ABSTRACT
When the patient reports undergoing even routine medical or lab exams, for instance, we need to assess the degree to which the person may be experiencing unexpressed anxiety. When working with an individual who indicates a behavior management disorder (e.g., drug/alcohol misuse, unmanageable sexual behavior, self-mutilation), which reduces his or her anxiety, it is useful to, when appropriate, assist the patient in finding alternate routes for anxiety management. Anxiety may present as an impatient mood or disproportionate worry over relatively minor issues. Stressrelated somatic complaints may evoke fear, which becomes attached to the presence of HIV. For example, nervous stress may produce diarrhea, which frightens the long-term nonprogressor. The anxiety may then result in a skin rash. These symptoms may suggest to the person that HIV is at work. We need to be able to tolerate the anxiety ourselves and help the patient find soothing, thereby meeting some idealizing self-object needs.
