All medical test results are normal, but the patient persistently feels that something is abnormal in the body. This condition is known as:

1. A

   Somatization disorder

2. B

   Hypochondriasis

3. C

   Conversion disorder

4. D

   Delusion of persecution

Appeared in: NORCET 9 Mains - 2025

Explanation

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• Hypochondriasis, or Illness Anxiety Disorder, is defined by a preoccupation with the fear of having a serious illness.
• A key diagnostic criterion is that somatic (physical) symptoms are not present, or if present, are only mild in intensity.
• The patient's distress comes from the anxiety about what the perceived abnormality might mean, rather than from the physical sensation itself.
• This fear persists for at least six months, despite appropriate medical evaluation and reassurance that no serious illness is present.

Why Other Options Were Wrong

• Option A: Somatization Disorder (now largely included under Somatic Symptom Disorder) requires the presence of one or more significant, distressing physical symptoms (like pain or fatigue). The question implies a lack of symptoms, with only a persistent 'feeling' of abnormality.
• Option C: Conversion Disorder involves specific, unexplained neurological symptoms, such as paralysis, blindness, or non-epileptic seizures. The patient's complaint is a vague feeling of abnormality, not a loss of a specific neurological function.
• Option D: A delusion of persecution is a psychotic symptom characterized by a fixed, false belief that one is being conspired against, cheated, or harmed by others. This is unrelated to health anxiety.

Related Visual

• Visual 1: Flowchart: A decision tree to differentiate Somatic Symptom and Related Disorders. Start with 'Does the patient have physical symptoms?'. If no/mild -> Illness Anxiety Disorder. If yes -> 'Are they neurological?' If yes -> Conversion Disorder. If no -> Somatic Symptom Disorder.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differentiating Somatic Symptom and Related Disorders to guide bedside assessment, documentation, and the next nursing action.
• Nurses must build a strong therapeutic relationship based on trust and empathy, acknowledging the patient's distress without reinforcing the illness fears.
• Management involves scheduling regular, brief appointments that are not contingent on new symptoms. This helps contain the patient's anxiety and reduces 'doctor shopping'.
• The focus of care should shift from finding a physical cause to coping with anxiety. Cognitive Behavioral Therapy (CBT) is a primary treatment to help patients challenge their health-related fears and change their checking behaviors.

How to Approach the Question

• First, analyze the patient's primary complaint. Is it a specific physical symptom, or is it a fear/idea about being sick?
• The stem emphasizes a 'feeling' of abnormality despite 'normal medical tests'. This points away from disorders defined by clear physical symptoms.
• Evaluate the options based on this core distinction. Somatization and Conversion disorders involve tangible symptoms (general physical and neurological, respectively).
• Eliminate 'Delusion of persecution' as it belongs to the category of psychotic disorders and is not primarily about health.
• Select 'Hypochondriasis' (Illness Anxiety Disorder) as it best fits the description of fear of illness in the absence of significant physical symptoms.

Concept Tested & Keywords

• Concept Tested: Differentiating Somatic Symptom and Related Disorders
• Stem keywords: normal medical test, persistently feels, abnormal in the body
• Lead-in keywords: known as
• Clinical cues: Discrepancy between subjective feeling and objective medical findings is the central clue.

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