La belle indifference in the context of somatic symptom disorders is best described as which of the following?

• A. An irrational, deliberate feigning of symptoms for external gain.
• B. An excessive fear of having a serious illness.
• C. A historical notion of indifference to symptoms; not required for diagnosis.
• D. A belief that symptoms are under voluntary control.

Answer: (C)

La belle indifference is a historical description of how some patients with somatic symptoms have appeared to react to those symptoms—showing a surprising lack of concern or distress about what would typically be viewed as serious. In the past, this indifference was thought to be characteristic of conversion disorders, but in modern practice it is not required for diagnosis and is not a reliable feature to rely on. The current approach to somatic symptom disorders centers on the presence of persistent somatic symptoms plus disproportionate thoughts, feelings, or behaviors related to those symptoms, or a high level of distress and impairment, rather than a person’s emotional response.

The other options don’t fit this concept. Deliberate feigning for external gain describes malingering, which is about intentional production or exaggeration of symptoms for tangible benefits. An excessive fear of having a serious illness aligns with illness anxiety disorder rather than indifference to symptoms. Believing that symptoms are under voluntary control contradicts the typical understanding that somatic symptoms are not consciously controllable in a way that would explain indifference.

So, the best description is that la belle indifference is a historical notion of indifference to symptoms, not required for diagnosis.