Which psychiatric diagnosis best explains refusal to undergo a barium enema due to fear of radiation?

• A. Hysterical Personality
• B. Dissociative State
• C. Conversion Reaction
• D. Phobic Neurosis

Answer: (D)

A specific, excessive fear of a defined object or situation leads to avoidance of that thing, even when it’s medically necessary. In this case, the fear of radiation from a barium enema causes the patient to refuse the procedure, which fits a phobic pattern: a persistent, irrational fear that leads to avoidance and distress around the medical test.

Other patterns don’t match as well. A hysterical (histrionic) personality tendency would center on dramatic, attention-seeking behavior rather than a focused, avoidance-based fear of a specific medical procedure. A dissociative state involves disruptions of memory, identity, or consciousness, not a fear-driven avoidance of a test. A conversion reaction would present as neurological symptoms (weakness, paralysis, seizures) without a medical cause, rather than a fear-induced refusal.