A 38-Year-Old Man Comes to the Office Stating That "My

question 513

Multiple Choice

A 38-year-old man comes to the office stating that "my skin is being eaten away by flesh-eating bacteria."  He has repeatedly used a stiff brush to apply antibacterial soap and disinfectant to the skin he insists is infected.  The patient describes a progression of itching and redness followed by intense, burning pain at infected sites that spreads almost daily to new body areas.  The patient systematically inspects his skin twice a day and records detailed descriptions of the affected areas.  He is able to fall asleep at night but awakens sometimes to scratch his skin.  He works as an accountant and has had a stable job performance.  Current medications include a multivitamin and acetaminophen as needed.  He drinks alcohol socially and does not use tobacco or illicit drugs.
Temperature is 36.5 C (97.7 F) , blood pressure is 122/76 mm Hg, and pulse is 62/min.  Physical examination reveals scattered lesions on his extremities that appear to have been caused by intense, abrasive scrubbing.  The remainder of the physical examination is unremarkable.
Which of the following is the patient's most likely psychiatric diagnosis?

• A)Body dysmorphic disorder
• B)Delusional disorder
• C)Illness anxiety disorder
• D)Obsessive-compulsive disorder
• E)Somatic symptom disorder

---

Definitions:

Incongruence

A psychological state characterized by a discrepancy between an individual's self-perception and their actual experience, leading to discomfort and anxiety.

Self-Concept

An individual’s understanding and evaluation of their own behaviors, attributes, and attitudes, which forms a coherent picture of who they are.

Actual Experience

The direct and personal involvement or participation in events or activities.

Conditional Affection

Conditional affection is an emotional response or feeling of love that is dependent on the other person meeting certain conditions or expectations.