Body Dysmorphic Disorder In An Adolescent Male Secondary to HIV-related Lipodystrophy: A Case Study

Kenn M Kirksey; Brian K Goodroad; Ellen A Butensky; Mary Holt-Ashley

摘要

This article presents a case study of a 17-year-old male with acquired immunodeficiency syndrome (AIDS), experiencing significant body changes secondary to human immunodeficiency virus (HIV) treatment. These physical changes led to dysfunctional preoccupation with his appearance and suicidal behavior, and he was eventually diagnosed with body dysmorphic disorder (BDD). This paper reviews the concepts of BDD and metabolic changes, with particular emphasis on lipodystrophic changes related to HIV medications. Sociodemographic characteristics, clinical manifestations, and treatment modalities with special focus on the role of the nurse practitioner in recognizing and managing these conditions are presented. Acknowledgements:The first three authors were supported during the preparation of manuscript by the National Institute of Nursing Research, NIH, HIV/AIDS Nursing Care and Prevention (T32 NRO7081), William Holzemer, RN, PhD, FAAN, Project Director. Thank you to Dr. William Holzemer and Dr. Eli Haugen Bunch for their thoughtful review and editorial assistance in the preparation of this article. Thank you to Jason W. Mowery, RN, BSN for his contributions to an earlier draft of this paper. Introduction Adolescence is challenging to even physically and emotionally healthy young adults. Physical changes occurring during this period of development add significant life stressors. For the teenager with human immunodeficiency virus (HIV) disease, these problems are dramatically compounded. This article presents a case study of a 17-year-old male with acquired immunodeficiency syndrome (AIDS), experiencing significant body changes (fat redistribution known as lipodystrophy) associated with HIV treatment. These physical alterations led to dysfunctional preoccupation with his appearance and suicidal behavior, and he was diagnosed with body dysmorphic disorder (BDD). This article reviews the concepts of BDD and lipodystrophy, related sociodemographic characteristics, clinical manifestations, and treatment modalities, with special emphasis on the role of the nurse practitioner in recognizing and managing these conditions. Case Study A young man named Alex (pseudonym) was admitted to the emergency department (ED) unresponsive with labored breathing. A male friend who accompanied him stated, “about a half hour ago, Alex threw up and it looked like blood.” Triage assessment revealed pallor, respiratory distress, diaphoresis and cool skin. Vital signs were: temperature 37.8 C, heart rate 134 beats/minute, respirations 34 per minute, and blood pressure 88/48 mm Hg. Usual emergency protocols were performed, including nasotracheal intubation and ventilator support. During intubation, the physician noted that the patient’s breath smelled like gasoline. Upon further questioning, it was determined that he had attempted suicide by drinking gasoline siphoned from a lawnmower. His friend noted that Alex “was coughing so hard” after ingesting the liquid.The patient’s mother, Janet (pseudonym), arrived thirty minutes after he was admitted to the ED. She shared that her son had been diagnosed HIV positive 13 months ago and had “really been down lately.” She indicated that he had been taking Combivir TM (lamivudine/zidovudine) and Crixivan TM (indinavir) for twelve months. She also reported that he had an undetectable viral load (Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1987.2 Generally, the male-to-female ratio of BDD is one-to-one. The majority of the patients (75%) have never been married.3 Often, health care providers mistakenly identify symptoms of BDD as an obsessive-compulsive disorder (OCD). Phillips, Gunderson, Mallya, McElroy and Carter1 conducted a survey to determine the similarities and differences between BDD (n = 53) and OCD (n = 5), in those persons with both disorders (n = 33). These researchers also assessed the rate of BDD among 62 subjects initially diagnosed with OCD. Nine (14.5%) of the subjects with OCD had co

机译：本文提供了一个案例研究，该案例研究了一名患有获得性免疫缺陷综合症（AIDS）的17岁男性，该疾病在人类免疫缺陷病毒（HIV）治疗之后发生了明显的身体变化。这些身体变化导致他的外表和自杀行为导致功能失调，最后被诊断出患有身体畸形症（BDD）。本文回顾了BDD和代谢变化的概念，特别强调了与HIV药物相关的脂肪营养性变化。介绍了社会人口统计学特征，临床表现和治疗方式，重点关注护士从业人员在识别和管理这些疾病中的作用。致谢：在手稿的准备过程中，前三名作者得到了美国国立卫生研究院，美国国立卫生研究院，HIV / AIDS护理和预防研究所（T32 NRO7081），威廉·霍尔泽默（RN），博士，FAAN，项目总监的支持。感谢William Holzemer博士和Eli Haugen Bunch博士在撰写本文时进行了周到的审查和编辑帮助。感谢BSN的RN的Jason W. Mowery对本文的早期草案所做的贡献。简介青春期对身体和情感上健康的年轻人都是充满挑战的。在这一发展时期发生的身体变化会增加生活压力。对于患有人类免疫缺陷病毒（HIV）疾病的青少年，这些问题更加复杂。本文提供了一个案例研究，该案例研究了一名患有后天免疫机能丧失综合症（AIDS）的17岁男性，该人经历了与HIV治疗相关的重大身体变化（脂肪再分配称为脂肪营养不良）。这些身体上的变化导致他的外表和自杀行为导致功能失调，并被诊断患有身体畸形症（BDD）。本文回顾了BDD和脂肪营养不良的概念，相关的社会人口统计学特征，临床表现和治疗方式，并特别强调了护士从业者在识别和管理这些疾病中的作用。案例研究一名名为Alex（化名）的年轻人因呼吸困难而被送往急诊科（ED）。一位陪同他的男性朋友说：“大约半小时前，亚历克斯吐了出来，看上去像鲜血。”分流评估显示苍白，呼吸窘迫，发汗和皮肤凉爽。生命体征为：温度37.8摄氏度，心率134次/分钟，呼吸每分钟34次，血压88/48毫米汞柱。进行了常规紧急方案，包括气管插管和呼吸机支持。插管过程中，医生注意到病人的呼吸闻起来像汽油。经进一步询问，确定他曾试图通过喝割草机虹吸的汽油来自杀。他的朋友指出，亚历克斯（Alex）摄入液体后“咳嗽得很厉害”。患者的母亲珍妮特（化名）在接受急诊科治疗30分钟后到达。她分享说她的儿子在13个月前被诊断出HIV阳性，并且“最近真的病倒了”。她表示他已经服用了Combivir TM（拉米夫定/齐多夫定）和Crixivan TM（indinavir）十二个月了。她还报告说他的病毒载量无法检测到（《精神障碍诊断和统计手册》（DSM-III）于1987.2）。通常，BDD的男女比例是一对一，大多数患者（75 3）通常，医疗保健提供者会错误地将BDD的症状识别为强迫症（Phillips，OCD）。Phillips，Gunderson，Mallya，McElroy和Carter1进行了一项调查，以确定BDD之间的异同（n在这两种疾病中（n = 33）分别为53和OCD（n = 5），这些研究人员还评估了最初诊断为OCD的62名受试者中BDD的发生率，其中9名（14.5％）患有OCD的受试者合作

Body Dysmorphic Disorder In An Adolescent Male Secondary to HIV-related Lipodystrophy: A Case Study

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