basis

This page considers 'cyberchondria', aka 'internet print out syndrome' or 'patient printout syndrome'.

It covers -

• introduction
• hypochondria
• before the net
• a media phenomenon?
• how many people
• studies

It supplements discussion elsewhere on this site regarding 'internet addiction', search behaviour, computer rage, anxiety and other aspects of life online.

     introduction

People have been imagining that they afflicted by medical disorders (or by demons and witches) for as long as there have been recorded accounts. Hypochondria thus has a long and fertile history, one that has enriched peddlers of potions, filled empty hours and provided the inspiration for authors such as Moliere (La Malade Imaginaire, 1673), Austen (Sanditon, 1817), Jerome (Three Men in A Boat, 1889) and Mann (Der Zauberberg, 1924).

With normalisation of the online population - and claims that the internet has particular authority or that 'everything is online' - it is unsurprising that people have come to trawl the net for information about ailments, real or imagined, and for treatments that range from the sensible (stay warm if you have the flu, seek professional advice if symptoms persist) to the cruel and bizarre (prune juice enemas as a 'cure' for AIDS).

That use of the net has been reflected in the emergence of 'cyberchondria', something that is both a media phenomenon - always good for a headline or press release - and area of attention by clinicians, sociologists and students of digital literacy.

Australian specialist Peter Yellowlees commented in 2000 that

Cyberchondria is a syndrome closely related to Internet addiction disorder that is also becoming increasingly common, and which occurs in anxious or hypochondriacal patients who start spending too much time chasing around the Web searching for information which may make them more anxious ... I can see no reason to define cyberchondria as a new form of psychiatric disorder, as it is simply a modern-day approach taken by those hypochondriacal patients who in the past have tended to read too many medical dictionaries.

     hypochondria

Characterisations of hypochondria (less pejoratively hypochondriasis) have varied considerably over past centuries. They are affected by an individual's role, for example as -

• an experienced or novice medical practitioner
• the exasperated parent of a teenager
• a peeved colleague who considers that a peer is malingering
• an advocate for an amorphous bundle of disorders such as Electrical Hypersensitivity Syndrome (EHS)

Classical medical literature conceptualised hypochondria as an imbalance of the humors or temperaments, something experienced by men as that gender's counterpart of hysteria. It has come to be seen as a psychological disorder, with hypochondriacs evincing a persistent, unrealistic preoccupation with the possibility of having a serious disease. Common sensations and appearances are frequently misinterpreted as abnormal, life threatening and attributes of pathologies such as Ebola virus, cancer, diabetes or MS.

Recognition of the disorder is apparent in a range of major diagnostic manuals. The fourth edition of the US Diagnostic & Statistical Manual of Mental Disorders (DSM-IV) for example indicates that an unfounded preoccupation with a non-existent must last at least six months and result in clinically significant impairment or distress. Criteria in the tenth revision of the International Classification of Diseases (ICD-10) merely require the presence of a persistent belief in at least one serious physical illness underlying the presenting symptom/s and persistent refusal to accept reassurance from several doctors that there is no physical illness.

Contemporary hypochondria has been dismissed as a problem of psychology, rather than physiology, with claims that hypochondriacs take refuge in supposed physical disorders because those disorders - however resistant to detection - are more acceptable than emotional problems. That acceptability encompasses the hypochondria and fellow sufferers: family, colleagues and society at large.

     a media phenomenon?

As with much online activity, cyberchondria has proved to be a rich field for exploitation by the mass media and by web metrics services, problematizing behaviour that would not receive much attention if conducted offline and using definitions that would be laughable if not accepted uncritically by publishers.

In 2001 for example the UK Observer and New Zealand Herald for example warned that 'Cyberchondria Sweeps The Internet' -

Like hypochondriacs constantly imagining they have various fatal illnesses, cyberchondriacs declare themselves outrageously sick after reading medical material on the Web. Because online drug stores bypass doctors to deliver drugs, medical professionals are beginning to take alarm at cyberchondriac behavior.

