A 45 yrs old male came to the psychiatric OPD complaining of continuous, dull, non-progressive headache for the last 8 years. The patient has seen numerous neurologists in the belief that he has a brain tumor even though all his investigations have been normal. The patient insisted that he had a brain tumor and requested yet another workup. Psychiatric evaluation reveals disease conviction in the background of normal investigations. The most probable diagnosis is:
Patient in the question suffering from headache since 8 years believes that he has brain tumor despite of all the investigations being normal. His symptoms are suggestive of hypochondriasis. Essential feature of hypochondriasis, is a belief of serious medical illness that persists despite reassurance and appropriate medical evaluation. These patients have a history of poor relationships with physicians because of the feeling that they have been evaluated and treated inappropriately or in adequately. This disorder is disabling in intensity and is persistent, with waxing and waning symptomatology. Although somatization and somatoform disorders are similar, the major difference is that in somatization patient is not concerned about any paicular diagnosis e.g. cancer. They however are worried about symptoms e.g. aches and pains. Ref: Harrison's Principles of Internal Medicine, 18th Edition, Chapter 391
Hypochondriasis
Conversion disorder
Somatization disorder
Somatoform pain disorder