SOMATOFORM DISORDERS

Intended Learning Outcomes (ILOs)

1. Knowledge and understanding
1.1 List common characteristics of somatoform
disorders.
1.2 Identify various types of somatoform disorders.
3- Professional and practical Skills.
3.1 Apply nursing care plan for patient with
somatoform disorders.
4- General and transferable skills.
4.1 Develop the ability to perceive the clients
symptoms as a real to him.
2- Intellectual Skills.
2.2 Analyze etiological factors contributing to
somatoform disorders.
2.3 Evaluate assessment data to formulate an
appropriate nursing diagnoses for patient with
somatoform disorders.
Somatoform disorders
Somatoform disorders
_ A broad group of illnesses that have bodily signs
and symptoms as a major component. Pathological
concern of individuals with the appearance or
functioning of their bodies when there is no known
medical condition causing the physical complaints.
Common characteristics of somatoform disorders
The symptoms are not intentionally produced
or feigned. In most disorders, the client is
worried about the symptom and excessively
seeks medical assistance. (Dr shopping )
Common characteristics of somatoform disorders
The somatic symptoms & complaints cause
impairment in patients ability to function in
social & occupational roles.
The purpose of the symptom is anxiety relief.
Classifications of somatoform disorders
1. Somatization disorder
2. Conversion disorder
3. Pain disorder
4. Hypochondriasis
5. Body Dysmorphic Disorder
Somatization disorder
Known as Briquets syndrome (100 years ago) Its
characterized by multiple physical symptoms for
which medical attention is sought but which
have no apparent physical cause.
Cont . Somatoform Disorders
Multiple recurrent physical complaints over many
years
(combination of pain, problems in gastrointestinal
,nervous system, and reproductive system ).
Begins before age 30.
Chronic pattern.
Higher prevalence for women than men. women
(5-20 times more common)
Somatization Disorder occurs more often with
people of low income and little education
WHAT ARE THE 3 MAIN DISTINCTIONS FOR
SOMATIZATION DISORDER?
1) they are not faking their symptoms
2) their complaints are vague and generalized
3) there is no physical cause for their pain
Example on CN symptoms or pseudo neurological : 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.
Somatization Disorder
Conversion disorder
Conversion refers to unconscious
conflicts being converted into physical
symptoms .It involves unexplained
usually sudden, deficits in sensory
and/or motor function that suggest a
neurological disorder but are
associated with psychological factors.
Freud
Common symptoms: blindness, paralysis,
mutism, or seizures.
la belle indifference often accompanies
Conversion disorder.It means Isolation of
affect: where reality is accepted but without
the expected human emotional response to
that reality.
How do you distinguish between Somatization
Disorder and Conversion Disorder?
Somatization Disorder: is often polysymptomatic, the
age of onset is under 30, F>M, prognosis is poor to
fair
Conversion Disorder: Acute and generally transient,
monosymptomatic, onset 10-35 yrs, F>M, prognosis
excellent
Men with conversion disorder frequently served in
the military
Pain disorder
The primary symptom of pain disorder is the
presence of pain in one or more sites that can
not be explained by medical or neurological
tests. e. g low back pain, headache, facial pain &
chronic pelvic pain.
Pain Symptoms
Pain Symptoms: (4 or more experienced) pain
in head, abdomen, back and joint
Can also feel uncomfortable pain in the
rectum.
Abnormalities in
menstruation, urination
and sexual intercourse.
Acute pain disorder <6 months
Chronic pain disorder >6 months
the most type of pain seen in chronic pain
disorder?
burning pain
Hypochondriasis
Is the preoccupation with the fear that one has
or will get a serious disease based on the
persons misinterpretation of bodily symptoms.
The preoccupation persist despite absence of
pathophysiological findings of medical and
neurological examination.
it is equally as common in men and women.
In hyperchondriasis there is no correlation to
social status/income.
Prognosis is generally good, but symptoms
wax and wane over time.
How do you tell the difference between hypochondriasis and
somatization disorder?
