Year : 2015 | Volume
: 5 | Issue : 4 | Page : 163--165
The man who was tested for HIV 100 times
Mohammed Al. Alawi, Hamed Al. Sinawi
Department of Behavioural Medicine, Sultan Qaboos University, Muscat, Oman
Mohammed Al. Alawi
P.O. Box 38, Code 123, Al Khod, Muscat
Health anxiety disorder is a very distressing disorder both to the patients and his health care providers. This case of a man who presented with a preoccupation with having human Immunodeficiency virus (HIV) infection that made him pay for repeated tests-approximately more than 100 times. In this case report, we describe a case of a man who presented with preoccupations with having HIV that made him pay for repeated tests more around 100 times.
|How to cite this article:|
Al. Alawi M, Al. Sinawi H. The man who was tested for HIV 100 times.Int J Nutr Pharmacol Neurol Dis 2015;5:163-165
|How to cite this URL:|
Al. Alawi M, Al. Sinawi H. The man who was tested for HIV 100 times. Int J Nutr Pharmacol Neurol Dis [serial online] 2015 [cited 2021 Aug 6 ];5:163-165
Available from: https://www.ijnpnd.com/text.asp?2015/5/4/163/167500
Patients with health anxiety disorder present to primary care and specialized medical service with repeated requests for medical investigation. Despite reassurance and negative results, they continue to exhibit this preoccupation, and any attempt to stop them from seeking medical advice leads to tremendous stress and anxieties that impair their functioning. Such patients have psychological bases to their symptoms and need psychological interventions to help them cope. We describe a case of a man who presented with a preoccupation with having human immunodeficiency virus (HIV) infection that made him pay for repeated tests—approximately more than 100 times.
A 36-year-old government employee presented with a 10-year history of excessive worry that he may have acquired immunodeficiency syndrome (AIDS) after working in a health education program that involved reading several articles and websites about AIDS. Around that time, one of his neighbors died of AIDS, which made him more worried about having the disease himself despite not having a close relationship with that neighbor. He started attending local hospitals and asking to be tested for HIV infection after shaving or sharing cups with other people. He continued having himself tested repeatedly and contacting international labs in France and Germany, sending them his blood samples. He spent hours reading different articles about HIV testing and the HIV genome. He continued to send his blood for testing, around 100-200 times, despite getting negative results every time. He is aware that his excessive worries about having AIDS are irrational but cannot stop himself from sending his blood for testing; this has cost him lots of money, and he has had to borrow money from his wife and brothers.
He is married and has four children. He has no medical illness, and his early childhood was uneventful. Both of his parents are alive and healthy, and there is no family history of mental illness.
He was well dressed but appeared tearful and anxious, his speech was coherent, and he described his excessive fear of AIDS as irrational but was unable to resist being fearful. He had no abnormal perception, he believed that he had a psychiatric disorder, and he was seeking professional help.
The patient was diagnosed with hypochondriasis, started on fluoxetine 20 mg o.d., and was referred for cognitive behavioral therapy (CBT). He showed significant improvement of his symptoms and continued to attend CBT sessions.
What is hypochondriasis?
Hypochondriasis (also known as illness anxiety disorder) is a preoccupation that physical symptoms are signs of a serious illness, even when there is no medical evidence to support the presence of an illness. Both the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorize hypochondriasis under somatoform disorders. In hypochondriasis, patients make catastrophic overestimates of the probability and seriousness of having a medical illness that leads to preoccupation with the suspected illness, pay selective attention to illness-related stimuli, and experience irresistible urges to seek medical advice and reassurance to a degree that causes psychosocial impairment (Ewen 2004).
Excessive worries about one's health are also observed in patients with other mental health problems, such as obsessive-compulsive disorder (OCD ; Abramowitz, Brigidi, and Foa, 1999; McKay et al., 2004), generalized anxiety disorder (GAD) (American Psychiatric Association, 2000), and some types of specific phobias known as illness phobia (Marks, 1987).
According to international studies, the prevalence of hypochondriasis from the general population and primary care studies is estimated to be 0.02-8.5%, (Creed 2004) However, 10-20%.
of healthy people and 45% of those without a major psychiatric diagnosis have intermittently experienced worries related to illness anxiety.
