A Brief Look at Medical Student Syndrome
Medical trainees can experience the symptoms of diseases they study.
Posted Sep 29, 2016
Most of you reading this will probably be aware of the psychosomatic condition of hypochondria (also known as hypochondriasis) in which individuals have a preoccupying fear of having a serious illness despite appropriate medical evaluations and reassurances that their health is fine. However, what you may not be aware of is there appears to be some empirical evidence that some particular sub-groups of people appear to suffer hypochondria-related disorders relating to the medical conditions they are studying educationally and/or vocationally.
One such condition is ‘Medical Students’ Syndrome’ (also referred to by many other names including ‘Medical Students’ Disease,’ ‘Medical Student Disorder,’ ‘Medical School Syndrome,’ ‘Third Year Syndrome,’ ‘Second Year Syndrome,’ and ‘Intern’s Syndrome’), a frequently reported psychological condition among medical trainees that experience the symptoms of the disease or diseases they are studying. In a review of the relevant literature in a 2004 issue of the Journal of Curriculum Theory, Dr. Brian Hodges (2004) noted that Medical Student Syndrome (MSS) was first reported in the 1960s. A Wikipedia summary of MSS noted that:
“The condition is associated with the fear of contracting the disease in question. Some authors suggested that the condition must be referred to as nosophobia [a specific phobia, an irrational fear of contracting a disease], rather than ‘hypochondriasis,’ because the quoted studies show a very low percentage of hypochondriachal character of the condition, and hence the term ‘hypochondriasis’ would have ominous therapeutic and prognostic indications. The reference suggests that the condition is associated with immediate preoccupation with the symptoms in question, leading the student to become unduly aware of various casual psychological and physiological dysfunctions; cases show little correlation with the severity of psychopathology, but rather with accidental factors related to learning and experience.”
Dr. Bernard Baars in his 2001 book In the Theater of Consciousness: The Workspace of the Mindwrites:
“Suggestible states are very commonplace. Medical students who study frightening diseases for the first time routinely develop vivid delusions of having the ‘disease of the week’ – whatever they are currently studying. This temporary kind of hypochondria is so common that it has acquired a name, ‘medical student syndrome.’”
Dr. Hodges also suggested that in the 1960s:
“[The] phenomenon caused a significant amount of stress for students and was present in approximately 70 to 80 percent of students… papers written in the 1980s and 1990s conceptualized the condition as an illness in the psychiatric spectrum of hypochondriasis…Marcus found that the dream content of year two medical students frequently involved a preoccupation with personal illness. Marcus’s subjects reported many dreams in which they suffered illnesses of the heart, the eyes and the bowels, among others.. [Learning about a disease] creates a mental schema or representation of the illness which includes the label of the illness and the symptoms associated with the condition. Once this representation is formed, symptoms or bodily sensations that the individual is currently experiencing which are consistent with the schema may be noticed, while inconsistent symptoms are ignored.”
In a 1998 paper in The Lancet, Dr. Oliver Howes and Dr. Paul Salkovskis briefly reviewed the literature on MSS and reported the findings of two studies that had examined the condition. The first study claimed that approximately 70 percent of medical students had “groundless medical fears during their studies” and the second study found that 79 percent of randomly chosen medical students demonstrated a “history of medical student disease.” However, more interestingly, they also cited various other studies on non-medical students showing that various types of students not studying medicine also had high rates of hypochondria.
A study by Dr. Ingrid Candel and Dr. Harald Merckelbach examined whether the role of thought suppression and fantasy proneness were predictors of MSS complaints in 215 medical students. Summarizing the study in a 2001 issue of The Psychologist, Dr. Fiona Lyddy defined thought suppression as “the habitual tendency to suppress unpleasant thoughts, which can produce counterproductive hyperaccessibility of the worrying information” and that fantasy-prone individuals “often report physical sensations associated with fantasies or thoughts they have engaged in (e.g. if they had the thought that they might have a blood clot after flying, they might report feeling tightness in the leg muscles).” Candel and Merckelbach hypothesised that those students that scored highly on both thought suppression and fantasy-proneness would be more likely to experience MSS. Just under one-third (30 percent) of the sample (n=65) reported various MSS complaints with 33 medical students reporting psychiatric, cardiac, pulmonary, and gastrointestinal complaints. The authors found that gender and age were not significant predictors of MSS but as hypothesized, both thought suppression and fantasy proneness strongly predicted MSS complaints (the strongest being fantasy proneness).
