Question:

A 28 years old mobile-phone salesperson presented with a twelve-month history of “俾鬼壓” (a feeling of a ghost having lain on top of her). She described a subjective sensation of being awake yet almost unable to move her body during these times. She found the experiences extremely distressing and as a result became afraid of falling asleep at night, especially while alone.

She believed that her problems were caused by malign demons or poltergeists. She therefore consulted several local practitioners of indigenous cults such as Taoist fashi and Shaman exorcists and moved house a couple times. These measures were of no avail.

She attended the surgery after she had lost faith in magic tricks involving supernatural powers. She had by now become exhausted from lack of sleep and was increasingly distressed by anxiety and fear towards the evening each day. She hoped that the doctor could help relieve her suffering and provide an explanation of her experience.

What are the issues that need to be considered before medical management is attempted?