A person repeatedly visits a clinic with complaints of serious illness despite normal clinical examination and investigations. The patient genuinely believes that they are ill. What is the most likely diagnosis?

1. A

   Hypochondriasis

2. B

   Somatic symptom disorder

3. C

   Factitious disorder

4. D

   Conversion disorder

Appeared in: NORCET 10 Prelims-2026

Explanation

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• Hypochondriasis, now largely classified as Illness Anxiety Disorder, is defined by a preoccupation with having or acquiring a serious illness.
• A key diagnostic criterion is that somatic (physical) symptoms are not present, or if they are, they are only mild in intensity.
• The patient's anxiety is not about the symptoms themselves but about the meaning, significance, or cause of the supposed illness.
• The scenario describes a patient with complaints but normal findings, whose core issue is a persistent, genuine belief of being ill, which perfectly matches the profile of Hypochondriasis.

Why Other Options Were Wrong

• Option B: Somatic Symptom Disorder requires the presence of one or more significant and distressing physical symptoms (like pain or fatigue) that cause excessive concern. The question implies symptoms are absent or not clinically significant ('normal clinical examination').
• Option C: Factitious Disorder involves the intentional faking or production of symptoms to assume the 'sick role' for internal psychological gain. The question explicitly states the patient 'genuinely believes' they are ill, ruling out conscious deception.
• Option D: Conversion Disorder (Functional Neurological Symptom Disorder) is characterized by specific, unexplained neurological symptoms, such as paralysis, blindness, seizures, or loss of sensation. The question does not mention any such neurological deficits.

Related Visual

• Visual 1: Flowchart: A decision tree flowchart starting with 'Patient complains of illness.' Branches would include 'Are symptoms intentionally produced?' (Yes -> Factitious), 'Are symptoms present?' (No -> Illness Anxiety; Yes -> 'Are they neurological?' Yes -> Conversion; No -> Somatic Symptom Disorder). This visual would clarify the diagnostic pathway.
• Visual 2: Infographic: A comparative table infographic visually highlighting the core features (Intent, Symptoms, Primary Concern) of Hypochondriasis, Somatic Symptom Disorder, Factitious Disorder, and Conversion Disorder.

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 must build a therapeutic, non-judgmental relationship with these patients. Dismissing their concerns as 'all in their head' is counterproductive and damages trust.
• The nursing focus is on managing the patient's anxiety and distress, rather than on finding a non-existent physical illness. Interventions include acknowledging their suffering, setting limits on medical testing discussions, and redirecting focus to coping strategies.
• What if? If the patient was found to be secretly taking a substance to induce vomiting before each clinic visit, the diagnosis would shift from a somatic disorder to Factitious Disorder, as this demonstrates intentional production of symptoms.

How to Approach the Question

• First, analyze the patient's core belief and intent. The stem says the patient 'genuinely believes' they are ill. This immediately makes you question any disorder based on deception (like Factitious Disorder).
• Next, evaluate the nature of the symptoms. The stem says 'normal clinical examination and investigations.' This suggests physical symptoms are absent or minimal.
• Now, compare the remaining options. Somatic Symptom Disorder requires significant physical symptoms. Hypochondriasis is characterized by fear of illness without significant symptoms.
• Based on the absence of significant symptoms and the presence of genuine fear, Hypochondriasis is the most logical fit.
• Eliminate Conversion Disorder as there is no mention of specific neurological symptoms.
• Confirm your choice: The patient's presentation (fear of illness, no physical findings) is the classic definition of Hypochondriasis.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of somatic symptom and related disorders.
• Stem keywords: repeatedly visits, complaints of serious illness, normal clinical examination, genuinely believes
• Lead-in keywords: most likely diagnosis
• Clinical cues: The cue 'genuinely believes' is critical for ruling out disorders involving intentional deception, such as Factitious Disorder or Malingering.
• Clinical cues: The cue 'normal clinical examination' is key to differentiating between disorders focused on fear of illness (Hypochondriasis) versus those focused on existing symptoms (Somatic Symptom Disorder).

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