Rosh Psychiatry Board Practice Exam

A woman with chronic anxiety fixates on chest pain and fears a recurrent pulmonary embolism. What is her likely diagnosis?

1. Factitious disorder

2. Illness anxiety disorder

3. Malingering

4. Somatic symptom disorder

The correct answer is: Somatic symptom disorder

In this scenario, the woman is experiencing chronic anxiety and has a specific fixation on her chest pain, accompanied by the fear of a serious condition like a recurrent pulmonary embolism. This pattern suggests she is experiencing significant distress and impairment related to her physical symptoms, which aligns with the diagnostic criteria for somatic symptom disorder. Somatic symptom disorder is characterized by having one or more somatic symptoms that are distressing or result in significant disruption of daily life. The symptoms may or may not be explained by a medical condition, and the individual often experiences excessive thoughts, feelings, and behaviors regarding those symptoms. In this case, the woman's persistent fear regarding chest pain and the idea of a serious medical condition indicates an unhealthy preoccupation with her health that is typical for somatic symptom disorder. Illness anxiety disorder could be considered if the individual is primarily worried about having a serious illness despite having little to no somatic symptoms. However, in this case, the focus on specific physical symptoms (i.e., chest pain) coupled with the anxiety surrounding them leans more toward somatic symptom disorder. Factitious disorder involves intentionally producing or feigning symptoms for psychological gain, and malingering involves faking illness for external benefits (e.g., avoiding work). Neither of these