Cyberchondria: ‘O tempora! O mores!’

Cyberchondria is the new epidemic of the digital age. The Internet Users Survey 2020, conducted by the Malaysian Communications and Multimedia Commission, reported that 88.7 percent of the population are Internet users. [https://www.mcmc.gov.my/skmmgovmy/media/General/pdf/IUS-2020-Report.pdf] Current reports peg Internet penetration in Malaysia at above 97.4 percent, indicating that almost everyone uses the Internet.

Recently, one can hardly recall a patient who has not come armed with information gleaned from the Internet. Occasionally, the desire to update oneself on diseases afflicting one’s kin metamorphoses into a preoccupation with perceived illness and persistent concern about one’s health, leading to endless online searches to confirm the diagnosis and its prognosis. Being concerned about one’s health is normal. However, excessive health anxiety, preoccupation with one’s health, and endless online searches in this regard have given rise to ‘Cyberchondria,’ a term coined by Eoin McElroy and Mark Shevlin to describe a form of anxiety characterized by excessive online health search, leading to increased distress, worry, and medical expense. [J Anxiety Disord 2014;28(2):259-265]

Cyberchondria is different from Munchausen syndrome, which is an artificial disorder imposed on oneself by falsifying, exaggerating, or inducing physical, emotional, or cognitive disability, a result of a need to be seen as ill and not to achieve any benefit. Cyberchondria is also different from malingering, where someone fakes or exaggerates an illness for physical benefit, to get out of work, or to earn higher compensation. Cyberchondria is similar to what used to be known as hypochondria.

As per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypochondriasis is no longer a diagnosis. Roughly 75 percent of patients previously diagnosed as hypochondriacs are now known to have ‘somatic symptom disorder,’ and the rest who have health anxiety in the absence of somatic symptoms are diagnosed as having ‘illness anxiety disorder.’ [https://psycnet.apa.org/record/2015-01137-026]

The Cyberchondria cycle
Drivers of the endless Cyberchondria cycle are the compulsive search for health information and the distress caused by search results. These drive further online searches to confirm the diagnosis and reassurance regarding possible cures from multiple sources. Those coupled with a mistrust of available medical professionals, drives the cycle into a more exhaustive and time-consuming search for health information. [Compr Psychiatry 2020;99:152167]

The information overload generated by predatory publishing and a plethora of web-based symptom-checker applications (SCAs) has led to a propensity to self-diagnosis, anxiety, and Cyberchondria. Metacognition, that is, thinking about one’s thinking and the strategies that regulate a person’s cognition, play a moderating role in health anxiety and Cyberchondria. Negative metacognitive beliefs of uncontrollability and danger significantly predict emotional disorders such as boredom, depression, anxiety, Internet addiction, emotional dysregulation, and illness anxiety disorder. [J Clin Med 2022;11(9):2590]

Cyberchondria is not a formal diagnosis but is similar to illness anxiety disorder. Cyberchondria implies a preoccupation with an illness discovered in an online search. It starts to take over life, leading to obsessive googling to the extent that it impacts daily life and relationships.

Healthcare delivery to the Cyberchondriac
Cyberchondria adds to the workload of nearly all healthcare services and may negatively impact preventative and prophylactic healthcare initiatives. The effects of Cyberchondria extend beyond health anxiety. [BMC Public Health 2024;24:902] Cyberchondriacs are misled by their Google searches and end up spending time and money in the wrong clinics, on wrong tests, and avoiding preventative and promotive public healthcare initiatives.

Patients with wrong beliefs and ideas gleaned from the Internet are quite the disruption busy clinicians do not need. An understanding that Cyberchondria is an illness like any other may help clinicians provide a compassionate approach to sharing information and supporting sage advice with authoritative texts and links to academic websites. Patients with formidable lists of complications gleaned from the Internet find it challenging to navigate past the informed consent process. Here, too, a compassionate and caring attitude to explain the low probability of each complication cited by the well-researched scholar-patient may be time-consuming but pays dividends to both parties.

One may extrapolate that increased awareness of pitfalls in the disease management process may induce heightened levels of stress and anxiety in the caregiver. Current working environments for doctors dictate that they must work harder, perform better, and have better outcomes, leading to heightened stress levels at all times. The inability to manage stress impacts a doctor’s technical skills, judgment, decision-making, and teamwork. Managing stress is an integral part of a doctor’s career. Doctors can effectively counter the additional stress imposed by handling a Cyberchondriac by applying cognitive psychology techniques to differentiate between good and bad stress, reducing the importance of the stressful moment, and taking active steps to improve their well-being and performance.

Managing the Cyberchondriac:
Many people with Cyberchondria feel embarrassed or ashamed about their tendency to believe that they have a significant illness. This embarrassment can worsen the anxiety and even exacerbate the physical, stress-related symptoms. Avoiding shaming and using a compassionate, caring approach restores the Cyberchondriac’s self-confidence, arms them with tools to dispel their incomplete knowledge, and directs them toward appropriate professionals to manage their care.

Cyberchondriacs are to be guided by their doctors to be compassionate towards their health-related fears and to realize that these arise from anxiety that may be deep-seated. Such worries may be challenging to understand but are valid. Cyberchondriacs should be taught to practice relaxation skills, like deep breathing exercises, guided imagery, progressive muscle relaxation, and journalling, to write their illness-related concerns along with evidence against these concerns.

Caregivers should shortlist trusted sources of information to facilitate delegating health monitoring tasks to competent professionals. A significant period of handholding is necessary before cyberchondriacs realize that there is a lot of misleading information on the Internet, and some of it is purposefully presented in a way that grabs the reader’s attention and increases their anxiety.

Anxiety medications like selective serotonin reuptake inhibitors (SSRIs) help to manage the obsessive thoughts involved in Cyberchondria. The basis for this treatment is the similarity between Cyberchondria, illness anxiety disorder, and obsessive-compulsive disorder (OCD). The same medications that help treat OCD may help reduce the obsessive and compulsive aspects of Cyberchondria.

Cyberchondria is increasingly regarded as a public health problem because of its potential to affect healthcare. Given this recognition, developing prevention and management programs for Cyberchondria should be prioritized. [World Psychiatry 2023;22(2):233–234]

Conclusion
The overload of inaccurate online information predatory publishers provide drives Cyberchondria. It targets and manifests in people with negative metacognitive beliefs of uncontrollability and danger. Since it impacts individual and public health, a multimodality approach towards safe Internet use and digital housekeeping to flag appropriate and inappropriate health information websites will be a timely and sage step toward improving public health initiatives.