You get a bad headache. You pop a few aspirin, down a big glass of water. A few hours later, your head’s still throbbing, so you take a few more. But the pain just won’t go away. I’ve had headaches before, you think. No biggie. I’ll just lie down for a little while.
When you wake? It’s still there.
Now you’re concerned. Naturally, you go online. “Bad headache won’t go away” you type into Google, and before you know it, you’ve completely forgotten about your headache—because, after falling down a rabbit hole of WebMD, Healthline, obscure Reddit threads, and medical horror story blogs, you’re sweating. You’re biting your nails. Your heart is racing. You’re convinced you have a brain tumor.
Then you make the mistake of clicking on Google Images.
But you shouldn’t be worried about your headache or any brain tumor, for you’ve come down with something altogether different: cyberchondria.
From the Four Humors to Health Anxiety
Cyberchondria sounds like something straight out of science fiction, but it’s a very real problem. As the Collins Dictionary defines it, cyberchondria is the “unfounded anxiety concerning the state of one’s health brought on by visiting health and medical websites”; as the Mayo Clinic explains, “searching the internet because of illness anxiety…only makes that anxiety worse.”
First, a little medical, and lexical, history. The coinage first appeared in British newspapers around 2000 and is a blend of cyberspace and hypochondria—the latter of which has been for centuries. Though the concept reaches back to antiquity, the word hypochondria in English dates to the 1560s, based on Greek roots literally meaning “below” (hypo-) the “cartilage,” referring to the area right below the ribs once thought to be the seat of melancholy in the body. (Remember the four humors when you read Shakespeare in school?)
In the 1600s, hypochondria shifted to a “causeless sadness,” with doctors seeking earnest explanations in the 18th century. They even gave it a more clinical name: hypochondriasis, originally thought to be a disorder of the nervous system, marked especially by indigestion.
In the ensuing centuries, medical understanding of hypochondriasis evolved to view the condition as a mental disorder, though still grounded in that core sense of the fear that one is suffering from a major disease, often on the basis of misinterpreting minor symptoms. Hypochondriasis was even described in the bible of all things psych, the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)—until 2013.
That year, the DSM eliminated the term for its fifth edition. For one, the terms hypochondria, hypochondriac, and hypochondriasis have become pejorative, reduced to punchlines in popular culture and stigmatizing mental health disorders. “That’s it then,” The Big Bang Theory’s Sheldon Cooper doom-says after accidentally drinking from his friend’s glass of water. “I’m dead.”
For another, mental health professionals didn’t find the term as diagnostically and therapeutically effective. So, the DSM replaced hypochondriasis with two new ones: somatic symptom disorder (SSD) and illness anxiety disorder (IAD).
With SSD, a patient is experiencing some actual symptoms, such as weakness or shortness of breath, which results in “major distress” due to “excessive thoughts, feelings and behaviors relating to the physical symptoms,” the DSM explains. IAD is marked by similar anxieties, but in the absence of any physical symptoms.
Give SSD and IAD your WiFi password—and you’ve got cyberchondria.
“All I had to do was put some lotion on.”
Google, the world’s most popular search engine, kicked off in 1994, and just two years later, the leading health information website, WebMD, launched. That’s not even 10 years before the earliest appearance of the word cyberchondria. In that small window, these powerful resources transformed our everyday knowledge and behavior about health and wellness.
Like never before, the average person can now access information about medicine previously accessible only to highly trained and educated specialists—or, if you’re old enough to remember it, the Merck Manual of Diagnosis and Therapy, that dense doorstopper that collected dust on your grandparents’ bookshelf. In addition to all the world’s knowledge at our fingertips, the internet also opened new lines of communication, from email to chat rooms, between patients and their doctors.
But all this information, ironically, can really leave one in the dark. And that’s especially true during times of great bodily changes and questions.
“I had an itchy belly during my first pregnancy,” says Jessica Douglas, stay-at-home mother of two and part-time marketing manager in Southern California. “I went online and looked up ‘itchy belly during pregnancy’ and it came back as this disorder called PUPPP,” a cute shortening of the frighteningly named pruritic urticarial papules and plaques of pregnancy. “It’s some crazy skin condition that can cause early labor and is dangerous for the baby.”
