice every day
A recent report in the medical journal, Vital Decisions, says that about six million Americans go online for medical advice on a typical day.
This means that in the US, more people go online for medical advice on any given day than visit health professionals.
"Cyberchondriacs want to know they are sick and sometimes argue with the doctor, trying to convince him or her that they have the same diagnosis as the one they presume," says Dr Rajini Ashok, specialist in internal medicine, at Zulekha Hospitals, Sharjah.
"They tend to gather information of illnesses from the internet and extend it to themselves, convinced that a minor chest pain indicates an onset of a heart attack. Since each disease can have multiple symptoms and since symptoms can overlap in different diseases, patients often have several doubts and questions.
"Some of the most common problems cyberchondriacs seem to latch on to in this part of the world are imagined tumours caused by headaches, heart attacks caused by minor chest pains, and more recently the bird flu. Most cyberchondriacs insist on check-ups at least once a month even if they are completely healthy," adds Dr Ashok.
"A doctor should not be hostile if she (or he) is questioned, and should understand the situation from the patient's point of view," she adds.
"Every patient has a right to know about his health and disease. However, if the patient is repeatedly counterchecking the doctor's views, the patient is the ultimate loser. For where there is no faith, there is no cure."
"Cyberchondriacs are easy to spot with their incessant quest for the worst and their questions of 'but I read this on the net' statements. Doctors have to treat these queries carefully and it is the duty of the doctor to guide them along the right track – and ask them to consult a psychologist in the eventuality that they are diagnosed as cyberchondraic."
"Used properly, the internet is a positive tool. Often, a lot of my patients would go on to the net to find out more about symptoms they are embarrassed to discuss with their doctors. But sometimes, it just makes matters worse."
But the trouble begins when the information seekers step a tad bit too far, believing almost everything the Net has to offer.
"For instance, it's very easy for a cyberchondriac to believe he has diseases with common or ambiguous symptoms that are hard to diagnose," says Sidani.
"For example, illnesses such as HIV or lupus and neurological disorders including multiple sclerosis can cause vague symptoms like fatigue, swollen glands and strange physical sensations. With symptoms such as these, it's easy for cyberchondriacs to convince themselves they are sick," she says.
But let's not paint the benefits of technology so black. Thanks to it, "most patients are much better informed than they used to be.
Sometimes it makes it easier for the doctor," says Dr Ashok. "The internet is a great source of information, but the flip side of the coin is, it doesn't teach you how to interpret the facts it provides."
"Most of the online medical sites use simplified language for the layperson to understand and in turn, that ironically, makes it much more stark and scary for the web surfer," she says. "There's no real answer to (this problem), except to create more awareness."
"It is also important for the medical profession to collaborate with schools and universities to educate the younger generation on cyberchondria as a condition to be taken seriously."
So whether you think your week-long cough is just a result of a change in the weather or it is indeed Sjogren's syndrome, don't make up your mind so fast. Instead, make an appointment with your doctor.