A study led by Dr. G. Singh and colleagues and published in a 2004 issue of the journal Medical Education examined whether being at medical school causes health anxiety and worry in British medical students compared to a control group of non-medical students (and hypothesizing that medical students were more likely to report such conditions). A total of 449 medical students and 485 non-medical students across four years of study (first year to fourth year) were surveyed. Health anxiety was assessed using the appropriately named Health Anxiety Questionnaire whereas worry was assessed using the Anxious Thoughts Inventory. Contrary to their hypotheses, no evidence was found that medical students were more health anxious and greater worriers than non-medical students. In fact, the authors reported that health anxiety was significantly lower in medical students in the first year and the fourth year than non-medical students and that worry was significantly lower in the medical students across all years of study. The authors therefore concluded that “medical students are not a cohort of preselected health-anxious people, nor are they ‘worriers’ [and that] medical education at a clinical level [mitigates] health anxiety in the medical student population.”
MSS has also been reported in cognate disciplines to medicine (such as psychology). In 1997, in the journal Teaching of Psychology, Dr. M. Hardy and Dr. L. Calhoun investigated psychological distress and MSS in a group of American undergraduate students studying abnormal psychology. Their research found that students that planned to major in psychology reported more worry about their psychological health than those planning not to major in psychology. Interestingly – but not a surprise to me – students that had previously undergone some kind of psychological treatment were more likely to intend to pursue an advanced degree in counseling or psychotherapy than those that had not received prior psychological treatment. The authors also claimed that the students that learned about various psychological disorders demonstrated (i) decreased anxiety about their own mental health, and (ii) increased likelihood of seeking out mental health services on the university campus for personal psychological distress.
A more 2011 recent paper (also published in Teaching of Psychology) by Dr. M. Deo and Dr. J. Lymburner investigated whether psychology students can suffer Psychology Student Syndrome (PSS) – a direct analogue to MSS. To do this, they looked at the relationship between self-ratings of psychological health and the number of courses that students took in psychopathology. In addition to standard personality tests, the undergraduate students were asked to rate their level of concern about suffering from symptoms of various psychological disorders. However, Deo and Lymburner found no evidence of PSS. However, they did report a positive correlation between neuroticism and psychological health anxiety. As a result of this finding, they recommended that lecturers on psychopathology courses need to be aware that their neurotic students may be at a higher risk for believing they have psychological problems.
Taken as a whole, the results of studies to date appear to be very mixed as to whether students are more prone to suffering hypochondria-like conditions related to the subjects (i.e., medicine, psychology) they are studying. Even if the rates of hypochondria are higher in medical and/or psychology students, it might be that these students seek out such courses because of pre-existing conditions they have or think they have. More research with bigger samples, better control groups, and better control for pre-existing psychological and/or medical problems are warranted as there does appear to be some evidence that such conditions exist even if there may be good explanations as to why.
References and further reading
Baars, Bernard J. (2001). In the Theater of Consciousness: The Workspace of the Mind. Oxford University Press US.
Candel, I. & Merckelbach, H. (2003) Fantasy proneness and thought suppression as predictors of the medical student syndrome. Personality and Individual Differences, 35, 519–524.
Deo, M. S., & Lymburner, J. A. (2011). Personality traits and psychological health concerns: The search for Psychology Student Syndrome. Teaching of Psychology, 38, 155-157.
Hardy, M.S., & Calhoun, L.G. (1997). Psychological distress and the “medical student syndrome” in abnormal psychology students. Teaching of Psychology, 24, 192-193.
Hodges, B. (2004) Medical student bodies and the pedagogy of self-reflection, self-assessment, and self-regulation. Journal of Curriculum Theory, 20(2), 41-51.
Howes, O.D. & Salkovskis, P.M. (1998). Health anxiety in medical students. The Lancet, 351, 1332.
Hunter, R.C.A, Lohrenz, J.G., & Schwartzman, A.E. (1964). Nosophobia and hypochondriasis in medical students. Journal of Nervous and Mental Diseases, 130,147-152.
Lyddy, F. (2001). Medical Student Syndrome. The Psychologist, 16, 602.
Singh, G. (2006). Medical students’ disease: Health anxiety and worry in medical students. Stress and mental health in college students. New York, NY: Nova Science Publishers, 29-62
Singh, G., Hankins, M., & Weinman, J. A. (2004). Does medical school cause health anxiety and worry in medical students? Medical Education, 38(5), 479-481.
Wikipedia (2013). Medical students’ disease. Located at: http://en.wikipedia.org/wiki/Medical_students’_disease