Derealization/ Depersonalization

[peterg532]

Dear Doctor,

I had a risky sexual exposure 9 months ago. 7 days following this encounter, I started feeling strong lethargy, brain fog, fatigue, dizziness, dry eyes/mouth, night sweats, rash on chest/back, mouth ulcers, weight loss (14 pounds in 5 weeks), fat loss from face, shoulders, hands, legs; gaining fat around stomach, memory problems, inability to concentrate and think clearly etc. After multiple negative HIV and STD tests (last were 9 months post-exposure), I started investigating the psychological path. I found out that I probably suffer from derealization/depesonalization (DR/DP)problem. What I thought was brain fog and lethargy at the beginning is actually feeling like I live in a movie and detached from reality. That exactly describes my feelings. I have the following questions:

- If I really suffer from DR/DP, can it cause the other symptoms as well? Like chronic fatigue syndrome, dizziness, dry eyes/mouth, mouth ulcers etc.?
- Is it possible that DR/DP was triggered by HIV virus and I may still be HIV positive (if I am a very slow developer)?
- Is it possible to get rid of DR/DP after some time?
- Can HIV phobia start mental problems like DR/DP? Is it so common because I see many people complaining about similar symptoms after having risky sexual exposure and negative HIV tests.

Thank you for you answer!
Peter

[ronbelladog]

Wow a doctor that doesnt want to shove an antidepressant dow your throat before checking for actual physical illness..my hats off to you

[peterg532]

Thank you again, Dr. Mathur. I gained all weight back after some time however the fat distribution is different - more around stomach, less around eyes, on cheeks, on shoulders, hands, legs. All doctors I talked with about my problems were not able to find any reasonable answer to my issue (described fully in my posts above). They only blame anxiety. In my opinion that's a myth of current medicine - if there is not answer based on the limited # of tests, the mental health is to blame.

Thank you for understanding. All the best to you!

[Dr. Kokil Mathur]

If you suffered from IBS like symptoms before, then yes, push your doctor for more tests, especially to rule out Crohn's, celiac, IBS, ulcerative colitis, food intolerance and H pylori infection. Also, you must get a stool test to rule out amoebiasis, giardiasis and parasitic infections.
The symptoms are unlikely to be due to a psychological issue alone, unless you are now not eating as before. This can also cause weight loss. Also, if you are not eating as usual, you may not experience the IBS like symptoms.
Please discuss all these aspects with your doctor. Take care!

[peterg532]

Thank you for your answer, doctor. I was tested for all common STD's including HIV 1/2 multiple times and with negative results. The interesting part is that myself I don't feel stressed at all, so I am surprised I may suffer from anxiety or disorder like DR/DP. I used to have problems with my stomach before the encounter and also with IBS, but all this disappeared after I started experiencing weight loss and my current problems which surprised me a lot because these problems lasted 20+ years.

My doctor did some blood tests and all the results look fine. Now she keeps telling me that my only problem is anxiety and doesn't want to send me for any other test or exam which is quite frustrating for me because we didn't ruled out some other diseases as you also mentioned. Even the infectious diseases specialist didn't want to see me once he learned my HIV tests were negative. My doctor suggested taking Zoloft, but I refused for now because I don't want to be addicted to any kind of medication like this especially if we are not sure what it is exactly.

I would fully accept DR/DP as a cause of my problems, but what about photophobia, fatigue or sunken eyes I also suffer? Can these symptoms also have psychological base?? Should I push my doctor to do more exams and tests? Should I eventually change the doctor?

[Dr. Kokil Mathur]

Hi Peter!

Yes, risky sexual exposure can cause a lot of fears, especially, since you developed a plethora of symptoms thereafter. It is less likely to be derealization/depesonalization (DR/DP) disorder as you have many other symptoms. It appears more as over-anxiety, stress, post exposure stress disorder than DR/DP. However, DR/DP can co-exist with other medical problems, so only a detailed evaluation of your case can rule out DR/DP.
Yes, psychosis has been reported in HIV patients. However, often there are other underlying causes or it is the side effect of medications used. The most common type of psychosis in people exposed to risky sex is unexplained fear and worry of contacting HIV.

If you are a slow HIV developer, then you should test positive after six months at least. Also, since you had so many tests, possibility of a false negative test is ruled out. You could however, just find out, whether the tests you underwent only detects HIV-1 or is sensitive against HIV-2 as well. Of the two, HIV-2 is a less common infective strain and most usual HIV tests are for HIV-1. Architect HIV Ag/Ab Combo assay detects both HIV 1 and 2 and if positive, the Western Blot assay can be done to confirm.  

In a person suffering from weight loss, fatigue, rash and brain fog, the following conditions should be ruled out: anemia, bone marrow disorders and lupus. STDs which can present with a rash on body are syphilis, gonorrhea, Chlamydia, and herpes. So, check your STD panel and see if it included syphilis.

Also, Chlamydia tests are at times negative. You could discuss with your doctor and opt for specific tests for Chlamydia which include Nucleic acid amplification tests (NAAT, to find the genetic material of Chlamydia), Nucleic acid hybridization tests (DNA probe test, Enzyme-linked immunosorbent assay (ELISA, EIA), Direct fluorescent antibody test (DFA) or chlamydia culture.

Other than this, extreme stress associated with your worries could have triggered severe acidity with H pylori infection and gastric reflux, hypoglycemia, carcinoid syndromes, hyperthyroidism, and sleep disorders.

A comprehensive investigation is required keeping all the points in mind. Please consult your doctor regarding this. Hope you get well soon! Good Luck and take care!