Abnormal illness behaviour and the sick role — C-L MEQ

(i) Definitions and axes (≈4 marks)

Sick role (Parsons teaching): rights — temporary role exemption; not held morally responsible for becoming ill. Obligations — desire to get well; seek competent help and cooperate.^[3]

Illness behaviour (Mechanic): monitoring, interpreting and acting on symptoms and using care systems.^[3]

AIB (Pilowsky): maladaptive perception/evaluation/action regarding health, disproportionate after adequate assessment, persists despite explanation.^[1]

This stem is illness-affirming, somatically focused (cardiac disease conviction, checking, high utilisation, work exit, family accommodation) — not illness-denying.^[2]

(ii) Differential and mapping (≈4 marks)

Working psychiatric formulations: illness anxiety disorder if residual somatic symptoms are mild and health anxiety dominates; SSD if distressing somatic symptoms plus disproportionate B-criteria; panic disorder comorbidity possible; depression (PHQ-9 14).^[8] AIB is formulation language, not a substitute code.^[1][8]

Factitious/malingering: require intentional production and (for malingering) external incentives — not supported by default here; avoid accusation without evidence.^[7] Keep organic door ajar for change/red flags despite extensive normal work-up.^[4]

(iii) Assessment (≈4 marks)

Alliance-first history of feared diseases, checking/reassurance/internet behaviours, prior explanations, function, family reinforcement, utilisation. MSE, suicide risk, substance use. Scales: health-anxiety/Whiteley lineage items, PHQ-15 if multi-symptom, PHQ-9/GAD-7. Collateral GP. Agree shared investigation thresholds and single medical home rather than endless loop monitoring without new indications.^[4][5]

(iv) Management (≈5 marks)

Both–and explanation (sensations real; threat system and behaviour maintain disability). Henningsen principles: scheduled reviews, limit unfocused specialist shopping, functional goals (return-to-work graded plan with partner education against permanent invalidism).^[4] CBT for health anxiety (Barsky; CHAMP medical-clinic CBT-HA).^[5][6] Treat depression with standard antidepressant pathway if indicated; no drug cures AIB as a construct.^[5] Non-collusion if later intentional features emerge.^[7]

(v) Prognosis and pitfalls (≈3 marks)

Better with engagement, treated mood, reduced iatrogenesis, family renegotiation of sick role. Pitfalls: pejorative dismissal; endless tests; missing suicide/depression; premature factitious label; closing organic door forever.^[1][4][7]