Chapter 19 Somatoform Disorders

1. Chapter 19Somatoform Disorders

2. Somatoform Disorders Definitions • Somatization is the transference of mental experiences and states into bodily symptoms • Somatoform disorders are the presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for them

3. 3 Central Features • Physical complaints suggest major medical illness but have no demonstrable organic basis • Psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms • Symptoms or magnified health concerns are not under the client’s conscious control

4. 5 Somatoform Disorders • Somatization disorder: multiple physical symptoms; combination of pain, GI, sexual, and pseudoneurologic symptoms • Conversion disorder: unexplained deficits in sensory or motor function associated with psychological factors; attitude of “la belle indifference” (lack of concern or distress) • Pain disorder: pain unrelieved by analgesics; psychological factors influence onset, severity, exacerbation, and maintenance • Hypochondriasis: preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia) • Body dysmorphic disorder: preoccupation with imagined or exaggerated defect in physical appearance

5. Onset and Clinical Course • Onset of symptoms usually occurs in adolescence or early adulthood • All the somatoform disorders are either chronic or recurrent • Clients will go from one physician or clinic to another, or they may see multiple providers at once in an effort to obtain relief of symptoms

6. Related Disorders • Malingering: the intentional production of false or grossly exaggerated physical or psychological symptoms; motivated by external incentives • Factitious disorder (also known as Munchausen syndrome): a person intentionally produces or feigns physical or psychological symptoms solely to gain attention In malingering and factitious disorders, people willfully control the symptoms. In somatoform disorders, clients do not voluntarily control their physical symptoms.

7. Related Disorders (cont’d) • Munchausen’s by proxy occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a “hero” for saving the victim

8. Etiology • Psychosocial theories: • Unconsciously expressing internalized stress through physical symptoms (somatization) • Primary gains are achieved when the direct external benefits of being sick provides relief of anxiety, conflict, or distress • Secondary gains are obtained when the person receives internal or personal benefits from others because one is sick • Biologic theories: • Familial tendencies • Differences in the way body stimuli are regulated and interpreted

9. Cultural Considerations • Somatization disorder is rare in men in the United States but more common in Greece and Puerto Rico • Men in India often have dhat, which is a hypochondriacal concern about loss of semen • Koro occurs in Southeast Asia and may be related to body dysmorphic disorder • Falling-out episodes, found in the southern United States and the Caribbean islands, are characterized by a sudden collapse • Hwa-byung is a Korean folk syndrome attributed to the suppression of anger and includes insomnia, fatigue, panic, indigestion, and generalized aches and pains • Shenjing shuariuo occurs in China and includes multiple symptoms

10. Treatment • Treatment is focused on managing symptoms, improving quality of life, and improving coping skills • Antidepressants are sometimes used for accompanying depression • Referral to a pain clinic is helpful in pain disorder • Involvement in therapy groups to improve coping and express emotions verbally has shown some benefit

11. Application of the Nursing Process: Somatization • Assessment • Investigate the client’s physical health status thoroughly to rule out underlying pathology requiring treatment • History: client likely provides a detailed medical history; quite distressed about their health status (except the client with conversion disorder, who displays la belle indifference)

12. Application of the Nursing Process: Somatization (cont’d) • Assessment (cont’d) • General appearance and motor behavior: normal • Mood and affect: may be labile, shifting from sad and depressed (describing physical ailments) to bright and excited (describing trips to healthcare providers) • Thought processes and content: intact; content is about physical symptoms; vague in their description but use colorful, exaggerated terms

13. Application of the Nursing Process: Somatization (cont’d) • Assessment (cont’d) • Sensorium and intellectual processes: alert and oriented • Judgment and insight: little or no insight; judgment may be affected by exaggerated responses to physical health concerns • Self-concept: low self-esteem, lack of confidence, difficulty coping

14. Application of the Nursing Process: Somatization (cont’d) • Assessment (cont’d) • Roles and relationships: difficulty fulfilling family roles; few friends or social activities; may report lack of family support • Physiologic and self-care concerns: legitimate health concerns may include disturbed sleep patterns, poor nutrition, lack of exercise, overuse of prescription medications

15. Data analysis Nursing diagnoses include: Ineffective coping Ineffective denial Impaired social interaction Anxiety Disturbed sleep pattern Fatigue Pain Application of the Nursing Process: Somatization (cont’d)

16. Application of the Nursing Process: Somatization (cont’d) • Outcomes • The client will: • Identify the relationship between stress and physical symptoms • Verbally express emotional feelings • Follow an established daily routine • Demonstrate alternative ways to deal with stress, anxiety, and other feelings • Demonstrate healthier behavior regarding rest, activity, and nutrition

17. Application of the Nursing Process: Somatization (cont’d) • Intervention • Provide health teaching • Assist client to express emotions • Teach coping strategies • Emotion-focused coping strategies (progressive relaxation, deep breathing, guided imagery, and distractions) • Problem-focused coping strategies (learning problem-solving methods, applying the process to identified problems, and role-playing interactions with others)

18. Application of the Nursing Process: Somatization (cont’d) • Evaluation • Is the client making fewer visits to physicians with physical complaints? • Is the client using less medication and more positive coping techniques? • Are the client’s functional abilities increased? • Does the client have improved family and social relationships?

19. Community-Based Care • Make appropriate referrals, such as a pain clinic for clients with pain disorder • Provide information about support groups in the community • Encourage clients to find pleasurable activities or hobbies

20. Mental Health Promotion • Assist clients to deal with emotional issues directly • Assist clients to continue gaining knowledge about themselves and their emotional needs

21. Self-Awareness Issues • Deal with feelings of frustration • Be realistic about small successes • Validate client’s feelings • Deal with feeling that client “could do better if he tried”