Cyberchondria
Encyclopedia
Cyberchondria refers to the unfounded escalation of concerns about common symptomology based on review of search results and literature online. Articles in popular media position cyberchondria anywhere from temporary neurotic
excess to adjunct hypochondria. Cyberchondria is a growing concern among many healthcare practitioners as patients can now research any and all symptoms of a rare disease, illness or condition, and manifest a state of medical anxiety.
. (The term "-chondria" derives from Greek and literally means "cartilage
" or "breast bone.") Researchers at Harris Interactive clarified the etymology
of cyberchondria, and state in studies and interviews that the term is not necessarily intended to be pejorative
.
A review in the British Medical Journal publication "Journal of Neurology, Neurosurgery, and Psychiatry" from 2003 says cyberchondria was used in 2001 in an article in the United Kingdom newspaper The Independent to describe "the excessive use of internet health sites to fuel health anxiety." The BBC also used cyberchondria in April, 2001. The BMJ review also cites the 1997 book from Elaine Showalter
, who writes the internet is a new way to spread "pathogenic ideas" like Gulf War syndrome
and myalgic encephalomyelitis
. Patients with cyberchondria and patients of general hypochondriasis often are convinced they have disorders "with common or ambiguous symptoms."
Cyberchondriac was a word of the year in 2008 for the Webster's New World Dictionary
. Webster's shows a list of uses for cyberchondriac on publications and the internet.
researchers Ryen White and Eric Horvitz
, who conducted a large-scale study that included several phases of analysis. The New York Times covered the study. White and Horvitz defined cyberchondria as the “unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web.” They analyzed a representative crawl of the web for co-occurrences of symptoms with diseases in web content as well as the content returned as search results from queries on symptoms and found surprisingly high rates of linkage of rare, concerning diseases (e.g., brain tumor) to common symptoms (e.g., headache). They also analyzed anonymized large-scale logs of queries to all of the popular search engines and noted the commonality of escalations of queries from common complaints to queries on concerning diseases. They characterized the nature of escalations within a specific session and also found that potentially disruptive querying about disorders (arrived at via a search escalation) could continue in other sessions over days, weeks, and months, and that the queries could disrupt non-medical search activities. Finally, the researchers did a survey of over 500 people that confirmed the prevalence of web-induced medical anxieties and that probed several aspects of the phenomenon. The survey noted that a significant portion of subjects considered the ranking of a list of results on a medical query as somehow linked to the likelihood of relevant disorders. The researchers highlight the difference between the information provided by standard approaches to “relevance” used by search engines in ranking results and answers to medical questions, especially when searchers are looking for likelihoods of different explanations. They point out the potential importance of findings drawn from the psychology of judgment in their work. In particular, they point out that previously studied "biases of judgment" play a role in cyberchondria. The researchers highlighted the potential biases of availability
(the recency and density of exposure of someone to events raises the assessed likelihood of the events) and base-rate neglect
(people often do not properly consider the low prior probability of events in assessing the likelihood of events when they review evidence in support of the event) as influencing both search engines and then people searching the web. Confirmation bias
, a tendency for people to confirm their preconceptions or hypotheses, may also contribute to cyberchondria.
In a paper published in the proceedings of the 2009 Symposium of the American Medical Informatics Association
, White and Horvitz present further findings from their 500-person survey on peoples’ experiences with the online investigation of medical concerns and self diagnosis. They found that overall, people report to having a low level of health anxiety, but that Web-based escalation of concerns occurs frequently for around one in five people. Two in five people report that interactions with the Web increases medical anxiety and approximately half of people report that it reduces anxiety. Traits such as a person’s general anxiety level and predispositions to anxiety may contribute to the levels of medical anxiety experienced and to the likelihood of Web-induced medical escalation. White and Horvitz suggest that Web content providers be cognizant of their potential to heighten medical anxiety and consider the ramifications of publishing alarming medical information, emphasize the importance of Web content in facilitating patient-physician interaction, and recommend periodic surveys and analysis with different cohorts to track changes in health-seeking experiences over time.
