Case Report
Dental Fetish as Somatic Coping: Managing A Case of PTSD Misdiagnosed as Bipolar Disorder
- Parinda Parikh 1*
- Aatish Dutta Bhatta 2
- Shaurya Kumar Singh 3
- Himani J. Suthar 4
- Arnesh Shukla 5
- Avinash-Reddy Kesavarapu 6
- Parthiv Pansuriya 7
- Arushi Parikh-Kaushik 8
- Mahiya Buddhavarapu 9
- Zoe Gellert 10
- Sahia Manepalli 11
- Mina Oza 12
1Department of Psychiatry, Weill Cornell Medical College, White Plains, USA.
2KIST Medical College and Teaching Hospital, Lalitpur, Nepal.
3Pravara Institute of Medical Sciences, Loni, Maharashtra, India.
4GMERS Medical College and Civil Hospital, Gandhinagar, India.
5St. Martinus University, Willemstad, Curacao.
6University of Pittsburgh, Pennsylvania, USA.
7Government Medical College Surat, India.
8NYU Steinhardt School of Culture, Education, and Human Development, New York, USA.
9University of Pittsburgh, Pennsylvania, USA.
10Tulane University, New Orleans, USA.
11University of South Florida, USA.
122ND ARC Associates, White Plains, USA.
*Corresponding Author: Parinda Parikh, Department of Psychiatry, Weill Cornell Medical College, White Plains, USA.
Citation: Parikh P, Aatish D. Bhatta, Shaurya K. Singh, Himani J. Suthar, Shukla A, et al. (2025). Dental Fetish as Somatic Coping: Managing A Case of PTSD Misdiagnosed as Bipolar Disorder, Journal of Clinical Research and Clinical Trials, BioRes Scientia Publishers. 4(4):1-3. DOI: 10.59657/2837-7184.brs.25.059
Copyright: © 2025 Parinda Parikh, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: June 16, 2025 | Accepted: July 01, 2025 | Published: July 07, 2025
Abstract
Background: Post-traumatic stress disorder (PTSD) can masquerade as other mood disorders, particularly bipolar disorder (BD), because of shared symptoms such as sleep disturbance, irritability, and mood lability. Unconventional coping behaviors may further cloud the clinical picture and delay appropriate care.
Case Presentation: A 30-year-old man was referred after failing to improve on high dose lithium, valproate, and olanzapine prescribed for presumed BD. Careful reassessment uncovered childhood trauma, flashbacks, nightmares, and a distinctive coping pattern. The patient would cope by making compulsive, unnecessary dental appointments driven by fantasies of facial contact during examinations. These findings led to a revised diagnosis of PTSD with a maladaptive somatic coping strategy.
Management and Outcome: Mood stabilizers were tapered and the patient was initiated on prazosin, clonazepam, lamotrigine, naltrexone, and a short course of olanzapine, alongside trauma-focused psychoeducation. Persistent dental visit urges were addressed with dialectical behavior therapy. Within three months, intrusive memories, hyperarousal, and sleep disturbances had substantially decreased, and the frequency of elective dental visits fell from several per month to none.
Conclusion: Symptom sharing between two different psychiatric illnesses, such as PTSD and BD can lead to misdiagnosis of the condition in the patient. Evaluating cases like this in a more thorough manner can prevent misdiagnosis and polypharmacy. Eventually appropriate diagnosis can lead to the administration of correct medications and therapy, which eventually leads to improvement in symptoms of the patient's condition.
Keywords: post-traumatic stress disorder; bipolar disorder; dental fetish; 30-year-old man
Introduction
Post-traumatic stress disorder (PTSD) is characterized by exposure to a traumatic event(s), presence of the intrusion symptoms associated with the traumatic event(s), avoidance behavior, negative changes in mood and cognition, changes in arousal and reactivity; present for more than one month causing clinically significant impairment in daily life and functioning that is not attributable to substance use or other medical condition, with or without dissociative symptoms or delayed expression [1]. In a study done among adults in the USA, the lifetime prevalence of PTSD was 6.8% [2]. In clinical settings, PTSD can sometimes present as other psychiatric conditions due to the overlap between mood symptoms, and is often subject to misdiagnosis [3]. One such example is PTSD being misdiagnosed as bipolar disorder (BD). Symptoms such as sleep disturbance, difficulty concentrating, increased risk-taking behavior, loss of interest in usual activities, feelings of excessive or inappropriate guilt, increased irritability, and persistent negative emotional state are present in both PTSD and BD, making the accurate diagnosis often challenging [4].
