YOUR HEALTH Dr James Le Fanu: Hypochondriasis
Thursday, 29 November 2012

Dr James Le Fanu: 30 November

How to treat hypochondriasis, what to do about burning-foot syndrome and how to wish away warts

Written by Dr James Le Fanu
Some people are more preoccupied with the physical workings of their bodies than others. Beyond a certain point, this can take over their lives, resulting in hypochondriasis.

The hypochondriac, notes Harvard psychiatrist Dr Arthur Barsky, has an unrealistic concept of what it means to be ‘healthy’, thus entirely normal sensations – such as a gurgling stomach or missed heartbeat – are perceived as being ‘incompatible with health and therefore indicate they are sick’.

The misfortune of the modern hypochondriac is that family doctors tend to pass the buck, referring them to one specialist after another. Dr Christopher Bass, of Oxford’s John Radcliffe Hospital, describes one 54-year-old woman who, for 20 years, had attended 12 hospitals for her symptoms of abdominal and chest pains. She had had six barium meals, three barium enemas, four gastroscopies, three CT scans of the head, two CT scans of the abdomen and five spinal X-rays. Despite all this, Dr Bass reports ‘she dislikes doctors, claiming they have wrecked her life’.

And on that point she is right, as the failure to recognise and treat her hypochondriasis would have caused her much unnecessary physical and mental suffering. The most successful approach is undoubtedly cognitive therapy, as illustrated by a study conducted by psychiatrists at Oxford’s Warneford Hospital. ‘The central feature of hypochondriasis is tendency to misinterpret the significance of innocuous physical symptoms,’ they write in the British Journal of Psychiatry. During 16 sessions of therapy the patients learn to identify misinterpretations and replace them with a more realistic understanding of their significance. The results can only be described as astonishing; compared with a control group, the severity of their hypochondriasis, as confirmed by an independent assessor, fell by almost 75 per cent.

This week’s medical problem comes courtesy of a lady from Suffolk with ‘burning-foot syndrome’ caused by faulty functioning of the sensory nerves to her legs, otherwise known as peripheral neuropathy. The standard treatment with the drug amitriptyline gives her a crashing hangover the following day.

‘I am left with the choice of a reasonable night’s sleep followed by a zombie day or a very disturbed night followed by a pleasant day,’ she writes. What alternatives might there be? Two simple remedies that can mitigate the symptoms of burning-foot syndrome are to take a hot-water bottle, but filled with cold water, to bed at night, on which to rest the feet; also to apply a foot balm such as Nelsons Arnica Cooling Gel or Dermacool 1% Aqueous Cream.

For those who are very sensitive to the effects of amitriptyline, there is the option of a trial of gabapentin or carbamazepine, which are reputedly of value in this condition.

Power of belief

Many remedies for warts can only be described as quackery, such as: ‘The wart should be rubbed with a piece of buried meat.’ This might work, as warts are open to suggestion. If the person strongly believes, the wart will disappear. As Dr Christopher McKeown, a skin specialist from Louisiana, reports: ‘I have treated children who could not tolerate freezing liquid nitrogen, so I gave them a harmless substance to apply and told them it was a “very strong medicine”. It worked.’

Dr Nicholas Spanos, a psychologist from Ottawa, says ‘We tell patients to imagine warts shrinking, with tingling as they do so. Those with vivid imagery are more likely to lose the warts.’

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