I tested HIV-positive one year ago. My problem is that I feel very tired and stressed out and I think every minute, "O.K. this is it, I now have AIDS!" I go to the doctor all the time and the appointments always end in the same way. This is how it goes: after a minor examination my doctor states that there is nothing wrong with me and suggests I consider psychotherapy or taking medication to control my stress level. Then I feel like I am going crazy and I leave not knowing if I am really sick or I just think I am.
When I tell my friends or my parents I feel stressed, burned out and fed up, they think it's AIDS-related and encourage me to see my doctor. However, now my doctor has requested that I call him before coming in and to limit my medical visits to once a month, unless it is an emergency. Am I going crazy or am I becoming a hypochondriac?
A Response to this Composite Case Study
Wisely, your doctor has restricted your medical visits, suggested therapy and has indicated that he will prescribe medication for your anxiety. Please listen to what your medical doctor is telling you. Your exhaustion seems to be related to your own stress, not to your HIV status. Although this may be hard for you to consider please look at your own thoughts and how they may affect your health and daily outlook. How often do you think about your HIV status and how much do you think these thoughts effect how you feel?
People who are dealing with HIV are sometimes filled with stressful thoughts that can affect their perception of their mental and physical health. In time, these dysfunctional thoughts can impair one's sense of reality and ability to think reasonably about their HIV status.
A distortion of perception, coupled with a high stress level, is a no-win situation! Stress has been found to play a role in 50 to 70 percent of all physical illnesses and research in the field of psychoneurommunology has shown that stress can cause immuno-suppression, resulting in an increased risk for illness and premature death. Psychological studies with animals have also found that exposure to inescapable electric shocks reduces the production of lymphocytes, the white blood cells that help combat illness. Similar effects have been found among humans who are exposed to high levels of stress.
The most important first steps you can take is to lower your stress level. That can be a good, healthy start to gaining control over these overwhelming thoughts. On a more positive note, there is some evidence that laughter and positive states of mind can actually enhance the immune system. Thus, along with your doctor's orders, you should run -- don't walk -- to your video store and select comedy tapes that will make you laugh!
When discussing your situation with your family and friends, please keep in mind a common human trait that could contribute to your stress. People in general tend to make simple direct causal solutions when someone has informed them of their HIV status. Sadly this seems to be a common part of our human nature, so always keep this in your mind when you inform friends that you feel "sick." Friends and family mean well but they can make snap judgements about your health and your HIV status without fully taking into account all the other variables in life.
Overgeneralizations are not your "friend" when it comes to protecting your health. You really need to use your judgement in these conversations. Start by getting away from dichotomous thinking, or thinking in "either/or ways," and try to stay away from people who talk this way and continue to draw general conclusions (sickness = AIDS) on the basis of one event (testing HIV-positive). If you have friends who only point out the downsides or consistently remind you of your HIV status when you are feeling down, maybe you should consider staying away from those "downer" type of friends.
In one case study, an individual who worked as a waiter reported feeling "exhausted" to 5 medical professionals and requested information on anything he could do to feel less exhausted. He had also filled out a prewritten form indicating his sexual orientation, which was male homosexuality.
The medical professionals with no additional information all responded in the same way, "have you had an AIDS test." The fact that he was a waiter working full-time at night, attending college full-time during the day and living in a noise-filled studio apartment with 3 other people was not even considered in their assessment.
Thus, if medical professionals aren't considering any additional information in their responses, one could think that making quick, snap judgements is somehow acceptable or the "norm." It is human to think this way but we would naturally expect medical professionals to be above this type of thought process, but this may not always be the case. The point here is to see a doctor that you perceive as making logical, lengthy assessments and who chose their words wisely when discussing your own personal situation.
You state that you may be acting "like a hypochondriac" in your behavior, and I do hear this commonly from many people who have tested HIV-positive. However, I would stay away from clinical labels and focus more on unlearning what you have "learned" from your environment. Hypochondriacs' behavior is characterized by an unrealistic preoccupation with a serious illness based on a misinterpretation of bodily symptoms. The preoccupation persists despite a lack of medical evidence telling the person otherwise. People with hypochondria may present their medical illnesses in great detail. They often engage in "doctor shopping," believe that they're not getting proper care, and strongly resist referrals for psychological intervention. A possible real complication is that even an ethical physician may, due to the patient's long history of multiple complaints, overlook an actual serious medical need.
Always remember to consider how words can make you feel. When someone tells you that you look tired, does it make you feel more tired then you were previously? There is a part of the human makeup that takes in what other people's perceptions and beliefs are and then integrates those assumptions into one's self-identity. If enough people inform you numerous times about yourself, psychology tells us you are more likely to accept it as the "truth." If more than two people report you look sick or look stressed or exhausted does this mean it must be fact? Of course not, so attempt to do your own assessment at all times.
Always ask yourself these questions: Are you in a stressful working and living situation? Do others in your area have the cold or flu? Are you the only one who feels stressed? What are you doing to feel good, to relax, to enjoy life? Always try to remember that people seldom look at anything in a totally unbiased way. If you tell people you have HIV and then state you feel sick, they may make the simple connections that you are sick due to your HIV status and this can affect how you think and more importantly how you feel health wise. You could be just plain stressed out just like millions of other people everyday in the world.
The bottom line is to slow down and check yourself when you feel those negative thoughts coming on. Cut them off and replace them with rational positive objective thoughts. Be motivated to lower your stress level and seek out ways to enjoy life in a consistent daily way.
_J. Buzz von Ornsteiner, Ph.D., is a psychologist and behavioral consultant in New York City and will periodically write the "Psychologically Speaking" column.
Back to the May 2001
Issue of Body Positive