Review Question - QID 213722

This patient with excessive concerns about having a brain tumor with only minor symptoms of head and neck pain likely has illness anxiety disorder.

Illness anxiety disorder falls in the differential diagnosis for somatic symptom and related disorders, which are characterized by the lack of conscious effort for primary or secondary gain. Illness anxiety disorder involves a fear of having a serious illness that lasts for greater than 6 months. Some patients may have mild symptoms which are real, but symptoms can be absent as well. This preoccupation with illness leads to multiple medical encounters despite reassurance from providers. This differs from somatic symptom disorder in that patients with somatic symptom disorder have one or more physical symptoms which may be unexplained. The symptoms can range from mild to severe. This patient’s symptoms are more consistent with mild tension headaches or mild muscle pains; his excessive preoccupation with a brain tumor fall under illness anxiety disorder. Treatment for illness anxiety disorder include cognitive behavioral therapy and regular patient follow-up with the same provider, as well as avoiding unnecessary specialist referrals and diagnostic work-up.

Incorrect Answer:
Answer 1: Factitious disorder occurs when a patient deliberately fakes symptoms for primary gain. This does not involve an external benefit, but instead, the chief goal is to receive attention or sympathy as a patient.

Answer 3: Malingering occurs when the patient deliberately fakes symptoms for secondary gain. This is for external benefits such as time off from work or compensation for an illness.

Answer 4: Pain disorder involves chronic pain that can be multifactorial in nature. Psychologic factors can significantly impact the experience of pain. While this patient does endorse neck and head tightness, his preoccupation with having a brain tumor is out of proportion to his symptoms.

Answer 5: Somatic symptom disorder involves one or more physical symptoms that may be unexplained. Symptoms can be severe, so concern with the disease is not necessarily out of proportion to the symptoms. As with illness anxiety disorder, the patient also develops dysfunctional thoughts regarding disease in somatic symptom disorder.

Bullet Summary:
Illness anxiety disorder is characterized by excessive preoccupation with mild or absent physical symptoms and results in maladaptive behaviors associated with health.