This diagnostic challenge might affect the correct prescription of medication and the appropriate plan of care, delaying the patient’s overall well-being. We present a case of a 30-year-old male with PTSD, initially misdiagnosed as BD, who, after undergoing treatment for PTSD, showed significant clinical improvements. However, interestingly, he had developed a fetish for multiple unnecessary dental visits as a coping mechanism for his trauma. This study aims to showcase a unique presentation of dental fetish as a coping strategy for trauma, the role of accurate diagnosis and early interventions in the prognosis of PTSD, plus the behavioral intervention for the holistic management of unhelpful coping strategies, sometimes presenting as an addiction.
Case Presentation
A 30-year-old man first presented to the office with the chief complaint of difficulty concentrating, restlessness, difficulty falling asleep, frequent outbursts of anger, decreased interest in activities, and erratic mood swings. He had a history of overdosing on his prescription medications, which, according to him, was to “get rid of stress.” He was initially diagnosed with BD at another clinic before presenting at our office. He was on olanzapine 50mg BD, Lithium 1400 mg, and sodium valproate 1200mg, but didn’t respond. Upon further inquiry, the patient reported underlying childhood trauma (unspecified) and the associated flashbacks and nightmares regarding the traumatic event. As a result, he had built a unique coping strategy. He developed a fetish for dental visits. He would schedule multiple dental visits for no apparent reason. He fantasized about the idea of him “being touched in the face and beard” by the dentist. He was started on medications like prazosin, clonazepam, lamotrigine, naltrexone, and a short course of olanzapine, and gradually tapered off his previous medications. He responded well to the medicines, but the fetish for dental visits persisted. He was then started on behavioral therapy with a clinical psychologist. After several sessions, he significantly improved his urge for dental visits. During his latest psychiatry office visit, when asked if he still had the urge for dental visits over the past month, he replied, “Almost never.”
Discussion
This case highlights the complexity in the management of PTSD due to the overlap of its symptoms with bipolar disorder (BD), and the development of unique coping strategies like fetish behaviors, in patients with a history of trauma. This presentation also underscores the importance of providing a comprehensive evaluation for early diagnosis of PTSD which yields a better overall outcome with appropriate pharmacological and behavioral intervention. Emphasising the distinction between PTSD and BD is vital when providing adequate care, as they have considerable overlap. Management of BD includes mood stabilizers and antipsychotics; in contrast PTSD utilizes trauma focused therapies along with SSRIs, alpha adrenergic antagonists like prazosin and anxiolytics [5].
Unconventional coping mechanisms are not unusual in PTSD, but are typically neglected. The rise of compulsive behaviors is indicative of the individual attempting to regulate their emotional distress [6]. As presented in the case, the patient has nurtured a fetish towards dental care, envisioning facial and beard contact during appointments without any evidence of requiring dental attention. A psychodynamic perspective brings forth this ideology that such fetishistic behaviors can be a method of simulating helplessness, control, or affection [7]. In accordance with the somatic experiencing model puts forth that trauma may be “restrained” within the nervous system, generating compulsive behavior through somatosensory channels [8]. Hence, the dental visits may be a result of somatically driven recreation, allowing for a controlled clinical setting to regain control over their body.
To address the patient’s symptoms, initial stabilization was required through pharmacotherapy, which included medication like prazosin, clonazepam, lamotrigine, naltrexone, and a short course of olanzapine. The patient showed symptomatic improvements; however, fetishistic behaviors toward dental visits remained. As a result, the patient was encouraged to attend dialectical behavioral therapy (DBT). The therapy played a crucial role as it was geared to reduce the dependence on unconventional coping mechanisms. With that rationale, DBT was the best approach, as evidence highlights efficacy in treating individuals with compulsive fetish behaviors [9].