“I went to the doctor and all she said it was just dry skin from the belly stretching,” Douglas continues. “Going online freaked me out. All I had to do was put some lotion on.”
It was even worse when her first baby was born, Douglas says, with every cough, sneeze, and gurgle raising a new mother’s alarm. “They send you home with a little human with no instructions. You’re searching for someone to tell you this weird noise your baby is making normal. So, you go online and the next thing you know your baby has some horrible disease or is missing a chromosome.”
And she’s far from alone. Douglas shared a scare her friend recently experienced when her son was unusually quiet and unresponsive. “She was concerned that he wasn’t developing normally. She went online and plugged in some of his symptoms and, lo and behold, WebMD said he had personality disorder and autism,” she says. Panicked, she took her son to the doctor.
“Turned out he just had a bunch of wax buildup in his ear.” The wax was making it hard for him to hear.
Don’t jump—or click—to conclusions.
Douglas—and her many peers—are smart, conscientious people. And indeed, according to the Royal College of Surgeons in Ireland Student Medical Journal, occasional illness anxiety is a frequent occurrence in healthy populations. Full-fledged hypochondriasis affects only between 4 to 9 percent of people.
But in a fall 2017 study, some researchers, led by professors at the Imperial College London and King’s College London, found that one in five patients at British health clinics were experiencing health anxiety—fueled in large part by internet searches, they reasoned.
What’s up with the internet?
Judgment biases, as a landmark 2008 study on cyberchondria by Ryen White and Eric Horvitz at Microsoft concluded. As our teachers admonished us time and time again, don’t just click on the first link Google gives you.
White and Horvitz found that web searches for a symptom like a headache yielded as many results linking it brain tumors as it did for caffeine withdrawal. To be sure, a headache can portend a brain tumor—this is what feeds hypochondriasis after all—but brain tumors are exceedingly rate. Caffeine withdrawal, meanwhile, is common and mundane. And searches for chest pain, as another example, pointed participants more frequently to heart attacks than indigestion.
These skewed results “escalate” medical concerns, White and Horvitz found, compelling people to look up more serious illnesses than in all likelihood they really had.
We humans like to jump to conclusions—often catastrophic ones. And it doesn’t help that the internet overwhelms us with so much information at once, making it even harder to filter out the signal from the noise.
This escalation, this constant checking, only further spikes one’s anxiety. In a 2016 study, New York State Psychiatric Institute’s Emily Doherty-Torstrick and colleagues indeed found that when people go online to seek reassurance for anxiety they are feeling about a symptom, they report feeling even more anxious during and after their searches. The internet backfires.
Cyberchondria is vicious circle: You are worried about a symptom, so you go online. Your search results take your symptoms out of proportion and you get more nervous. You want learn out more, hoping to get some other information that will relieve your concerns, but you’re finding out only makes you more troubled, so you keep searching, spiraling ever faster in the vortex of anxiety.
“There is a lot, too, besides WebMD,” Douglas says. She feels like social media and “mommy forums” are “almost just as dangerous. People [kind of] bandwagon…There’s so much noise, so many opinions being thrown out.”
And not even medical professionals are immune to all that noise.
The internet really adds fuel to the fire.
Brittany Raulino, an oncology nurse in Oregon who previously worked in a primary care clinic, recounts a number of colleagues—yes, fellow nurses—ironically succumbing to cyberchondria.
“One nurse,” she says, “had issues waking up with night sweats. So she googled her symptoms and it was the number one thing that came up.” Lymphoma—a cancer of the lymph nodes.
“It was late at night and she was thinking about the [worst-case] scenario,” Raulino says. “‘Oh my god, I have night sweats. Oh my god, do I have lymphoma?’ When she googled it, she spent the rest of the night panicking.”
Fortunately, Raulino continues, “the next day she called her doctor and her friends and talked her out of it.”
But unfortunately, many of Raulino’s patients, who are battling cancer and don’t have friends who are medical professionals, try to talk themselves out of certain treatments as a result of cyberchondria.
