American Board of Psychiatry and Neurology (ABPN) Practice Exam

A man believes he has a serious illness despite negative tests. What is the most appropriate diagnosis?

1. Somatic symptom disorder

2. Illness anxiety disorder

3. Factitious disorder

4. Malingering

The correct answer is: Illness anxiety disorder

The most appropriate diagnosis for a man who believes he has a serious illness despite negative tests is illness anxiety disorder. This condition is characterized by excessive worry about having or developing a serious illness. Individuals with this disorder often misinterpret bodily sensations or minor symptoms as indicative of severe health issues, leading to significant anxiety and preoccupation with health that persists even when medical evaluations are reassuring. In cases of illness anxiety disorder, the focus is on the anxiety related to the belief in having a serious illness, rather than the presence of actual physical symptoms. This differentiates it from somatic symptom disorder, where individuals experience actual physical symptoms that may or may not be explained by a medical diagnosis but are associated with significant distress or impairment. Furthermore, factitious disorder involves intentionally producing or feigning symptoms for the purpose of assuming the sick role, which does not apply here since the individual genuinely believes he is ill. Malingering also involves the deliberate production of symptoms, often for external incentives (such as financial gain), which is not relevant in this case as the man is not seeking tangible benefits through his belief of being ill. Thus, illness anxiety disorder accurately captures the focus on persistent concern about one's health without the presence of significant somatic symptoms, making it the most fitting diagnosis