Symptoms of Cyberchondria

We consult the Internet for answers to all kinds of questions. The vast majority seem to be about porn and online gaming. But we ask a good number of serious questions, too, especially about our health. The average American apparently spends 52 hours per year looking up health information online, and sees a doctor just three times. A recent study by the Pew Research Center found that one-third of Americans say they have gone online specifically to diagnose a medical condition.

I’m surprised that so few people ‘fessed up to being digital diagnosers. Doesn’t everybody do this? Here’s how it works for me. I get a symptom — a small mole on my arm, say, that has started bleeding for no good reason. I do a Google Image search of said symptom, find a photo that matches, and assume that person’s diagnosis as my own. Done and done. Who needs health insurance?

I’m kidding, of course — that’s never how it turns out. What actually happens is, the more I read about the possible ailments my symptom may be marking — blood blister, sunburn, dry skin, ingrown hair, malignant melanoma — the more panicked I feel. I go to Internet for more certainty, but usually end up with less.

So far, I’ve managed to walk away from the computer before convincing myself that I have a deadly disease. But many people don’t. When confronted with a list of possible explanations for their symptoms, they believe the worst-case scenario. This behavior is called cyberchondria, and, like its sister condition, hypochondria, it understandably causes a lot of anxiety.

The term ‘cyberchondria’ started cropping up in newspapers around 2001, referring to anecdotal reports of patients bringing their doctors print-outs from the Internet. But the concept didn’t get a lot of attention until 2008, when computer scientists at Microsoft published a study describing its causes and consequences.

The researchers analyzed the search patterns of hundreds of thousands of people who used Microsoft search engines. About one-third of people searching for medical-related terms tended to “escalate” their searches, the study found, meaning that their search would ratchet up to more and more dire outcomes. An initial search of “headache,” for example, might be followed by “headache tumor” and then “brain tumor treatment.”

The Microsoft researchers also gave a survey about online medical searches to more than 500 of the company’s employees. Of the people who said they had done search escalations, about 70 percent said they repeated the searches of the more serious illness at some point in the future, and 60 percent said these subsequent searches disrupted other activities, both online and off.

Last week, a study published in Cyberpsychology, Behavior and Social Networking reported that there are certain types of people who are most likely to be negatively affected by cyberchondria: those who feel the most anxiety about uncertainties of the future.

Psychologist Thomas Fergus of Baylor University in Waco, Texas, gave a survey to 512 people using Mechanical Turk, a service of Amazon.com in which people can post ads for rote jobs (like filling out surveys). Of this web-savvy group, 454 people reported ever searching for medical information online. In that subset, Fergus found a significant relationship between the frequency of online health searches and the amount of anxiety the person felt about his or her health, as you’d probably expect.

What’s more interesting is that the strength of the relationship between anxiety and searching was strongest for people who had high scores on the “Intolerance of Uncertainty Scale,” which gauges how well you handle the fact that you can’t know everything about your future. One of the items on the scale, for example, asks responders to rate on a scale of 1 to 5 how much they agree with the statement: “I always want to know what the future has in store for me.”

Fergus’s finding is pretty intuitive, right? The more uncomfortable you are with uncertainty, the more you might seek answers on the Internet. And when you get lots and lots of possible answers, some of them quite unpleasant, this might increase your anxiety and fuel yet more searching.

Fergus points out that measures of uncertainty tolerance are not typically used when doctors treat anxiety, and suggests that they should be.

I’ve been thinking about these results in the context of genetic tests. There’s been an ongoing debate over how people react to genetic information, particularly when the information is ambiguous. I wonder if consumer genetics companies such as 23andMe have considered offering their customers the opportunity to take online surveys about their uncertainty tolerance before showing them their results? It might be an effective (and efficient) way to guide them through various risk markers, especially those with serious health implications.

As for general cyberchondria, I think the bottom-line lesson of these results is to know thyself. If uncertainty makes you feel icky, it’s probably best to step away from WebMD and try a real MD instead.