“People hear ‘cancer’ and they hear these crazy horror stories about treatment-related side effects. They start fantasizing that they will develop them and it makes them paranoid and not want to get treatment.”
Anxiety often persists during treatment, too, says Raulino. “When people have funky side of effects of chemo, they google and feel like they have something a lot worse than it is. They will google the drug related to the side effect and think they have that weird side effect that affects only one percent. ‘I don’t want this drug.’”
“The internet really adds fuel to the fire,” she says.
Raulino, for her part, thinks a twofold behavior is behind cyberchondria. “I wonder if people automatically go to Google first as that easy method to discern that there symptoms are instead of actually turning to somebody and having to talk to somebody on the phone,” she says. “The internet is that first instinct…We don’t have to have to deal with people in real time. We want that quick-fix answer.”
So, what are we supposed to do?
On the one hand, that hunger for the “quick-fix answer” can needlessly drive us to the doctors—like the one in five found in the 2017 British assessment. That costs patients and healthcare systems money. It also costs doctors, many of whom are already overworked, time and energy. Plus, those extra visits can lead to unnecessary drugs, tests, screenings, further stressing the system.
On the other hand, as Raulino’s experience shows, cyberchondria can also compel people to withdraw from care they actually need owing to fear—or seek inappropriate, even dangerous, treatment as a result of self-misdiagnosis or misinformation. According to the 2008 Microsoft report, a lot of content on medical websites, to say nothing of personal blogs and community forums, can be unreliable or incomplete.
With cyberchondria, it seems like we’re damned if we do and damned if we don’t. And either way we go, we’re dealing with anxiety, which, if it gets severe enough, needs treatment in its own right. What are we supposed to do?
First off, you might not want to go googling if you think have cyberchondria. Remember that a low level of illness anxiety is normal and that nearly all of us use the internet to look up our symptoms—the key to cyberchondria is excessive checking, after all.
Then, use a trusted self-diagnostic tool to help you determine whether or not your symptom-checking is a problem. Based on the Doherty-Torstrick study, Susan Krauss Whitbourne, PhD and professor emerita of psychology and brain sciences at the University of Massachusetts, Amherst, provides a handy five-point guide on Psychology Today. One of the signs you may have a problem, Whitbourne says, is if “you check online for symptom information from up to 1 to 3 hours a day.”
If you do think you may be experiencing cyberchondria, stop checking, as it will likely only increase your anxiety, and consult a doctor. Psychological methods like cognitive behavioral therapy have proven incredibly effective for managing health anxiety.
If you are concerned you are at risk or want to be mindful of it, Joni Johnston, PsyD, also for Psychology Today, offers three helpful guidelines: 1) self-screen but don’t self-diagnose, as trusted health questionnaires can be useful starting places for further consultation; 2) check your sources, as not all websites are of equal quality and vetting; and 3) consider the context—health anxiety can spike when a loved one is ill or has passed away.
Brittany Raulino would especially agree the second guideline. “The most important thing is to ask your healthcare provider what websites they can go on if they want to research the symptoms,” she says, highlighting federal websites and the Mayo Clinic online.
Paging Dr. Context
Jessica Douglas is a living example of Johnston’s third guideline: context. With her second child, “it was way easier because all those rashes and weird coughing sounds I knew were fine because I had asked my [pediatrician] the first time,” she says. “I didn’t even bother going online this time because I didn’t want to freak myself out.”
Just because the internet says it does not mean it’s true.
Instead, she swears by her healthcare provider’s nurse hotline. “If they have any trepidation [about a symptom], they will tell me to schedule an appointment. Most of the times they’ve seen it a million times and there’s nothing to be afraid of,” she says.
“I think it’s just important for people to remember that when they type in that search box, an algorithm is picking out things for them,” Douglas says.
“It’s ones and zeroes. It’s impersonal. Just because the internet says it does not mean it’s true.”
So, the next you get that lingering headache, use the internet cautiously and remember the wise words of Douglas—and Arnold Schwarzenegger, for in all probability, “It’s not a tumor.”