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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 25  |  Issue : 1  |  Page : 63-66

Cyberchondria: Technology-mediated expression of hypochondriasis


1 Department of Clinical Psychology, SHUT Clinic (Service for Healthy Use of Technology), National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
3 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Submission01-May-2020
Date of Decision31-May-2020
Date of Acceptance12-Jul-2020
Date of Web Publication7-Oct-2020

Correspondence Address:
Manoj Kumar Sharma
Department of Clinical Psychology, SHUT Clinic (Service for Healthy Use of Technology), National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmhhb.jmhhb_35_20

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  Abstract 


Cyberchondria involves excessive indulgence in online health-related platforms for information. This trend becomes more due to the presence of easy access to Internet and availability of health portals. A 34-year-old male presented with the complaints of pricking and spasm-like sensation in his throat and fear of developing cancer of the mouth or throat for the past year and excessive use of Internet. The case was assessed using clinical interview and Cyberchondria Severity Scale. It revealed the presence of excessiveness, distress, and reassurance related to online health research. These characteristics are being seen in cases with hypochondriasis. The case implies for screening and evolving psychoeducational approach to manage cyberchondria.

Keywords: Anxiety, cyberchondria, hypochondriasis, Internet


How to cite this article:
Thakur PC, Sharma MK, Chaturvedi SK, Ganjekar S, Anand N, Jha A, Mondal I, Singh P, Ajith S J. Cyberchondria: Technology-mediated expression of hypochondriasis. J Mental Health Hum Behav 2020;25:63-6

How to cite this URL:
Thakur PC, Sharma MK, Chaturvedi SK, Ganjekar S, Anand N, Jha A, Mondal I, Singh P, Ajith S J. Cyberchondria: Technology-mediated expression of hypochondriasis. J Mental Health Hum Behav [serial online] 2020 [cited 2020 Oct 29];25:63-6. Available from: https://www.jmhhb.org/text.asp?2020/25/1/63/297418




  Introduction Top


In the past two decades, all types of information from every domain are available to us over the Internet. As a result of this, nowadays, more and more people are turning toward the Internet for health-related queries. More than 75% of participants make use of the Internet for health-related searches among the 12,000 participants from around 12 countries.[1] Thus, this phenomenon of online health research (OHR) is on the rise worldwide.

There can be several reasons due to which Internet has become such a widespread medium to seek medical information. It is easy and quickly accessible, cost-effective, less laborious and prevents one from the harassment of administrative hurdles in health-care centers. It is also an anonymous process and gives people a sense of empowerment. OHR can have positive implications such as promoting healthy eating habits, exercise, and improved adherence to medication among the public.[2] However, such practice can impose a challenge as well with the possibilities of self-diagnoses by laypersons, quality, and trustworthiness of source of information being unchecked by the searchers. This also involves reliable risk factors for heightened anxiety regarding subjective health status.[3] The harmful pattern which involves increased anxiety regarding health and repeated health-related searches subsequent to that, have been deemed a problematic Internet behavior- Cyberchondria. Cyberchondria encompasses a range of behaviors, beginning with a solitary activity performed with the purpose of arriving at a diagnosis and may gradually involve other Internet users via forums and chat rooms to confirm (or disconfirm) a diagnosis or seek support and advice from them. In addition, they may consult various other websites. These include websites that provide information and support to people who have already been diagnosed with certain illnesses and those that provide a range of possible diagnoses for specific symptoms.[2]

Researches in the Indian context reported that the prevalence of cyberchondria was 55.6% and the dominant pattern was excessiveness of online searching, requirement of reassurance followed by distress due to health anxiety, and compulsivity.[4] The case consulted tertiary specialty clinic is going to provide a greater understanding and clarity about the evolving phenomenon of cyberchondria.