In somatization disorder, patient is concerned about their
symptoms but does not overreact to having those symptoms
In hypochondriasis, patient is super concerned about their
symptoms and overreacts to having those symptoms
Also for hypochondriasis, there is no specific age of onset
M=F
For somatization disorder, the age of onset is under 30. F>M
Medical students frequently think they have
symptoms of disease/s they are studying. It
may be a type of hypochondriasis or it could
simply be nosophobia (fear of contracting a
disease)
Hypochondriasis
Body Dysmorphic Disorder
Is the preoccupation with some imagined defect
in their physical appearance. The preoccupation
is out of proportion to any actual abnormalities
Body dysmorphic disorder is often associated with
Eating disorders (e.g. anorexia nervosa)
Sufferers of this disorder complain of several specific
features or a single feature, or a vague feature or
general appearance.
75% percent of patients with this disorder complain
about their skin.
suicidal rate in body dysmorphic disorder is higher
What disorder is a form of body dysmorphic
disorder where males feel like they are 'puny'
and thus work out excessively but they are
never big enough?
Bigorexia also known as muscle dysmorphia or
the Adonis complex
Factitious Disorders
Characterized by:
Physical or psychological symptoms that are
intentionally produced or feigned in order to
assume the sick role.
Conscious fabrication of symptoms to gain
attention.
The presence of factitious symptoms does not
preclude the coexistence of true physical or
psychological symptoms.
Munchausens 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. An example would be a nurse who
gives excess intravenous potassium to a client
and then saves his life by performing CPR.
Malingering
Intentionally feigning or grossly exaggerating
illness or disability to derive benefit or
secondary gain (e.g., to escape work, gain
compensation, or obtain drugs)
Factitious Disorder vs. Malingering
Factitious Disorder
May agree to
unnecessary surgery
and interventions
Motivated by
psychological needs
(attention, security,
etc)
Malingering
Will not agree to
unnecessary
surgery/intervention
Motivated by
secondary gains
(avoid work/stay on
disability)
More common in
military populations
and legal settings
Etiology of Somatization
Neurobiological
Somatization results from defective or
deficient neurobiological processing of
sensory and emotional information.
These disorders encompass mind and body
interactions in which the brain, sends various
signals that impinge on the patient's
awareness, indicating a serious problem in
the body.
Additionally, minor or as yet undetectable
changes in neurochemistry, and
neurophysiology, may result from unknown
mental or brain mechanisms that cause illness
Psychodynamic
Somatized physiological sensations occur as
expressions of underlying emotional conflict.
Somatization enables patients to meet latent
needs for nurturing and support.
Mechanisms of Somatization
Behavioral
Somatization is viewed as behavior that is
brought about and reinforced by others in the
patients environment
Illness-maintenance systems
Mechanisms of Somatization
Sociocultural
Social norms concerning emotions.
When a culture does not allow direct
communication of emotional content, one means
available to express emotions is through physical
symptoms
Somatization serves to notify others of emotional
or psychological distress in an acceptable or non-
stigmatized manner.
Contributing Factors for
Somatization
Childhood abuse
Acute stress
Societal roles
Learned behavior
Secondary gain
Cultural factors
Histrionic, narcissistic, and borderline
personality traits
Assessment
It is helpful for nurses to assess for:
Presence of secondary gains.
Cognitive style.
Ability to communicate emotional needs.
Dependence on medication.
Assessing secondary gains
Getting out usual responsibilities .
Getting extra attention .
Manipulating others in the environment.
Fulfillment of dependency needs.
Financial gain from insurance, workers
compensation, or sick benefits.
Nursing diagnosis
Ineffective individual coping may be related to
Repressed anxiety.
Unmet dependency needs.
Psychological conflicts/stressors.
Ineffective use of adaptive coping strategies.
Evidence by
Verbalization of physical complaints in the absence
of any pathophysiological evidence.
Total focus on the self and physical symptoms.
