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The corona pandemic has made it clear that people deal with fear of the virus very differently: While some people meticulously monitor compliance with all protective measures and their own health out of fear of infection, others dismiss such behavior as "hypochondria".
The term does not mean general fears of illness, but a narrowly defined mental disorder with serious consequences for those affected - who, surprisingly, do not particularly suffer from the pandemic.
The clinical picture would have suggested this: People with the full picture of hypochondria are afraid of a serious, usually fatal disease.
Often these are fatal types of cancer, but also neurodegenerative diseases such as multiple sclerosis or dementia.
"So not every fear in the context of health is a symptom of hypochondria," explains Winfried Rief, Professor of Clinical Psychology and Psychotherapy at the University of Marburg.
Rather, hypochondria is characterized by the fact that a visit to the doctor, for example, only brings brief calming, adds Michael Witthöft, Professor of Clinical Psychology at the University of Mainz.
In this context he speaks of "pathological fears of illness", since the term hypochondria is heavily loaded.
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In fact, those affected are still often smiled at in public as plaintive or hysterical.
“Such stereotypes are extremely harmful because they drive people into isolation,” Rief points out.
“In view of the prejudices, the sick no longer talk about their fears.
This silence leads to them being completely caught up in those fears. "
For the psychologist, there is arrogance in the disdain for the clinical picture: “People pretend that hypochondriacs are different from other people.
Initially, it is a matter of completely normal psychological dynamics that contribute to functional life outside of hypochondria and are dysfunctional and exaggerated in certain places in hypochondria. "
There is a lack of public awareness that it is a serious illness.
“The fears of a hypochondriac are of an intensity that no one wants them to be, and not a small affluence quirk,” emphasizes Rief.
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Unlike other anxiety disorders, women and men are almost equally affected by hypochondria.
The main period of illness is often between the ages of 30 and 40, according to Michael Witthöft.
"In the middle phase of life, psychosocial stressors from work or starting a family often come together, which can lead to the disease reaching its full extent." However, there are also cases that occur in adolescence or later in life.
Sufferers developed different strategies to deal with the overriding fears.
This could include, for example, repeatedly reassuring oneself in one's own environment or with doctors that the difficulty swallowing is not an indication of larynx cancer, said Rief.
Another mechanism is the compulsive search for relieving information on the Internet: "Most of the time, those affected come across exactly the opposite, so that concerns even increase and searches continue online," says Witthöft, describing the phenomenon also known as "cyberchondria" .
And finally, the compulsive examination of one's own body, if, for example, lymph nodes or areas of skin are repeatedly palpated, is an attempt to overcome the fears.
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Exactly what factors lead to someone developing hypochondria in the course of their life has not yet been clarified in detail. Early experiences with the issues of illness and death play a major role. “An overprotective home can have just as much impact as one in which pain is ignored,” psychologist Rief continues. In addition, there is the personality factor neuroticism, so Witthöft. This is associated with a tendency to nervousness, insecurity and anxiety, among other things.
Social aspects also play a role here.
“Nowadays we expect a perfectionism in the functioning of our body that has never been the case before,” says Rief and illustrates: “I lived in the country.
If the farmer, from whom you got the milk, said that his back hurts, then that wasn't an illness for him, it was part of his job.
Today we are better off in so many other areas than before, so we should be better physically too. "
This also describes the trap that arises for hypochondriac patients: The social image creates the expectation of errors that health means the absence of physical complaints.
"But you only reach this state when you are dead," says Rief pointedly.
The psychologist also emphasizes that people always have fears of illness, which they can deal with sometimes more, sometimes less well: "Now, in times of Covid, for example, there are many more people who have difficulty coping with it than there are hypochondriacs."
According to Peter Tyrer from London's Imperial College, growing health fears due to Covid-19 represent a hitherto neglected aspect of the pandemic. In an opinion article for the specialist journal "World Psychiatry", the psychiatrist writes that there will probably be at least a latent risk of infection from the virus for years to come will go out.
He therefore prophesies the emergence of a specific pathological "Covid fear" for which health systems worldwide should prepare.
For Michael Witthöft this is a bold thesis: “Such a statement also stirs up a kind of negative expectation that we are on the verge of a psychological pandemic.
However, I do not expect this in this form or in this vehemence, because fears of illness are temporary phenomena in the majority of cases, which increase briefly and then decrease again after a quarter to six months. "
Only a small proportion of such fears would become chronic and move in the direction of hypochondria, which is also shown by the low prevalence of the full picture of one percent of the population and less: “So different components have to come together for the disease to develop - a pandemic alone is enough Not."
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Nevertheless, according to Witthöft, it is correct that fears of illness generally increased, at least in the first corona wave in Germany, as a survey by his institute has shown.
This finding is probably due to an adjustment mechanism: "We are confronted with a situation that is threatening our health, and there it is probably an adequate reaction to react with increased attention and corresponding worries about one's own body." However, those fears are decreased rapidly in most people.
In a further survey, Witthöft and his colleagues concentrated on people who were already being treated for hypochondria: "We had the hypothesis that they were particularly suffering in the pandemic."
In fact, however, that was exactly the case - an observation which, according to the psychologist, is entirely plausible at second glance: “People who are completely absorbed with the thought that they might suffer from cancer and will not live long have no cognitive resources in order to deal extensively with the topic of corona. ”Accordingly, people with hypochondria did not necessarily represent a particularly vulnerable risk group in the pandemic.
On the other hand, people who already had an increased concern, a psychological disorder or an increased level of depression before the pandemic: “These groups tend to have corresponding fears and then under certain circumstances also to a kind of counterproductive protective behavior, which then leads to fears become more, ”describes Witthöft. Overall, however, it is not yet possible to say whether the pandemic will lead to a development of the full picture of hypochondria in people who are already prone to fear of illness.
What can already be observed, however, is that the pandemic is manifesting health fears in a wide variety of places and these are also changing, explains Winfried Rief: Some of the people with such fears are shifting them to vaccinations.
According to Rief, willingness to be vaccinated is ultimately the decisive question in coping with the pandemic.
Accordingly, he is particularly concerned about the large number of people who do not want to be vaccinated for fear of side effects: "Of course, this is not the full picture of hypochondria, but ultimately the same dynamic lies behind it."