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

1. A

   Factitious disorder

2. B

   Conversion disorder

3. C

   Illness anxiety disorder

4. D

   Dissociation

Appeared in: NORCET 9 Mains - 2025

Explanation

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• Illness anxiety disorder is defined by a preoccupation with having or acquiring a serious illness, where somatic symptoms are not present or are only mild.
• A core feature described in the stem is the persistence of this worry despite medical reassurance and normal diagnostic findings, which is a hallmark of the disorder.
• The patient's focus is on the idea of being sick, rather than on specific physical symptoms, which distinguishes it from Somatic Symptom Disorder.
• The anxiety is disproportionate to any actual health risk, leading to either excessive health-related behaviors or avoidance.

Why Other Options Were Wrong

• Option A: Factitious disorder involves the intentional falsification or induction of symptoms to assume the 'sick role.' The patient is consciously deceiving others. The scenario describes genuine worry, not deception.
• Option B: Conversion disorder (Functional Neurological Symptom Disorder) involves one or more symptoms of altered voluntary motor or sensory function (e.g., paralysis, blindness, seizures) that are incompatible with recognized neurological or medical conditions.
• Option D: Dissociation is a disruption in the usually integrated functions of consciousness, memory, identity, or perception. It includes conditions like amnesia or feeling detached from oneself (depersonalization). It is not primarily about fear of physical illness.

Related Visual

• Visual 1: Flowchart: A flowchart differentiating between Somatic Symptom Disorder, Illness Anxiety Disorder, Conversion Disorder, and Factitious Disorder based on key questions (Are symptoms present? Are they intentionally produced? Are they neurological?).
• Visual 2: Table: A comparison table detailing the core features, patient's intent, and typical presentation for each of the major somatic symptom and related disorders.

Clinical Relevance

• Nursing practice connection: Use the key finding related to 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 by building a therapeutic, trusting relationship, acknowledging their distress without reinforcing illness beliefs, and encouraging focus on coping with stress rather than seeking more tests.
• It is a patient safety issue to dismiss these patients' complaints entirely, as they can develop actual medical conditions. The nurse must balance validating the patient's feelings with avoiding unnecessary medical procedures.
• What if? If the patient was worried about a specific, distressing physical symptom (like chronic pain) that disrupts their life, and spent excessive time and energy focused on this symptom, the diagnosis would more likely be Somatic Symptom Disorder.

How to Approach the Question

• First, analyze the stem for the core components of the patient's presentation. Key elements are: 1) excessive worry about illness, 2) lack of supporting medical evidence ('normal reports'), and 3) failure of medical reassurance.
• Next, consider the primary motivation or experience of the patient. Is it a genuine fear, an actual physical symptom, a neurological deficit, or intentional deception?
• Evaluate each option against the clinical picture from the stem.
• Factitious disorder involves deception, which is not mentioned. Eliminate it.
• Conversion disorder involves specific neurological symptoms (like paralysis or blindness), which are not described. Eliminate it.
• Dissociation involves a break with identity or reality, not a health preoccupation. Eliminate it.

Concept Tested & Keywords

• Concept Tested: 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 combination of high anxiety about illness and the fact that medical tests are normal and reassurance is ineffective. This points away from a true physical illness and towards a specific psychiatric diagnosis.

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