  Case Report Top


Mr X. is a 34-year-old male, graduate, married, belonging from middle socioeconomic status, and working as a government schoolteacher. He presented in the psychiatric department of our hospital with complaints of pricking and spasm-like sensation in his throat and fear of developing cancer of the mouth or throat for the past year and was admitted as inpatient for further investigations. Due to this complaint, he had consulted around 26 ear-nose-throat (ENT) surgeons and 6 psychiatrists across the country; had undergone multiple Ultrasound Sonography (USG) of the neck, computed tomography/magnetic resonance imaging of the pharynx, 6–7 endoscopies; and had been on several different psychiatric and nonpsychiatric treatments since last year. However, he never stuck with an adequate trial of any treatment and was always lost to follow-up.

He reported beginning with nicotine use around 8 years back to cope with stressors of life (pressure to get a government job, break up of a romantic relationship, and legal dispute in the family). He also reported having anxiety-like symptoms (palpitations and trembling of hands) that time but did not take any psychiatric consultation for the same. Gradually, he developed a dependent pattern to nicotine and was diagnosed with oral submucosal fibrosis by an ENT surgeon 4 years back and was advised to quit tobacco as it was a precancerous condition. Subsequent to that, he reduced the amount of tobacco intake. In the beginning of last year, he had prolonged cold with a dry cough which was not resolving on medication. Along with that, he started to feel pricking sensation in his throat and steadily, these sensations became varied – sometimes he would feel spasms and sometimes as if a sharp blade was cutting through the muscles of the neck. These were sudden in onset, gradually progressive, and continuous. These sensations would keep him preoccupied all day long and he started to believe that he had developed cancer. The sensations would be relieved by rubbing his fingers over the skin of the throat, counting religious beads, and rubbing tobacco leaves against his palm. Due to this problem, he was irritable and had sleepless nights and he could not concentrate at work and had impaired socio-occupational functioning. He would cry often and tell family members that he would die soon. His family members initially showed concern toward his difficulty; however, after repeated consultation and no report of improvement from the patient, the family started ignoring his problem and would not entertain his complaints. They got him married 4 months back, against his wish, assuming the marriage would disengage his mind from the health issues. Nonetheless, his problem continued along with the distress and visits to the doctors. The possible stressors he might be facing leading to the distress was his sister's marital discord, another break up of romantic relationship and marriage.

Despite normal reports of physical investigation, he was convinced that something cancerous was growing inside the throat and went to multiple cities for consulting various physicians. The treating team did preliminary physical examination which showed no swellings in the tracheal and thyroid region, no enlargement of lymph nodes and thyroid gland, and no jugular venous distention warranting for no further investigation. On the basis of this examination, his probable diagnose was kept as persistent delusional disorder to be clarified with further interviewing. He was also showing depressive symptoms, but due to lack of pervasiveness and persistence, it was on a subsyndromal level and did not meet the criteria for clinical depression. The possibility of a tentative diagnosis of hypochondriasis/illness anxiety disorder/pervasive delusional disorder was kept for the client. He was treated with selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors targeted for his anxiety symptoms. He became unhappy with the team as he did not receive any medication for the sensations and got himself discharged within 4 days of hospitalization against medical advice. Due to early discharge, the proper line of treatment and psychological interventions could not be followed. The voluntary premature discharge from the institute suggested the repetition of the pattern of changing doctors without adhering to the treatment regime indicating mistrust toward medical professionals.

He started OHR since 2019 post developing the sensations in the throat. When he consulted ENT specialist for the same, he was diagnosed with Globus Hystericus and to get more details about the condition, he began searching online. Then, he started reading more about cancer, felt the symptoms mentioned online for throat cancer are matching his condition and was frightened. He mentioned that despite being afraid, he felt compelled to read more about cancer-related article for no known reason. He admitted to have developed “Cancer Phobia” as a result of his excessive research on this condition. He used to spend almost 8–9 h minimum a day for cancer-related research and reports referring to inauthentic sources and websites for information. He firmly believed the self-diagnosis he made via online medium and alleged that the doctors are not able to accurately gauge his condition. However, when he got some relief from psychiatric medicine that was the first time he realized that his problem might have a psychogenic basis as well. Following this, the focus of his research shifted from diagnoses to treatment-related information.