Verbalizes continued need to seek medical
assistance for perceived physical symptoms inspite
of physicians reassurance of no demonstrable
organic pathology doctor shopping.
Evidence by
Denies correlation between physical symptoms
and psychological conflicts/stressors.
Demonstrate excessive dramatic or exaggerated
behavior when describing perceived physical signs
and symptoms.
Goal
Patient will demonstrate adaptive coping
mechanism with anxiety without resorting to
physical symptoms.
Other possible nursing diagnosis
1. Impaired social interaction
2. Ineffective family coping
3. Self-esteem disturbance
Nurses reactions and feelings
At the first Nurses and other health care workers
often find working with clients with somatoform
disorders difficult and unsatisfying.
It is helpful to remember that the symptom the
client is experiencing is very real to him or her, even
though the objective data do not prove physiologic
basis.
NURSING MANAGEMENT
SOMATIZATION DISORDER
Nursing diagnosis
Ineffective coping related to repressed anxiety and unmet
dependency needs
Nursing interventions
Recognize and accept that the physical complaint is real to
the client, even though no organic aetiology can be identified
Identify the gains that the physical symptoms are providing
for the patient.
Initially fulfill the clients urgent dependency needs but
gradually withdraw attention to physical symptoms.
Minimize time given in response to physical
complaints.
Encourage client to verbalize fears and
anxieties.
Discuss possible alternative coping strategies
client may use in response to stress.
Help client identify ways to achieve
recognition from others without restoring to
physical complaints
Chronic pain
Recognize and accept that the pain is real to the individual,
even though no organic cause can be identified. Denying the
clients feelings is non therapeutic and hinders the
development of a trusting relationship.
Observe and record the duration and intensity of the pain.
Note factors that precipitate the onset of pain. Identification
of the precipitating stressor is important for assessment
purposes. This information will be used to develop a plan for
assisting the client to cope more adaptively.
Provide pain medication as prescribed by physician. Client
comfort and safety are nursing priorities.
Assist with comfort measures, such as back
rub, warm bath, and heating pad. Be careful,
however, not to respond in a way that
reinforces the behavior. Secondary gains from
physical symptoms may prolong maladaptive
behaviors.
Offer attention at times when client is not
focusing on pain. Positive reinforcement
encourages repetition of adaptive behaviors.
Identify activities that serve to distract client from focus on
self and pain. These distractors serve in a therapeutic manner
as a transition from focus on self or physical manifestations to
focus on unresolved psychological issues.
Encourage verbalization of feelings. Explore meaning that
pain holds for client. Help client connect symptoms of pain to
times of increased anxiety and to identify specific situations
that cause anxiety to rise. Verbalization of feelings in a
nonthreatening environment facilitates expression and
resolution of disturbing emotional issues.
disturbed body image
Nursing diagnosis
Confusion in mental picture of ones physical self.
related to low self-esteemunmet dependency
needs.
Interventions
If there is actual change in structure or function,
encourage client to progress through stages of
grieving. Assess level of knowledge and provide
information regarding normal grieving process and
associated feelings. Knowledge of acceptable
feelings facilitates progression through the grieving
process.
Identify misperceptions or distortions client
has regarding body image. Correct inaccurate
perceptions in a matter-of-fact,
nonthreatening manner. Withdraw attention
when preoccupation with distorted image
persists. Lack of attention may encourage
elimination of undesirable behaviors.
Help client recognize personal body boundaries. Use of touch
may help him or her recognize acceptance of the individual by
others and reduce fear of rejection because of changes in
bodily structure or function.
Encourage independent self-care activities, providing
assistance as required. Self-care activities accomplished
independently enhance self-esteem and also create the
necessity for client to confront reality of his or her bodily
condition.
Provide positive reinforcement for clients expressions of
realistic bodily perceptions. Positive reinforcement enhances
self-esteem and encourages repetition of desired behaviors.
Thanks for helping in our course . I appreciated your
commitment . I hope for all satisfaction & success.
My door open to you at any time..
Its the end but not the last
I am willing to listen for you at any time