Differential Diagnosis for a 31-year-old Female with Severe Health Anxiety Convined She Has Stage 4 Metastatic Melanoma
- Single most likely diagnosis:
- Illness Anxiety Disorder: This condition is characterized by excessive worry about having a serious illness despite medical reassurance and minimal or no somatic symptoms. The patient's severe health anxiety and conviction of having stage 4 metastatic melanoma without evidence are key indicators of this diagnosis.
- Other Likely diagnoses:
- Hypochondriasis: Although now considered part of Illness Anxiety Disorder in DSM-5, it's worth noting as it specifically refers to a preoccupation with the fear of having, or the idea that one has, a serious disease based on a person's interpretation of bodily symptoms.
- Somatization Disorder: This involves multiple, recurring physical complaints or symptoms that have no clear medical cause but cause significant distress. While the primary focus here is on anxiety about a specific disease, somatization could be a factor if the patient reports various unexplained physical symptoms.
- Adjustment Disorder with Anxiety: If the health anxiety is triggered by a specific stressor and is causing significant impairment, this could be considered. However, the specific focus on a severe disease like metastatic melanoma leans more towards illness anxiety disorder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Actual Metastatic Melanoma: Although the patient's conviction is driven by anxiety, it's crucial to rule out the actual presence of melanoma or any other serious condition through thorough medical examination and diagnostic tests.
- Other Serious Medical Conditions: Conditions like lymphoma, other cancers, or chronic diseases that could be misinterpreted or overlooked due to the patient's anxiety about melanoma specifically.
- Rare diagnoses:
- Factitious Disorder (Munchausen Syndrome): A condition where a person repeatedly acts as if they have a physical or mental illness when they are not really sick. This could be considered if the patient is fabricating symptoms of melanoma for attention, though this would be less likely given the context of health anxiety.
- Delusional Disorder, Somatic Type: This involves persistent delusions related to bodily functions or sensations, which could include a fixed belief in having a specific disease. However, this is distinct from health anxiety in that it involves a delusional disorder rather than anxiety about illness.