Persistent worry or complaints regarding physical illness without supportive physical findings, repeatedly visiting a health care provider despite repeated reassurance and normal test results?

Appeared in: AIIMS Delhi NO - 2017

Explanation

The question describes the classic presentation of Hypochondriasis, which is now termed Illness Anxiety Disorder in the DSM-5.
Core features include a preoccupation with having or acquiring a serious illness, the absence of significant somatic symptoms, and a high level of anxiety about health.
The individual performs excessive health-related behaviors (like repeated doctor visits) or exhibits maladaptive avoidance, and the preoccupation persists despite appropriate medical evaluation and reassurance.
The patient's behavior is driven by anxiety about the meaning or cause of physical sensations, even if they are normal.

Why Other Options Were Wrong

Option A: Personality disorders are characterized by long-standing, pervasive, and inflexible patterns of behavior and inner experience that deviate from cultural expectations. While a person with a personality disorder might have health concerns, the primary issue is not a specific fear of illness but a broader pattern of maladaptive functioning.
Option B: Dissociative disorders involve a disruption or discontinuity in the normal integration of consciousness, memory, identity, emotion, and perception. The primary feature is a disconnection from reality or self, not a preoccupation with physical illness.
Option D: Depersonalisation disorder is a type of dissociative disorder characterized by persistent or recurrent feelings of being detached from one's own mental processes or body (depersonalization) or from one's surroundings (derealization). The focus is on a feeling of unreality, not on the belief of having a specific disease.

Related Visual

Clinical Relevance

Nursing practice connection: Knowing Somatic Symptom and Related Disorders helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses play a crucial role in managing patients with illness anxiety. The primary nursing intervention is to build a therapeutic, trusting relationship, acknowledge the patient's distress as real, and shift the focus from finding a cure to coping with the anxiety.
It is vital to avoid reinforcing illness behavior. This means scheduling regular, brief appointments that are not contingent on new symptoms, and discouraging excessive diagnostic testing or 'doctor shopping'.
Patient education should focus on the role of stress and anxiety in producing physical sensations, and on developing healthy coping mechanisms.

How to Approach the Question

First, break down the question stem into key components: 1) persistent worry about illness, 2) no physical findings, 3) not relieved by reassurance, and 4) repeated doctor visits.
Next, evaluate each option against this set of components.
Recognize that the combination of high illness anxiety with minimal or no physical symptoms is the core definition of Hypochondriasis (Illness Anxiety Disorder).
Eliminate 'Personality disorder' as it describes broader, pervasive behavioral patterns, not a specific illness fear.
Eliminate 'Dissociative disorder' and 'Depersonalisation disorder' as they relate to disruptions in consciousness, identity, or perception of reality, not preoccupation with disease.

Concept Tested & Keywords

Concept Tested: Somatic Symptom and Related Disorders
Stem keywords: Persistent worry, physical illness, without supportive physical findings, repeatedly visiting, repeated reassurance, normal test results
Lead-in keywords: BEST, MOST RELEVANT CLUE
Clinical cues: The key cue is the mismatch between the patient's high level of worry and the objective medical evidence, which is normal.

Question ID

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Reference Book

E6 Medicine Davidson Principles Practice 24e p. 1222-1224

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 15606-15608

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1441-1443

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