Somatoform Disorders

Somatoform Disorders Adrianne Maltese, MN,GCNS-BC

Somatoform Disorders • Three central features of Somatoform Disorders: • Physical complaints without organic basis • Psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms • Symptoms or magnified health concerns are not under conscious control(Guggenheim2000)

Five Somatoform disorders • Somatization disorder • C/b multiple recurrent physical complaints over many years • No organic etiology for these complaints • Begins by age 30 • Pain, GI, sexual, pseudoneurologic symptoms: impaired coordination or balance,paralysis or localized weakness,difficulty swallowing, aphonia, urinary retention,hallucinations, loss of touch or pain sensation,double vision,amnesia,sensory losses,loss of consciousness (APA 2000 DSM IV-TR)

Interventions for somatization • Be aware of own responses • Rule out organic basis for complaints • Focus on anxiety reduction, mot physical symptoms • Minimize secondary gain(I.e. increased attention and decreased responsibilities)

Intervention –conversion d/o • Focus on anxiety reduction, not physical symptoms • Use matter-of-fact approach • Encourage client to discuss conflict • Minimize secondary gains • Provide diversionary activities • Encourage expression of feelings

Pain Disorder • C/b physical symptom of pain-one or more anatomic sites • May occur with a General medical condition • Pain –not relieved by analgesics • Onset,severity, exacerbation and maintenance affected by psychological stressors

Pain d/o interventions • Pain management • Encourage participation in activities • Provide distractions

Hypochondriasis • Client is preoccupied with fear that he/she has or will get a serious disease • History of seeing many doctors • Misinterpretation of bodily sensations or functions despite medical evaluations and reassurance • Preoccupation with symptoms is not as intense or distorted as in delusional disorder • Significant distress/impairment in function • Dependent behaviors/desires,demands attention

Hypochondriasis interventions • Rule out presence of actual disease • Focus on anxiety, not physical symptoms • Provide diversionary activities • Avoid negative responses to client demands/conference with staff • Provide client with correct information

Body Dysmorphic Disorder • Preoccupation with imagined or exaggerated defects in physical appearance • Causes clinically significant stressor impairment in social or occupational function… person may undergo repeated plastic surgeries for nose repair or to change face etc.

Dissociative Disorders DISSOCIATIVE AMNESIA: • One or more episodes of inability to recall personal information • Information is usually of a traumatic or stressful nature • Not due to effects of substance abuse

Dissociative Fugue • C/b sudden unexpected travel away from home or work • Unable to recall past(or where on has been) • Confused about personal identity/ or assumes new identity

Dissociative Identity Disorder • Individual demonstrates two or more distinct identities or personality states • Each personality is distinct • At least two of these personality states take control of the individuals behavior. • Unable to recall extensive personal information

Somatoform Disorders