His source for information seeking is mainly YouTube, wherein he watches videos of doctors giving lectures on conditions resembling his symptom. He revealed in the interview that through research, he gained information about his illness, its etiology (as explained by doctors in the video) as well as the clinical facility to be availed and where to visit for a consultation. He reported significant satisfaction from the explanation given online and feels that he is able to reach out various doctors from several domains as per his convenience and can study about any disease/disorder he wants to know. It appeared that OHR not only influenced his diagnosis but also guided his treatment process. His usage of Internet remained around 7–8 h/day for seeking health-related information. The dysfunctions were seen in biological and psychosocial domains due to the increased use of technology.

In view of excessive health-related online research influencing his notions about treatment, cyberchondria severity scale-12 was administered on him and the result indicated that he had high scores on domains of excessiveness, distress, and reassurance related to online research, indicating that he might be having cyberchondria. Hence, by analyzing this case, it can be ascertained that cyberchondria appears as a manifestation of hypochondriasis where in the patients are involved in “Excessive” online research related to illness due to the feeling of empowerment and easy accessibility associated with it. Furthermore, reassurance seeking is one of the maintaining factors that motivates patients into this acitvity.

According to [Table 1], he met the main criteria for hypochondriasis and cyberchondria and the criteria for Persistent Delusional Disorder (PDD) were to be clarified.
Table 1: Criteria met/not met for the tentative diagnoses

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  Discussion Top


Although the possibility of hypochondriasis/illness anxiety disorder/PDD was kept, the case got the predominantly the characteristics of cyberchondria [Table 1]. His Internet use was associated with psychosocial dysfunctions. Similar findings were reported in the Indian context that the pattern of cyberchondria was dominated by excessiveness, followed by requirement for reassurance.[4] The other two components of distress and compulsion were less dominant. According to the cognitive-behavioral model of cyberchondria, health-related anxiety and hypochondriasis can be considered as one of the main vulnerability factors that triggers OHR and reassurance seeking (by searching for information available online) temporarily alleviates this anxiety, thereby maintaining this behavior in the longer run.[5] Other researches in this area also indicate that heath anxiety, self-esteem, obsessive-compulsive symptoms, and intolerance of uncertainty are associated with cyberchondria.[6],[7] Hence, the literature available in this realm seems to support the idea that cyberchondria can be an indicator of hypochondriasis or health-related illness that is highlighted by excessiveness of searches and reassurance-seeking behavior over an online platform.

In terms of implications, this case will be useful in having a better understanding of the important features of this upcoming concept that mental health professionals are still figuring out. This might also add up to the empirical evidence of repertoire of such cases, which are not great in number but still significant enough to take into consideration.

Declaration of patient consent

The authors certify that they have obtained patient consent form. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Poll H. Cyberchondriacs'on the Rise? Those who go Online for Healthcare Information Continues to Increase. Available from: http://www.harrisinteractive.com/vault/HI-Harris-Poll-Cyberchondriacs-2010-08-04.pdf. [Last accessed on 2020 Mar 12].  Back to cited text no. 1
    
2.
Starcevic V, Berle D. Cyberchondria: Towards a better understanding of excessive health-related Internet use. Expert Rev Neurother 2013;13:205-13.  Back to cited text no. 2
    
3.
McElroy E, Shevlin M. The development and initial validation of the cyberchondria severity scale (CSS). J Anxiety Disord 2014;28:259-65.  Back to cited text no. 3
    
4.
Makarla S, Gopichandran V, Tondare D. Prevalence and correlates of cyberchondria among professionals working in the information technology sector in Chennai, India: A cross-sectional study. J Postgrad Med 2019;65:87-92.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Bagaric B, Jokic-Begic N. Cyberchondria – Health anxiety related to internet searching. Socijalna Psihijatrija 2019;47:28-50.  Back to cited text no. 5
    
6.
Fergus TA. Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria: A replication and extension examining dimensions of each construct. J Affect Disord 2015;184:305-9.  Back to cited text no. 6
    
7.
Bajcar B, Babiak J. Self-esteem and cyberchondria: The mediation effects of health anxiety and obsessive–compulsive symptoms in a community sample. Current Psychology. 2019:1-2.  Back to cited text no. 7
    



 
 
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