Too Much Information for the Health Anxious Consumer? CYBERCHONDRIA:

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1 CYBERCHONDRIA: Too Much Information for the Health Anxious Consumer? Amber Loos, MLIS, MPH Health Sciences Librarian Southern Illinois University Carbondale

2 CYBERCHONDRIA Not an official diagnosis in the DSM Recently included in the Oxford English Dictionary: a person who (obsessively) researches health information on the Internet, typically to find a disease matching particular (real or imagined) symptoms. Finalist for 2008 Word of the Year by Webster's New World

3 CYBERCHONDRIA First mention of cyberchondria was in a 1996 news wire article Cyberchondriacs Get What Goes Around on the Internet Now (Wall Street Journal, 1999) Popularized, particularly UK in early 2000s The deluded belief you suffer from all the diseases featured on the internet (Sunday Times, 2000) The excessive use of internet health sites to fuel health anxiety" (The Independent, 2001)

4 MEDICAL LEXICON Healthcare on the Internet: Buyers Beware warned the Medical Journal of Australia (Yellowlees, 2000) Since that time, a growing number of scholarly articles have explored the topic in greater depth (Stone and Sharpe, 2003; Lewis, 2006; Smith et al., 2006; White and Horvitz, 2009; Wickham, 2009; Baumgartner and Hartmann, 2011; Aiken and Kirwan, 2012; Starcevic and Berle, 2013)

5 PATHOLOGICAL? Popular and scholarly sources tend to use the word cyberchondria in negative terms Online health information seeking as a pathological/disordered behavior Possibility of online reinforcement of disordered behaviors (Rice, 2006), but all individuals who seek online health information don t have a mental disorder

6 HEALTH ANXIETY & INFORMATION SEEKING Research links excessive searching for health information with health anxiety (White and Horvitz, 2009; Baumgartner and Hartmann, 2011; Starcevic and Berle, 2013) Some researchers have begun using the term health anxiety in place of hypochondria (Taylor and Asmundson, 2004) Others claim not a clinical diagnosis but a phenomenon present in a number of medical diagnoses or psychiatric conditions listed in the DSM (Abramowitz and Braddock, 2011)

7 HEALTH ANXIETY & INFORMATION SEEKING Reassurance-seeking behaviors are common: repeatedly checking the Internet or medical texts for health symptoms presenting to several different doctors for multiple second opinions (Taylor and Asmundson, 2004) Can be heightened by the negative information an individual encounters online (Abramowitz and Braddock, 2011)

8 REASSURANCE-SEEKING May be difficult to stop because it can seem to work by producing a temporary reduction in anxiety The result is that a reassurance-seeking behavior, like searching for information online or visiting health care providers for second opinions, can become a habitual response to anxiety (Taylor and Asmundson, 2004)

9 PROBLEMS WITH ONLINE REASSURANCE-SEEKING Study participants erroneously used search engines as a diagnostic tool Believed the higher the search result ranking the higher the likelihood of the disease Greater proportion focuses on the rare (brain tumor) rather than the more common (headache) >> escalation of health anxiety if overestimate the likelihood (White and Horvitz, 2009)

10 ONLINE SYMPTOM CHECKERS FamilyDoctor.org -- Search by Symptom < HealthyChildren.org -- Symptom Checker < Isabel Symptom Checker < itriage Symptom Checker < Mayo Clinic Symptom Checker < WebMD Symptom Checker <

11 ONLINE SYMPTOM CHECKERS Now more health-care providers are turning the tables, steering patients to new and improved computerized symptom-checkers that make it easier for them to get reliable information about possible diagnoses, research their condition and even connect directly to a doctor. Doctors are adding these tools to their websites and incorporating them into electronic medical records, encouraging patients to use them before office visits to save time and make consultations more productive. (Wall Street Journal, 2013)

12 DISCUSSION Very little analysis as to whether or not online symptom checkers are accurate Boots WebMD (UK version) correctly diagnosed 70% of the patients in their study (Farmer, Bernardotto, and Singh, 2011) Further research needed: Determine accuracy of symptom checkers Pathways between reassurance-seeking through online symptom checkers, health anxiety, and cyberchondria

13 REFERENCES Abramowitz, Jonathan S., and Autumn E. Braddock Hypochondriasis and Health Anxiety. Cambridge, MA: Hogrefe. Aiken, Mary, and Gráinne Kirwan "Prognoses for Diagnoses: Medical Search Online and Cyberchondria." BMC Proceedings 6:30. Baumgartner, Susanne, and Tilo Hartmann "The Role of Health Anxiety in Online Health Information Search." Cyberpsychology, Behavior, and Social Networking 14: Brooks, Byron "Strategies to Manage the Patient with Health Anxiety." Journal of the American Academy of Physician Assistants 26:61-2. Carrns, Ann "Cyberchondriacs Get What Goes Around On the Internet Now. Wall Street Journal, October 05. 'Cyberchondria' Hits Web Users. BBC News, April 13, Accessed: July 22, Farmer, S.E.J., M. Bernardotto, and V. Singh "How Good is Internet Self-diagnosis of ENT Symptoms Using Boots WebMD Symptom Checker?" Clinical Otolaryngology 36: "Internet Health and Medical Info Gets Mixed Reviews, Study Finds." Business Wire, September 12, Landro, Laura A Better Online Diagnosis Before the Doctor Visit. Wall Street Journal, July 22. Accessed July 23, Lewis, Tania "Seeking Health Information on the Internet: Lifestyle Choice or Bad Attack of Cyberchondria?" Media, Culture & Society 28:

14 Oxford English Dictionary Cyberchondriac. Accessed: July 22, Rice, Ronald Influences, Usage, and Outcomes of Internet Health Information Searching: Multivariate Results from the Pew Surveys. International Journal of Medical Informatics 75:8-28. Rogers, Lois "The Internet Addicts Who Give Their GP a Headache." Sunday Times, April 2. Smith, Peter Κ., Adam Τ. Fox, Patrick Davies, and Laila Hamidi-Manesh "Cyberchondriacs." International Journal of Adolescent Medicine and Health 18: Starcevic, Vladan, and David Berle "Cyberchondria: Towards a Better Understanding of Excessive Health-related Internet Use." Expert Review of Neurotherapeutics 13: Stone, Jon, and Michael Sharpe "Internet Resources for Psychiatry and Neuropsychiatry." Journal of Neurology, Neurosurgery & Psychiatry 74: Taylor, Steven, and Gordon J. Asmundson Treating Health Anxiety: A Cognitive-behavioral Approach. New York: Guilford Press. Vallely, Paul "Are You a Cyberchondriac?" The Independent, April 18. Accessed: July 23, Webster s New World Word of the Year. Accessed: July 22, White, Ryen W., and Eric Horvitz "Cyberchondria: Studies of the Escalation of Medical Concerns in Web Search." ACM Transactions on Information Systems (TOIS) 27. Wickham, Sara "The Perils of Cyberchondria." The Practising Midwife 12:34. Yellowlees, Peter M "Healthcare on the Internet: Buyers Beware." The Medical Journal of Australia 173:629.