In a paper to be published in proceedings the 2010 ACM Special Interest Group on Information Retrieval
Conference, White and Horvitz present research on predicting escalations in medical concerns based on the structure and content of Web pages encountered during medical search sessions. They construct and then characterize the performance of classifiers that predict whether an escalation will occur in issued queries following the visit to a page. Their findings show that features such as serious illness preceding benign explanations in page (e.g., cancer is mentioned before caffeine in pages pertaining to headaches), serious illness vs. benign explanation appears in page title or near beginning of page, page from Web forum, and page has external verification are all important predictors of subsequent escalation (or non-escalation).
Patients who go against medical advice or refuse to accept a professional diagnosis while quoting questionable web sources have become more common and can be a frustrating obstacle to physicians trying to provide a professional standard of care. When in doubt, patients should attempt to get a second opinion
before turning to web-based sources. Self diagnosis should not be used as a substitute for a professional medical consultation.
Other doctors express concern about patients who self-diagnose
on the basis of information obtained from the internet when the patient demonstrates an incomplete or distorted understanding of other diagnostic possibilities and medical likelihoods. A patient who exaggerates one set of symptoms in support of their self-diagnosis while minimizing or suppressing contrary symptoms can impair rather than enhance a doctor's ability to reach a correct diagnosis.
(Harmony Books, 2010), The Prophet Murray states, "Thou shalt not Google thy symptoms and then phone thy internist at 2AM claiming to have a terminal illness."
Neurosis
Neurosis is a class of functional mental disorders involving distress but neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms. It is also known as psychoneurosis or neurotic disorder, and thus those suffering from it are said to be neurotic...
excess to adjunct hypochondria. Cyberchondria is a growing concern among many healthcare practitioners as patients can now research any and all symptoms of a rare disease, illness or condition, and manifest a state of medical anxiety.
Derivation and use
The term "cyberchondria" is a portmanteau neologism derived from the terms cyber- and hypochondriaHypochondria
Hypochondriasis or hypochondria refers to excessive preoccupation or worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the body’s condition despite the absence of an actual medication condition...
. (The term "-chondria" derives from Greek and literally means "cartilage
Cartilage
Cartilage is a flexible connective tissue found in many areas in the bodies of humans and other animals, including the joints between bones, the rib cage, the ear, the nose, the elbow, the knee, the ankle, the bronchial tubes and the intervertebral discs...
" or "breast bone.") Researchers at Harris Interactive clarified the etymology
Etymology
Etymology is the study of the history of words, their origins, and how their form and meaning have changed over time.For languages with a long written history, etymologists make use of texts in these languages and texts about the languages to gather knowledge about how words were used during...
of cyberchondria, and state in studies and interviews that the term is not necessarily intended to be pejorative
Pejorative
Pejoratives , including name slurs, are words or grammatical forms that connote negativity and express contempt or distaste. A term can be regarded as pejorative in some social groups but not in others, e.g., hacker is a term used for computer criminals as well as quick and clever computer experts...
.
A review in the British Medical Journal publication "Journal of Neurology, Neurosurgery, and Psychiatry" from 2003 says cyberchondria was used in 2001 in an article in the United Kingdom newspaper The Independent to describe "the excessive use of internet health sites to fuel health anxiety." The BBC also used cyberchondria in April, 2001. The BMJ review also cites the 1997 book from Elaine Showalter
Elaine Showalter
Elaine Showalter is an American literary critic, feminist, and writer on cultural and social issues. She is one of the founders of feminist literary criticism in United States academia, developing the concept and practice of gynocritics.She is well known and respected in both academic and popular...
, who writes the internet is a new way to spread "pathogenic ideas" like Gulf War syndrome
Gulf War syndrome
Gulf War syndrome or Gulf War illness describes a medical condition that affected veterans and civilians who were near conflicts during or downwind of chemical weapons depot demolition, after the 1991 Gulf War. A wide range of acute and chronic symptoms have included fatigue, musculoskeletal...
and myalgic encephalomyelitis
Chronic fatigue syndrome
Chronic fatigue syndrome is the most common name used to designate a significantly debilitating medical disorder or group of disorders generally defined by persistent fatigue accompanied by other specific symptoms for a minimum of six months, not due to ongoing exertion, not substantially...
. Patients with cyberchondria and patients of general hypochondriasis often are convinced they have disorders "with common or ambiguous symptoms."
