A patient is excessively worried about having a serious illness despite medical reassurance and normal reports. This condition is called:

1. A

   Somatization disorder

2. B

   Illness anxiety disorder

3. C

   Conversion disorder

4. D

   Factitious disorder

Appeared in: NORCET 9 Mains - 2025

Explanation

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• Illness Anxiety Disorder (formerly known as hypochondriasis) is defined by a preoccupation with the fear of having a serious illness.
• This fear persists despite appropriate medical evaluation and reassurance that no significant illness is present.
• Individuals with this disorder have either no somatic symptoms or, if present, they are very mild.
• The core issue is the distressing and excessive anxiety about health, not the physical symptoms themselves.

Why Other Options Were Wrong

• Option A: Somatic Symptom Disorder (formerly Somatization Disorder) is characterized by one or more distressing physical symptoms (like pain or fatigue) and excessive thoughts or behaviors related to those symptoms. The patient's focus is on the symptoms, not primarily the fear of a specific disease.
• Option C: Conversion Disorder involves symptoms of altered voluntary motor or sensory function (e.g., paralysis, blindness, or non-epileptic seizures) that are incompatible with recognized neurological or medical conditions. The patient in the scenario does not present with such neurological symptoms.
• Option D: Factitious Disorder involves the intentional falsification of physical or psychological signs or symptoms to assume the sick role. The patient consciously creates or fakes the illness for attention and medical care, which is not the case here; the patient's worry is genuine.

Related Visual

• Visual 1: Comparison Table - A table differentiating the key features of Illness Anxiety Disorder, Somatic Symptom Disorder, Conversion Disorder, and Factitious Disorder, focusing on the presence of symptoms, the nature of the patient's belief, and motivation.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differential diagnosis of somatic symptom and related disorders to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a crucial role in managing patients with Illness Anxiety Disorder by building a therapeutic, trusting relationship.
• Management involves scheduling regular, brief appointments to provide reassurance and reduce anxiety-driven 'doctor shopping,' rather than focusing on the feared illness.
• It is vital to avoid ordering unnecessary and repeated diagnostic tests, as normal results often provide only temporary relief and can reinforce the health anxiety.

How to Approach the Question

• First, analyze the core complaint in the question stem. Is the patient focused on a physical symptom, or the fear of an illness?
• Identify the key phrase: 'excessively worried about having a serious illness.' This points to anxiety as the primary driver.
• Note the modifying clause: 'despite medical reassurance and normal reports.' This rules out an actual, undiagnosed medical condition.
• Evaluate the options based on their core definitions: Somatic Symptom Disorder (focus on symptoms), Illness Anxiety Disorder (focus on fear of illness), Conversion Disorder (neurological symptoms), and Factitious Disorder (intentional deception).
• Select the option that best matches the patient's primary focus on fear and anxiety in the absence of significant physical findings.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of somatic symptom and related disorders.
• Stem keywords: excessively worried, serious illness, medical reassurance, normal reports
• Lead-in keywords: is called
• Clinical cues: The key cue is the discrepancy between the patient's high level of worry and the objective medical findings (normal reports and reassurance), which points away from a physical illness and towards a health anxiety condition.

Question ID

Q7GecuR3GJxdef7vA3-iFb

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