A study from Germany found the prevalence of hypochondriasis to be low (0.58%) using less restrictive diagnostic criteria, while a study conducted in Australia reported the prevalence among general practice attendees to be 18.6%, with an increase in patients with depression and anxiety (Clarke et al. 2008 Nov 17;189 (10):560-4).
Hypochondriasis is equally common among both genders and all age groups, and is associated with significant disability and high health costs (Creed 2004). A study by Barsky concluded that patients with unexplained physical symptoms but no organic causes for them accounted for 16% of all medical costs, the number of patients with hypochondrias is rising with the annual cost on health services reaching to billions of dollars (Creed 2004).
Excessive worries about one's health are also observed in patients with other mental health problems, such as OCD, GAD, stress-related disorders (American Psychiatric Association, 2000), and some types of specific phobias known as illness phobia (Warwick & Marks, 1987). Hypochondriasis is a relatively persistent condition over time (Barsky 1998); the coexistence of anxiety and/or depression is common and is associated with chronicity of the disorder (Simon 2001).
One hypothesis on the causes of hypochondriasis suggests the occurrence of a perceptual amplifi cation of bodily sensations in the patient followed by cognitive misinterpretation of the origin of these sensations; another theory explains it as a socially learned illness behavior, eliciting interpersonal rewards such as getting sympathy from friends and family or being exempted from work. There is evidence supporting each of these views, but more investigation is needed (Warwick & Marks 1988).
On the other hand, studies on biological markers have revealed that decreased plasma neurotrophin 3 (NT-3) levels and platelet serotonin (5-HT) levels were reported in patients who met the DSM-4 criteria for hypochondriasis, compared to healthy control subjects. NT-3 is a marker of neuronal function and platelet 5-HT is a surrogate marker for serotonergic activity. (Brondino et al. Nov 2008;65 (5):435-9).
Hypochondriasis is a distressing disorder for the patients and it is often underrecognized and too costly for health-care services to manage. Patients with hypochondriasis usually refuse referral to psychiatrists, as they do not agree that their distress is psychologically-based, and therefore tend to visit general practitioners or specialists. Thus, the management of the hypochondriac patient usually occurs within the primary-care setting. Complicated and treatment-resistant cases are referred to psychiatrists.
Treatment guidelines recommend the three most-agreed upon modalities, which are reassurance/supportive therapy, CBT, and psychotropic drugs.
CBT works by challenging dysfunctional assumptions about illness and modifying behaviors of avoidance and reassurance-seeking.
People with hypochondriasis often consult a variety of specialists and may be reluctant to see a psychiatrist. Clinicians need to consider this condition in patients presenting with frequent medical problems without a physical cause, and to consider psychotherapy as a treatment modality. They also need to be able to communicate to patients the nature of the disorder and to encourage them to accept effective treatment.
This article is part of a campaign to increase health-care professionals' awareness about mental illness.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
|1||Owens K, Asmundson G, Hadjistavropoulos T, Owens T. Attentional bias toward illness threat in individuals with elevated health anxiety. Cogn Ther Res 2004;28:57-66.|
|2||Abramowitz JS, Olatunji BO, Deacon BJ. Health anxiety, hypochondriasis, and the anxiety disorders. Behav Ther 2007;38:86-94.|
|3||Warwick HM, Marks IM. Behavioural treatment of illness phobia and hypochondriasis. A pilot study of 17 cases. Br J Psychiatry 1988;152:239-41.|
|4||Creed F, Barsky A. A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 2004;56:391-408.|
|5||Barsky AJ, Fama JM, Bailey ED, Ahern DK. A prospective 4-to 5-year study of DSM-III-R hypochondriasis. Arch Gen Psychiatry 1998;55:737-44.|
|6||Buskila D. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol 2001;13:117-27.|
|7||Kirmayer LJ, Robbins JM. Three forms of somatization in primary care: Prevalence, co-occurrence, and sociodemographic characteristics. J Nerv Ment Dis 1991;179:647-55.|
|8||Thomson A, Page L. Psychotherapies for hypochondriasis. In: Turner-Stokes L, Nair A, Sedki I, Disler PB, Wade DT, editors. Cochrane Database of Systematic Reviews. No: 4. PB: John Wiley and Sons Ltd; 2007. p. 33-5.|