Biopsychosocial Aspects of Chronic Illness

A 17-year-old female was brought in complaining of severe chest pain and difficulty breathing after being raped in the subway. During the assault, she developed palpitations, followed by dizziness, and ultimately loss of consciousness. Her medical history is significant for multiple surgeries for congenital heart disease. At the time of admission she was on furosemide and digoxin therapy but her compliance was doubtful. Both her parents were afflicted with AIDS. She had expressed suicidal thoughts, was sexually active, rarely used condoms and no other methods of birth control, and was regularly using marijuana. Her cardiac condition was promptly stabilized with cardioversion, but this case illustrates the important aspects of the interaction of biopsychosocial factors and chronic illness in adolescence. Serious sequelae, such as noncompliance with medical regimens, unintended pregnancies, sexually transmitted disease, substance abuse, sexual victimization, and suicide attempts, can result from failure to address such concerns in a timely fashion.