Cyberchondriac was a word of the year in 2008 for the Webster's New World Dictionary
Webster's New World Dictionary
Webster's New World Dictionary of the American Language is an American dictionary first published in 1951 and currently published by John Wiley & Sons....
. Webster's shows a list of uses for cyberchondriac on publications and the internet.
Studies
The first systematic study of cyberchondria, reported in November 2008, was performed by MicrosoftMicrosoft
Microsoft Corporation is an American public multinational corporation headquartered in Redmond, Washington, USA that develops, manufactures, licenses, and supports a wide range of products and services predominantly related to computing through its various product divisions...
researchers Ryen White and Eric Horvitz
Eric Horvitz
Eric Horvitz is a Distinguished Scientist at Microsoft, where he serves as a research area manager within Microsoft Research. His research interests span theoretical and practical challenges with developing systems that perceive, learn, and reason...
, who conducted a large-scale study that included several phases of analysis. The New York Times covered the study. White and Horvitz defined cyberchondria as the “unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web.” They analyzed a representative crawl of the web for co-occurrences of symptoms with diseases in web content as well as the content returned as search results from queries on symptoms and found surprisingly high rates of linkage of rare, concerning diseases (e.g., brain tumor) to common symptoms (e.g., headache). They also analyzed anonymized large-scale logs of queries to all of the popular search engines and noted the commonality of escalations of queries from common complaints to queries on concerning diseases. They characterized the nature of escalations within a specific session and also found that potentially disruptive querying about disorders (arrived at via a search escalation) could continue in other sessions over days, weeks, and months, and that the queries could disrupt non-medical search activities. Finally, the researchers did a survey of over 500 people that confirmed the prevalence of web-induced medical anxieties and that probed several aspects of the phenomenon. The survey noted that a significant portion of subjects considered the ranking of a list of results on a medical query as somehow linked to the likelihood of relevant disorders. The researchers highlight the difference between the information provided by standard approaches to “relevance” used by search engines in ranking results and answers to medical questions, especially when searchers are looking for likelihoods of different explanations. They point out the potential importance of findings drawn from the psychology of judgment in their work. In particular, they point out that previously studied "biases of judgment" play a role in cyberchondria. The researchers highlighted the potential biases of availability
Availability heuristic
The availability heuristic is a phenomenon in which people predict the frequency of an event, or a proportion within a population, based on how easily an example can be brought to mind....
(the recency and density of exposure of someone to events raises the assessed likelihood of the events) and base-rate neglect
Base rate fallacy
The base rate fallacy, also called base rate neglect or base rate bias, is an error that occurs when the conditional probability of some hypothesis H given some evidence E is assessed without taking into account the "base rate" or "prior probability" of H and the total probability of evidence...
(people often do not properly consider the low prior probability of events in assessing the likelihood of events when they review evidence in support of the event) as influencing both search engines and then people searching the web. Confirmation bias
Confirmation bias
Confirmation bias is a tendency for people to favor information that confirms their preconceptions or hypotheses regardless of whether the information is true.David Perkins, a geneticist, coined the term "myside bias" referring to a preference for "my" side of an issue...
, a tendency for people to confirm their preconceptions or hypotheses, may also contribute to cyberchondria.
In a paper published in the proceedings of the 2009 Symposium of the American Medical Informatics Association
American Medical Informatics Association
AMIA, formerly known as the American Medical Informatics Association, is an American non-profit organization dedicated to the development and application of biomedical and health informatics in the support of patient care, teaching, research, and health care administration.- History :AMIA is the...
, White and Horvitz present further findings from their 500-person survey on peoples’ experiences with the online investigation of medical concerns and self diagnosis. They found that overall, people report to having a low level of health anxiety, but that Web-based escalation of concerns occurs frequently for around one in five people. Two in five people report that interactions with the Web increases medical anxiety and approximately half of people report that it reduces anxiety. Traits such as a person’s general anxiety level and predispositions to anxiety may contribute to the levels of medical anxiety experienced and to the likelihood of Web-induced medical escalation. White and Horvitz suggest that Web content providers be cognizant of their potential to heighten medical anxiety and consider the ramifications of publishing alarming medical information, emphasize the importance of Web content in facilitating patient-physician interaction, and recommend periodic surveys and analysis with different cohorts to track changes in health-seeking experiences over time.
