Addressing Gaps in Knowledge about Cyberchondria

In the June issue of World Psychiatry, my curiosity was piqued by an article with the title “Keeping Dr. Google Under Control: How to Prevent and Manage Cyberchondria (Starcevic, 2023). The term cyberchondria was new to me, and perhaps to you as well. Therefore, I will share with you what I learned about it, concluding with some suggestions about addressing gaps that I identified in extant knowledge.

As you might surmise, the name of this construct refers to a combination of hypochrondria (excessive health-related worry) and cyber (excessive searching online for health-related information). Although turning to “Dr. Google” is quite common (and useful) across the globe, cyberchondria is more problematic, with deleterious consequences such as doctor hopping, ordering medical products online, worsened mental health, and lower quality of life (Starcevic, 2023; Zheng et al., 2020). In cyberchondria, the excessive health-related worry escalates rather than decreases as more and more information is retrieved from the internet. More and more time is spent compulsively searching and trying to evaluate the information that is conflicting and confusing. The amount of information is overwhelming.

Cyberchondria was identified prior to the pandemic, but the highly anxious societal context of COVID-19, including vaccine hesitancy and swirling conspiracy theories, provided fertile ground for cyberchondria to “go viral.” As is typical in the sciences, once a new construct was identified, a scale (Cyberchondria Severity Scale) was developed to enable measurement by researchers (McMullan et al., 2019). It is possible that scale development preceded careful conceptual clarification.

A CINAHL search revealed very little investigation of cyberchondria in nursing literature, but a sufficient quantity of research in other disciplines to generate a meta-analysis in 2019 and a systematic review in 2021 which I will draw upon here. (McMullan et al., 2019; Zheng et al., 2020). McMullan et al. (2019) summarized the findings of 20 studies concluding that there was a positive correlation between high health anxiety and online health information seeking, and between high health anxiety and cyberchondria. Over-reliance on measurement by a single instrument, the Cyberchondria Severity Scale, was noted. After critique of 40 studies, Zheng et al. (2020) concluded that research on cyberchondria is still in its “infancy,” with the majority of studies sampling university students and research participants obtained from the MTurk online platform. Additional scales have been developed to measure the construct, but they have only been tested in a few studies. Importantly, only two studies involved patients, and only one study had an experimental design, in which a cognitive-behavioral intervention for health anxiety improved cyberchondria (Newby & McElroy, 2020). A 2022 study provided some insights into the antecedents of cyberchrondria, including intolerance of uncertainty (a cognitive antecedent), and unhealthful affective responses (higher negative emotionality and ineffective coping with stress) (Afrin & Prybutok, 2022).

Based on this limited foray into the literature, I noticed several gaps. It seems that a rigorous concept analysis would be useful, with subsequent critical evaluation of the adequacy of the measuring instruments that have been developed. Recruitment of research participants beyond university students and respondents to MTurk is needed. Both qualitative studies (eliciting first-person narratives of persons diagnosed with cyberchondria) and quantitative studies of interventions (especially randomized controlled trials) are imperative to advance the science beyond infancy.

In the interim, while the science grows beyond infancy, Starcevic (2023) offers suggestions for prevention and management of cyberchrondria. All clinicians can engage in prevention by promoting greater health information literacy. We can encourage those in our sphere of influence to modify erroneous expectations of the internet, reduce the length of excessive online searching, and cope more successfully with information overload. Starcevic (2023) recommends asking the following questions before developing a management plan for cyberchrondria:

Why is that person presenting with cyberchondria at this particular time? What precipitated cyberchondria and what is its purpose? It is a specific symptom or health concern that initiated online health search, and is the person primarily seeking reassurance? What are the consequences of cyberchondria and how has one’s life changed because of excessive online health search? For example, has the person been avoiding his/her doctor or visiting the doctor too often? Why does excessive online health search persist despite the problems it has caused? Is it because the search is experienced as a way of coping with uncertainty? (Starcevic, 2023, p. 233).

I invite you to submit manuscripts (theoretical, clinical, empirical) about cyberchondria. We have much to learn. Your contributions are needed and welcomed.