Overall, this case delves deeper into providing a broad outlook on the clinical manifestation of PTSD. Additionally, it emphasizes the need for an extensive understanding of a patient's history when presenting with symptoms such as peculiar coping behaviors. This provides an insight to clinicians that trauma may present in nontraditional forms, which can be seen as uncorrelated to psychiatric conditions. In summary, there are crucial components to providing holistic care in patients with PTSD: diagnostic attentiveness and a proper integration of care strategies.
Conclusion
This case explained how the case of PTSD can be misdiagnosed with BD. Initially, because of his behavioral abnormalities, his symptoms were classified as a mood disorder; however, when we look deeply into his past medical history, some parts of the behavioral symptoms can be explained as a coping mechanism. What might have seemed like strange behavior was his way of trying to cope with emotional pain he didn’t yet know how to process. When he was correctly diagnosed with PTSD, he was treated with appropriate medications and therapy, and his symptoms improved significantly. This case shows a hidden trauma that cannot always present in the typical way of PTSD; we have to evaluate cases like this in a more precise way. Eventually, appropriate medications and therapy can help persons to heal correctly.
References
- Center for Substance Abuse Treatment. (2014). Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. Substance Abuse and Mental Health Services Administration (US): Rockville, MD, USA.
Publisher | Google Scholor - National Institute of Mental Health. (2025). Post-traumatic stress disorder (PTSD) prevalence statistics. National Institutes of Health.
Publisher | Google Scholor - Carmassi, C., Bertelloni, C. A., Cordone, A., Cappelli, A., Massimetti, E., et al. (2020). Exploring Mood Symptoms Overlap in PTSD Diagnosis: ICD-11 and DSM-5 Criteria Compared in a Sample of Subjects with Bipolar Disorder. Journal of Affective Disorders, 276:205-211.
Publisher | Google Scholor - Cogan, C. M., Paquet, C. B., Lee, J. Y., Miller, K. E., Crowley, M. D., et al. (2021). Differentiating the Symptoms of Posttraumatic Stress Disorder and Bipolar Disorders in Adults: Utilizing a Trauma-Informed Assessment Approach. Clinical Psychology & Psychotherapy, 28(1):251-260.
Publisher | Google Scholor - Raskind, M. A., Peterson, K., Williams, T., Hoff, D. J., Hart, K., et al. (2013). A Trial of Prazosin for Combat Trauma PTSD with Nightmares in Active-Duty Soldiers Returned from Iraq and Afghanistan. American Journal of Psychiatry, 170(9):1003-1010.
Publisher | Google Scholor - Van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., Spinazzola, J. (2005). Disorders of Extreme Stress: The Empirical Foundation of a Complex Adaptation to Trauma. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 18(5):389-399.
Publisher | Google Scholor - Scanavino, M. D., Guirado, A. G., Marques, J. M., Amaral, M. L. S. A. D., Messina, B., et al. (2023). Treatment Effects and Adherence of Sexually Compulsive Men in a Randomized Controlled Trial of Psychotherapy and Medication. Journal of Behavioral Addictions, 12(1):261-277.
Publisher | Google Scholor - Payne, P., Levine, P. A., Crane-Godreau, M. A. (2015). Somatic Experiencing: Using Interoception and Proprioception as Core Elements of Trauma Therapy. Frontiers in Psychology, 6:124489.
Publisher | Google Scholor - Harned, M. S., Korslund, K. E., Foa, E. B., Linehan, M. M. (2012). Treating PTSD in Suicidal and Self-Injuring Women with Borderline Personality Disorder: Development and Preliminary Evaluation of a Dialectical Behavior Therapy Prolonged Exposure Protocol. Behaviour Research and Therapy, 50(6):381-386.
Publisher | Google Scholor
