Do I or don't I have Huntington's disease?

Studies of the presymptomatic diagnosis of Huntington's disease have focused attention on the need to provide information and support to patients before and throughout the testing process. Many patients decline testing and many others test negative for the disease. An analysis of several clinical cases suggests that far from being an instance of irrational or paradoxical behavior refusal to undergo testing may be due to psychological identification with other family members and to the fear that this identification might be imperilled by the results of testing. This form of identification, which is distinct from the rational concept of lineage, involves a desire to represent the family, if needed via the development of an illness. Although unusually conspicuous in families affected with inherited diseases, this mechanism is probably operative in every individual.