In a paper to be published in proceedings the 2010 ACM Special Interest Group on Information Retrieval
Special Interest Group on Information Retrieval
SIGIR is the Association for Computing Machinery's Special Interest Group on Information Retrieval. The scope of the group's specialty is the theory and application of computers to the acquisition, organization, storage, retrieval and distribution of information; emphasis is placed on working with...
Conference, White and Horvitz present research on predicting escalations in medical concerns based on the structure and content of Web pages encountered during medical search sessions. They construct and then characterize the performance of classifiers that predict whether an escalation will occur in issued queries following the visit to a page. Their findings show that features such as serious illness preceding benign explanations in page (e.g., cancer is mentioned before caffeine in pages pertaining to headaches), serious illness vs. benign explanation appears in page title or near beginning of page, page from Web forum, and page has external verification are all important predictors of subsequent escalation (or non-escalation).
Medical websites
In 2002 the Sydney Morning Herald wrote "a visit to an Internet clinic will probably diagnose drowsiness as chronic fatigue, anal itch as bowel cancer and a headache as a tumour." Many reputable medical organizations maintain websites that may include brief overviews of various conditions for individuals with a general curiosity, or more detailed information to aid the understanding of people who have been properly diagnosed. Often listing diagnoses without regard to incidence, prevalence, or relevant risk factors, websites may lead users to suspect rather rare and unlikely diseases as the source of their complaints. Since many benign conditions share symptoms with more serious ailments and are listed side-by-side, users without proper medical consultation may assume the worst rather than the likely diagnosis. Web-diagnosis can cause a great deal of distress and anxiety in users who believe themselves to have incurable and serious illnesses.Patients who go against medical advice or refuse to accept a professional diagnosis while quoting questionable web sources have become more common and can be a frustrating obstacle to physicians trying to provide a professional standard of care. When in doubt, patients should attempt to get a second opinion
Second opinion (medicine)
A second opinion is a visit to a physician other than the one a patient has previously been seeing in order to get a differing point-of-view. Second opinions may be sought by a patient under the following circumstances:*Physician recommends surgery....
before turning to web-based sources. Self diagnosis should not be used as a substitute for a professional medical consultation.
Opening lines of communication
Some medical practitioners are open to a patient's personal research, as this can open lines of communication between doctors and patients, and prove valuable in eliciting more complete or pertinent information from the patient about their present condition.Other doctors express concern about patients who self-diagnose
Self diagnosis
Self-diagnosis is the process of diagnosing, or identifying, medical conditions in oneself. It may be assisted by medical dictionaries, books, resources on the Internet, past personal experiences, or recognizing symptoms or medical signs of a condition that a family member previously...
on the basis of information obtained from the internet when the patient demonstrates an incomplete or distorted understanding of other diagnostic possibilities and medical likelihoods. A patient who exaggerates one set of symptoms in support of their self-diagnosis while minimizing or suppressing contrary symptoms can impair rather than enhance a doctor's ability to reach a correct diagnosis.
In popular culture
In The Book of Murray by David M. BaderDavid M. Bader
David M. Bader is the author of such works as "The Book of Murray: The Life, Teachings, and Kvetching of the Lost Prophet ," "Haiku U.: From Aristotle to Zola, Great Books in 17 Syllables Haikus for Jews: For You a Little Wisdom , Zen Judaism: For You a Little Enlightenment and Haiku U.:...
(Harmony Books, 2010), The Prophet Murray states, "Thou shalt not Google thy symptoms and then phone thy internist at 2AM claiming to have a terminal illness."
External links
- Microsoft Examines Causes of ‘Cyberchondria’ a November 2008 article from the New York Times written by John MarkoffJohn MarkoffJohn Markoff is a journalist best known for his work at The New York Times, and a book and series of articles about the 1990s pursuit and capture of hacker Kevin Mitnick.- Biography :...
- Internet Makes Hypochondria Worse - WebMD - undated
- Confessions of a Cyberchondriac - 2009 article in Last Exit Magazine
- New disorder, cyberchondria, sweeps the internet — an April 2001 article from The New Zealand Herald