One day after nursing her six-month-old baby, Colleen Abel developed an itchy red rash on her right breast. The cause was a mystery. Abel speculated that scratches left by her son while he fed might have gotten infected, or that bedbugs might have bitten her. The 36-year-old writer from Illinois opened her laptop and investigated her symptoms on Google. What she found shocked her. The first result blared inflammatory breast cancer, “and that scared me out of my mind,” Abel says. Other diagnoses such as dermatitis were far more likely, but Abel was convinced that a fast-growing malignancy was in her body. Before long, she was spending three to four hours every day reading about breast cancer on the internet.
Abel was in the throes of cyberchondria—a technology-enabled malady that drives people to repeatedly query their symptoms on search engines. Nearly one in three people among the millions who seek health information online report feeling more anxious afterwards. Yet individuals with cyberchondria paradoxically keep searching, even as their distress continues to grow. The term cyberchondria was coined by the media nearly 20 years ago as a play on the much older medical term hypochondria, whose sufferers are convinced they are sick with an illness they do not really have.
Because cyberchondria has never been added to the American Psychiatric Association’s list of diagnosable mental disorders, reliable estimates of the number of people who have it are not available. But what is known, says Eoin McElroy, a psychologist at University College London, is that “cyberchondria has the potential to interrupt many aspects of your life.” Studies have linked it to depression, and its sufferers are prone to either see their doctors too often, or not enough for fear of what they might hear.
Now scientists are starting to define cyberchondria and untangle its psychological roots. These are early days, but researchers are revealing fresh insights into what drives people to engage in a behavior that leads mostly to unhappiness. A key finding is that the relentless searching, more than anything else, is for assurances of personal safety—which the internet by its very nature is unable to provide.
THINKING ABOUT THINKING
Thomas Fergus, a professor of psychology at Baylor University, is a pioneering investigator in assurance-seeking behavior. He links cyberchondria to a dysfunctional web of metacognitive beliefs, which are really just thoughts about thinking. Everyone has these sorts of belief systems. For instance, it is normal to believe that ruminating over a challenging problem will lead to a well-considered outcome. But in cyberchondria, metacognitive beliefs morph into a mental trap that chains people to online health content.
Together with his collaborator, Marcantonio Spada, an academic psychologist at London South Bank University, Fergus has shown that metacognitive beliefs in cyberchondria overlap to some degree with those of other anxiety disorders that have longer diagnostic histories. People with health anxiety, for instance, worry irrationally about having a serious medical problem, and hold maladjusted views about the role worry plays in maintaining their emotional and physical well-being. These cycling beliefs can either be positive (such as: worrying about a medical problem will help me prepare before it is too late) or negative (my worry is getting out of control and it is making me sick). Even after their worries subside, people with health anxiety will eventually begin worrying that they have not worried enough about their medical state, thus triggering the cycle anew. It is these same sorts of dysfunctional belief systems, Fergus says, “that send people with cyberchondria back for long sessions at the computer.”
Fergus and Spada published research in 2018 that further links cyberchondria with features of obsessive compulsive disorder (OCD). People with OCD believe that performing a ritualistic behavior will ease their anxiety, and they engage in that ritual until they hit a predetermined threshold or stopping point. Fergus and Spada discovered that similar metacognitive beliefs propel online search habits in cyberchondria. Individuals search ritualistically for health information to dispel their anxiety, and will only stop when they feel the search has sufficiently reduced the uncertainties they have about the state of their health. “What they’re really looking for is reassurance that nothing bad is going to happen,” Fergus says.
Unfortunately, online health content is too diverse and conflicting to deliver the certainty. So, sufferers keep looking. Knowing who to trust online amounts to little more than a guessing game. Abel says the websites sparking her initial fears of inflammatory breast cancer appeared authoritative. “The more I learned, the more I found reasons to believe my worst-case scenario was correct,” she explains. “I ignored the information that should have reassured me—such as the rarity of the disease—and focused instead on what confirmed my suspicions.”
ESCAPING THE TRAP
Current treatments for cyberchondria range from antidepressants to talk therapy and mindfulness training, although the relative benefits of one over another are unclear. According to Robin Bailey, a psychologist at Liverpool John Moores University, in the U.K., the condition has to be more fully defined before clinical studies can get underway. But appropriate therapies, Bailey says, could draw from the same principles used in treating other anxiety disorders. Health anxiety, for instance, has traditionally been treated with cognitive behavioral therapies that encourage people to question the evidence leading them to believe they have a dangerous medical problem. Cognitive behavioral therapy for health anxiety can last 30 weekly sessions or more, according to Bailey.
Alternatively, therapists can try metacognitive techniques that shift the focus away from a perceived health threat to the worry that surrounds it. Individuals are encouraged to “observe” thoughts about illness or injury without letting them intrude emotionally. Or they might postpone their health worries until a scheduled time of day. Applied in a cyberchondria context, Bailey says, metacognitive approaches would encourage people to question the psychological value of going online to relieve their anxiety, “when evidence from their own experience shows it has the opposite effect.”
Abel found a way out. After two months spent in chatrooms devoted to inflammatory breast cancer, too scared to go to an urgent care clinic, Abel finally went to a primary care doctor who told her she did not have cancer. Instead, she had thrush—a benign condition that cleared up fast with antifungal treatment. Remarkably, thrush had never appeared on any of her Google searches, an omission that Abel says reflects the internet’s deficiency as a tool for self-diagnosis.
Abel admits to a lifelong battle with anxiety, and says she is still prone to bouts of cyberchondria, which she knows can wreak more havoc on her life than any of the health ailments that prompt it. “You shouldn’t be embarrassed to show up at the doctor once in a while if you’re worried,” she says. “That’s normal. And if you are in the throes of anxiety or panic, you need a doctor for that too. Don’t be afraid to reach out for mental or physical health. Never be ashamed of that.”