Researching health symptoms online is a prescription for anxiety

Researching our symptoms online or on health apps can increase stress levels and is ultimately self-defeating, discovers Margaret Jennings.

WORRIED about that lingering headache or that persistent cough?

Consulting Dr Google may not always be good for our health and in fact a design flaw in search engines means we usually get the worst-case scenario for our medical symptoms — regardless of how harmless they are — which raises our anxiety levels as a result.

Depending on our disposition, those health anxiety levels can range from being temporary to becoming an obsession, similar to hypochondria, a commonly known syndrome now reclassified as an “illness anxiety disorder”.

Welcome to the world of cyberchondria, which if you Google it, describes the condition as “the unfounded escalation of concerns about common symptomology, based on review of search results and literature online.”

While cyberchondria has not yet been included in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association it is highly prevalent on the ground, says Mary Aiken, cyberpsychologist, and director of the RCSI CyberPsychology Research Centre.

“Cyberchondria is a phenomenon that is of research interest at the moment and that’s how many of these conditions start out,” she says.

However, it can take a decade of research studies before it appears in the DSM: “That is one of the problems with the DSM diagnostic procedure, in this case not keeping up with the pace of change in terms of technology and its impact on human behaviour.”

On the ground however, it is a growing problem. 

“We are getting increasing reports from client medical services of people walking in holding ‘Google stacks’ who are very anxious about the conditions they have searched online.”

Recent research revealed one in 20 searches using Google was for health-related information.

For every anxiety there is a trigger and in this case those stacks of pages, or whatever sinister conditions that show up on screen after a symptom is Googled, can quickly push a worried person over the edge unnecessarily.

Aiken, who has written research papers on the subject, says that a ‘design flaw’ in how search engines work, contributes towards escalating people’s anxiety around symptoms and if you have a predisposition to worry about your health, then it feeds into that cycle.

“The web runs on ranking algorhythms so it’s a frequency model, which means that the things that are repeatedly clicked on, are those things that get pushed up to the top. 

"So if everybody searching for a headache just searched under migraine or hangover, then those results would be served to everyone else, but when people escalate and start searching brain tumour then the algorhythms start serving brain tumour in the results.

“With that, and other exotic illnesses, the incidence might be one in a million or one in 10 million, but people don’t know that, when they are just reading it online.”

Back in the day, a hypochondriac would have to go to something like medical textbook Gray’s Anatomy to look up symptoms but it wasn’t intuitive and it wouldn’t give clusters of symptoms together. 

The problem with tech interfaces is they are intuitive, they prompt symptomology, which is highly suggestive to humans.

“So by the time you present to your doctor with a pain in your arm which you got from carrying a heavy bag, you now might be talking about pain radiating across the chest, palpitations, tingling in your fingertips, and so for all intensive purposes it presents to your GP like some sort of cardiac event, ” says the cyber psychologist.

If a surfer clicks on to a reputable website like the Mayo Clinic for example, there won’t be any escalation; it gives the facts and most likely will suggest a visit to your doctor. 

However, a 2010 study carried out of 12,262 people across 12 countries showed that nearly half used the search engine Google for self-diagnosis.

Research carried out earlier this year for Aviva Health Insurance revealed that 81% of Irish adults had gone online seeking to self diagnose, with 46% reporting increased stress or worry as a result of their search.

Anxiety can be fed further if people go into chat forums and see other people’s opinions and go to sites that are not trustworthy.

Mark Murphy, spokesman for the Irish College of General Practitioners, agrees that patients are being treated for anxiety levels due to self-diagnosis: “Because a diagnosis is reached many of the common ‘symptom checkers’ tend to be ‘risk averse’ and increase the probability of predicting a serious condition for patients when this probability is actually less. This heightens their anxiety and stress levels.

“Alternatively, once a diagnosis is made, many patients look to the internet to seek advice on prognosis and management options. 

"Even when certain websites are accurate, many patients may focus on a certain part of the patient leaflet, which though accurate, may not relate to their specific condition and also heightens their anxiety.”

The Aviva Health Insurance survey also found more than 78% of Irish people who use the internet to research their medical concerns cited speed of diagnosis as their number one reason for doing so, with 32% of those surveyed saying they couldn’t get to a GP appointment in a surgery at a time that suited them and 33% saying they couldn’t get the time off work.

Dr Murphy says Irish GPs are broadly supportive of patients taking initiative in their health, including looking up information on the internet about common symptoms, but are concerned about how diverse and incorrect information can be from unaccredited websites.

“Self-diagnosis and self-medication based upon undifferentiated symptoms can be dangerous and harmful and we would urge patients to avoid it,” he says.

A large study published in June in the British Medical Journal looked at smart phone applications, which aim to help patients diagnose and establish the severity of a condition. 

Assessing 23 of the most common ‘symptom checkers’ — all accredited — it concluded that symptom checkers had deficits in both triage and diagnosis.

“In many cases the symptom checkers over-predicted the risk of a serious diagnosis and encouraged patients to attend their GP when this was not necessary — potentially causing fear and anxiety,” says Dr Murphy.

“This new evidence underpins the importance of patients attending GPs when they are uncertain of the symptoms they have, and not to rely on the internet as a replacement for good self-care and primary care,” he says.

According to Mary Aiken, though cyberchondria is not a recognised syndrome yet, she would place it “somewhere along the spectrum of the worried well and health anxiety” and right across the population who have access to technology.

Increased access to mobile digital devices including apps and performance fitness trackers can exacerbate anxiety.

“There’s a fine line between people taking an active interest in their health and looking after themselves in a productive and controlled way, and becoming obsessive about every bodily symptom or everything they put into their body and everything that comes out of their body,” says Aiken.

“There are more serious clinical conditions, beyond health anxiet,y which would be what the DSM calls the somatic symptoms and related disorders as a result of obsessive interaction with technology.

“If you have an app bleeping 30 times a day to remind you to think about your heartbeat then that’s not constructive, because it’s technology prompting you to constantly think about your body.

“Part of somatic disorder is overly paying attention to your bodily symptoms such as feeling your own pulse, listening to your own breathing, imagining what’s going on in your stomach.”

As we interact increasingly with our digital devices it’s worth bearing in mind the words of GP representative Dr Daly, who says attending a doctor “provides a very important human and expert support for patients during challenging and frightening periods of their lives.”

That’s something Dr Google certainly can’t supply.

How anxious are you?

Though cyberchondria is the extreme version of internet health anxiety, you may find you fall somewhere along the scale with these behaviours:

1. You are regularly aware of symptoms in your body and go straight to Google information on any changes you notice.

2. Your search escalates to several sites which you visit often, increasing your anxiety around the conditions — real or imagined — that you suffer.

3. Surfing for health information does not make you feel better, but worse.

4. You regularly conclude that you have the worst scenario, without giving yourself time to see if your symptoms subside or have a simple cause.

5. You visit your GP regularly with ‘Google stacks’ of information on research you have done around your perceived symptoms.

6. You believe what you read, more than what your doctor concludes, about your state of health.

7. You insist that your doctor refer you for further tests to put your mind at rest, regardless of his/her opinion.

8. You have several health apps which you check regularly to monitor your physical state.

9. You search health websites on the internet more than any others.

10. You seek reassurance about your condition in chat rooms and use referrals to other sites indiscriminately.



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