Delusional disorder can be treated with medication or cognitive-behavioral therapy. I once treated a young man who believed that his head was coming to a point, causing him tremendous emotional distress. An antipsychotic resulted in prompt remission.
By contrast, Ms. M has a delusional belief that food and medicine make her sick and could lead to anaphylaxis. She will not take medication, even in a hospital.
Perhaps someday we will find a neurobiological or biochemical cause for Ms. M’s behavior. Positron-emission tomography or augmented MRI could uncover such clues, but both tests require ingesting a foreign substance—something Ms. M will not do.
FOLLOW-UP: MS. M’S NEW LIFE
Having exhausted her savings and work disability benefits, Ms. M receives Social Security disability benefits. With her health insurance coverage having expired, she stops psychotherapy after 2 years and pursues no further medical workup.
Two years after presenting to me, she does not seem depressed but her presenting picture is unchanged. She sounds happy and cognitively intact. Her life revolves around her perceived disability.
Ms. M has spent much of the last 2 years alone in her apartment, content in her solitude. She has resumed playing tennis but only occasionally and has not resumed the sport for which she has won many awards. She says she feels slightly better but remains too tired to return to work. She has gradually expanded her menu to about a dozen foods. Despite her problems Ms. M, who is 5 feet 2 inches, has maintained her weight (114 lbs) and attractiveness.
All the while, Ms. M has refused medication. I repeatedly suggest hospitalization so that she can take psychotropics in a safe, supervised setting, but she declines.
Related resources
- Pilowsky I. Abnormal Illness Behaviour. New York: John Wiley & Sons, 1997.
- Isaac A, Wise T. A low-frustration strategy for treating somatization. Current Psychiatry 2003;2(8):32-50.
Drug brand names
- Fluoxetine • Prozac
Disclosure
Dr. Bernstein reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.