The Observer portrayed one cyberchondriac thus -

She tried to weep quietly, to avoid waking her husband. But inevitably, eventually, he heard and opened his eyes to see her in bed beside him, in tears. On the bedclothes was her laptop computer, its modem connected to the bedside telephone socket. It had started with tingling and numbness in her legs. For months she had searched the web in an attempt to find out what kind of disease she had. She ended up in a neurological chat room, and came to a devastating conclusion - she must have multiple sclerosis. "I was reading what other sufferers had posted there," she says now. "It sounded exactly like what I had. I was sure I was dying." Indeed, Melissa Woyechowsky was ill. Yet she was not manifesting the early symptoms of MS (exacerbated, she later came to think, by Lou Gehrig's disease and several other self-diagnosed maladies). Rather, she was suffering from something that was already far more advanced. At the age of 30 she was one of the world's first out-of-control cyberchondriacs.

... the internet was like rocket fuel to my hypochondria. "For 18 months it took over my life," she says. At her worst, she was spending five hours a day in multiple sclerosis chat rooms. Her heart was beating so rapidly she was afraid to drive. After several months, she didn't want to go out in public. "It just took off to the point where I wasn't functional. I would visit the same sites again and again. I was not collecting facts, I was sharing feelings."

...Three years on, after hefty doses of therapy and Prozac, she is free of health anxieties "most days." But elsewhere, cyberchondria is strengthening its grip.

In 2007 US pollster Harris echoed past media releases with an announcement that the number of 'cyberchondriacs' seeking health information on the web had "soared" to about 160 million in 2006, supposedly a 37% rise over the preceding two years. Harris claimed that

Cyberchondriacs now represent 84 per cent of all online adults, up from last year's 80 per cent, and 72 per cent in 2005. The reasons for this increase are that the total number of Internet users has increased somewhat and the per cent of people online who have looked for information has increased as well.

Drawing on a US telephone poll of 1,010 adults it claimed that 'cyberchondriacs' search the net "almost six times per month". In reality the count covers anyone who has ever gone online for health information, a categorisation so broad as to be of doubtful value. Would you class anyone who had ever looked at a book for health information - including at home or at school - as a hypochondriac?

Powell, Darvell & Gray's 2003 'The doctor, the patient and the world-wide web: how the internet is changing healthcare' (PDF) noted that there were

over 16 million active users of the world-wide web in the UK. This is more than the estimated number of UK smokers yet little has been done to assess the potential health impact of the internet. .... Clinicians need to understand the possibilities of this technology, and to be aware of potential threats to health. ...

The quality of internet information needs to be examined in the wider context of imperfect health information generally, and there is little reason to view the internet as radically different from other information sources. While there have been isolated case reports of individuals coming to harm from information on the internet, there is no systematic evidence that more harm arises from this
medium than from others.

     how many people?

How large is the population of cyberchondriacs? Are there substantial gender, age, geographical or other differences?

The answer is that no one knows. Uncertainty reflects disagreement about definitions. The Harris figures for example do not mesh neatly with the DSM or ICD categorisations and, broadly, do not appear to have gained much respect from diagnosticians. Merely looking at a health web page - or at a magazine article, encyclopedia, family health primer, leaflet from an advocacy group or television documentary - does not necessarily require classification of an individual as a hypochondria.

There is a substantial gap between measurement of audiences and identification of behaviour. There is a greater gap in attributing behaviour to exposure to particular media, with some cyberchondria enthusiasts confusing causation and correlation.

     studies

For introductions to the literature on hypochondria see Hypochondria: Woeful Imaginations (Berkeley: Uni of California Press 1988) by Susan Baur and Hypochondriasis: Modern Perspectives on an Ancient Malady (Oxford: Oxford Uni Press 2001) edited by Vladan Starcevic & Don Lipsitt. Questions about contemporary anxieties and the media are highlighted in The Culture Of Fear: Why Americans Are Afraid Of The Wrong Thing (New York: Perseus 2000) by Barry Glassner and Elaine Showalter's Hystories: Hysterical Epidemics and Modern Culture (New York: Columbia Uni Press 1997).

The postmodern turn is evident in Catherine Belling's 2006 'Hypochondriac Hermeneutics: Medicine and the Anxiety of Interpretation' in 25 Literature and Medicine 2 (376-401).

 
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