How could it be that hypochondriacs have shorter lifespans?

“Dúirt mé leat go raibh mé breoite” is the epitaph on Spike Milligan’s grave in an English churchyard. The unexpected use of the Gaelic version of, “I told you I was ill” reportedly came about because the church authority baulked at the Irish comedian’s use of humour, leading to a neat linguistic sidestep by his family.

Milligan’s postmortem swipe at hypochondria reflected the stigma associated with the term until relatively recently. Defined as a psychological condition characterised by the persistent and unwarranted belief or fear that one has a serious illness, it had become a pejorative term both in and outside medicine.

Now, in an effort to move on from the previous baggage associated with hypochondria, the World Health Organisation prefers to use “health anxiety” to describe the phenomenon. And “illness anxiety disorder” (IAD) has become the accepted term in medicine.

While the figure of the hypochondriac in popular culture is a perfectly healthy person who is convinced they are sick, Caroline Crampton’s excellent book on the history of hypochondria, A Body Made of Glass, illustrates how health anxiety can coexist with real illness. Diagnosed with lymphoma as a teen, but successfully treated, she describes how: “I could never quite shake the anxiety that this could happen again, that a serious illness could be taking over my body without my knowing. As I got further away from being an active cancer patient, this hypervigilance and constant awareness of every little ache and twinge turned into health anxiety.”

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A recent Swedish study suggests that people who worry excessively about their health tend to die earlier than those who don’t. How could it be that hypochondriacs who, by definition, worry yet have nothing wrong with them, have shorter lifespans than the rest of us?

The Swedish researchers tracked about 42,000 people (of whom 1,000 had IAD) over 20 years. During that period, people with the disorder had an increased risk of death. Worriers died five years younger than those who worried less.

[ A Body Made of Glass: Unflinching interrogation of hypochondria ]

People with IAD dying of natural causes had increased mortality from cardiovascular and respiratory causes. But they did not have an increased mortality from cancer (which seems odd because cancer anxiety is an issue for many people with hypochondria). The principal cause of unnatural death in the IAD cohort was from suicide, with at least a fourfold increase over those without IAD.

Writing in The Conversation, Dr Stephen Hughes, senior lecturer in medicine at Anglia Ruskin University, attempts to explain this unusual association between illness anxiety and premature death. “IAD is known to have a strong association with psychiatric disorders. As suicide risk is increased by psychiatric illness, then this finding seems quite reasonable. If we add in the fact that people with IAD may feel stigmatised and dismissed, then it follows that this may contribute to anxiety and depression, leading ultimately to suicide in some cases,” Dr Hughes says.

However, the increased risk of death from natural causes is less easy to explain.

Dr Hughes points to the possible role of lifestyle factors: “Alcohol, smoking and drug use are more common in anxious people and those with a psychiatric disorder. It is known that such vices can limit one’s longevity and so they may contribute to the increased mortality from IAD.”

[ The anxiety hangover: Recovering from a panic attack takes time ]

While IAD is known to be more common in those who have had a family member with a serious illness, I’m afraid I find Dr Hughes’s explanation for this difficult to accept. “Since many serious illnesses have a genetic component, there may be good constitutional causes for this increase in mortality: lifespan is shortened by ‘faulty’ genes,” he writes.

While family doctors treat patients who have illness anxiety with a gently challenging tact and offer treatment with cognitive behavioural therapy (CBT), the Swedish study suggests a possible need for closer health monitoring.

The inescapable truth is that, in the absence of immortality, everyone with IAD is eventually proved right.