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Case Examples of People with Illness Fears and Unexplained Symptoms
Case 1. “Don’t make me go for a check-up” - the Avoider.
A 65 year old woman has been suffering for over 30 year with catastrophic fears that she might be diagnosed with a serious illness. Because she partly suspects that any physical symptom is a sign of a serious disease, she dreads going to the doctor for check-ups. She finds herself canceling appointments at the last minute and not following up on doctors’ recommendations for tests. Because of this avoidance, she has placed her physical health in jeopardy and she lives with daily terror that she has cancer slowly invading her organs.
Case 2.“Am I going to die doc?” – the Checker.
A 35 year old international businessman read an article about Avian Flu and, having been to Indonesia 1 year earlier, he is unable to get out of his mind the possibility that he might have contracted this deadly disease. He is somewhat reassured by the fact that he has not yet become deathly ill, but the fears reemerge with full strength whenever he gets a cough or feels his breathing is heavier than usual. He rushes to the doctor for a check-up and is temporarily reassured when the doctors indicates that there is no possibility he has Avian flu and that really this is just a mild upper respiratory illness. He feels fine for a week or two, then suddenly the fears return – either triggered by another article about Avian Flu or by a physical discomfort in his chest. This cycle of fear, checking, reassurance, and then fear again has been going on for the last 12 months and it appears to be getting worse.
Case 3.“I can’t deal with this illness.” – the overwhelmed woman.
A previously healthy 48 year old marketing executive who is very conscious about her diet and exercises regularly goes to her doctor and learns that she has signs of early diabetes. She is shocked and confused – “How could I develop diabetes when I’m not overweight and I eat carefully?” Most upsetting to her is that she feels a loss of control over her health and her future. To regain control, she self-monitors on a regular basis, checking her glucose not just once daily but 3-6x daily. Her physician tells her this is excessive. She calls the doctor urgently whenever a new symptom troubles her – be it a feeling of tingling in her fingers, floaters in her visual field, or feeling more tired. As her anxiety increases, she feels a sense of panic with racing heart beat, dry mouth, and an urgency to urinate. Her doctor tries to explain that dry mouth and an urgency to urinate also occur when a person is frightened, that these symptoms are temporally related to when she panics, and that she needs to get her fear of diabetes under better control. She hears this reassurance but she just feels dismissed. “How could he be taking these signs of worsening diabetes so lightly?” Her conviction that she will soon suffer a heart attack or stroke or go blind from diabetes increase over the months such that she lost focus at work and had to quit her job. Her family feels helpless as no amount of reassurance persuades her that her diabetes is not the main problem.
Case 4 with treatment.“The doctors aren’t telling me the truth.” – the frustrated and angry man.
A 25 year old contractor of Asian origin has become increasingly frustrated and angry with the medical profession because no one has been able to tell him the truth about why he has a burning uncomfortable sensation whenever he urinates. He has been to over 4 urologists and has had multiple procedures to identify the cause of these symptoms. The tests have identified mild urethral irritation but the doctors indicate that the patient’s degree of discomfort and distress far exceed the physical problem. This man suspects the doctors aren’t telling him the true cause of his symptoms – that he has a sexually transmitted disease that is slowly rotting away his body. He’s angered when they refer him to a mental health professional because, as he says, “I have a physical problem not a mental one”. He comes reluctantly. After hearing the psychiatrist explain that sometimes a neurochemical imbalance in the brain may lead to increased discomfort over physical symptoms and intrusive worrisome thoughts, he agrees to a trial of a medication known to help reduce obsessive thoughts. This medication, fluoxetine, results in gradual improvement that increases with time. His worry decreases, the sensation in his urethra becomes barely noticeable, and his personality changes from an irritable hostile one to his prior more agreeable self. He in fact is jubilant at the change and no longer fears that he has an undiagnosed serious illness.
Case 5 with treatment. “I’ve developed Lupus”- the despairing coed.
A 20 year old college student finds that she is becoming increasingly unable to focus on her studies as she is dwelling on a barely visible facial discoloration. A premed student, she suspects that she may have developed lupus and that the course of her future is now marked by that serious disease that can lead to severe suffering and death. Whenever she passes a mirror, she feels compelled to examine her face to see if the skin discoloration has developed into the classic butterfly rash of Lupus; each time as she approaches the mirror, she is filled with terror…but she can’t stop herself from checking. This terror and her secondary depression grow. She goes to a physician for an exam, quietly mentions the rash without revealing her suspicion of Lupus, and then when the doctor fails to really focus on it, she is too despairing to encourage further exploration. The physician indicates she is physically healthy. The college student is not reassured. She develops trouble sleeping. Each day is filled with greater dread. Finally, she hears about a treatment program for illness fears, comes for help, meets with a therapist for 10 sessions who helps her understand why these symptoms developed and how to cope better, and by session 5 she experiences a marked improvement of symptoms that is further enhanced by the remaining sessions. She feels she has been given her life back and is grateful to the therapist for having helped her overcome her illness fears.
