Lesson 1: Clinical Disorders - Part A

Description

Voluntarily seeking treatment, a 28 year-old computer programmer describes fears that prevent him from going to see his terminally ill father-in-law in the hospital. He explains that he is afraid of situations relating to bodily injury or illness. He does not like to have a blood sample taken or to see or hear about sick people. He does not seek medical treatment when he is sick nor does he visit sick friends or family members. He avoids listening to descriptions of medical procedures, bodily trauma, or disease. He even became a vegetarian to avoid thinking about killing animals.

When the programmer was nine years-old, his Sunday school teacher gave a descriptive account of a leg operation. As the teacher spoke, the patient began to feel anxious and light-headed. He then began to sweat profusely until he fainted. He also told of his dislike of vaccinations and other regular medical procedures throughout his school career. He recounted frequent fainting episodes and near-fainting episodes whenever he saw a sick or disfigured person. Even into adulthood, he would faint if he observed the slightest physical wound or heard of an injury or illness. He told the doctor of his recent encounter in a store with someone who was confined to a wheelchair. He started to wonder if the person was in pain – so much so that he became distressed and fainted. He was very embarrassed when he regained consciousness. The patient described no other emotional problems, enjoyed work, had a good marriage, and had many friends.

Diagnosis

The computer programmer had a fear of thinking about or being near any situation involving physical injury or illness. While he continued to avoid situations that may elicit an episode of fainting, he acknowledged that his fear was irrational. Although the avoidance behaviour did not appear to affect his normal routines and social life, he was distressed about his fear and wished to rectify the situation. The programmer did not have an obsession regarding germs, so an OCD diagnosis was not warranted. Post-traumatic stress disorder was also not implied because he did not observe mutilation or injury on the battlefield. The diagnosis, therefore, was simple phobia - specifically, a blood-injury phobia. Like many others who have this phobia, the patient felt faint in the presence of the phobic stimulus. His DSM diagnosis for Axis I is simple phobia.