Chapter 19 Somatoform Disorders

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Chapter 19Somatoform Disorders
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Psychosomatic

• Psychosomatic was a term first used to convey the
  connection between the mind and body in states of
  health and illness. Somatization is defined as
  the transference of mental experiences into
  bodily symptoms.
• The client ask the nurse, What does having a
  psychosomatic symptoms mean? Stress and or
  emotions are causing your symptoms.

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• Somatoform disorders are characterized by the
  presence of physical symptoms that suggest a
  medical condition without a demonstrable organic
  basis to account fully for the symptoms. Three
  central features of somatoform disorders
• Physical complaints that suggest medical illness
  but have no demonstrable organic basis
• The primary gain associated with developing
  physical symptoms in response to stress is to
  Decrease anxiety.

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• Psychological factors and conflicts that seem
  important in initiating, exacerbating, and
  maintaining the symptoms
• Symptoms or magnified health concerns that are
  not under the clients conscious control

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Somatoform disorders cont

• Clients are convinced they have serious medical
  problems, despite negative test results. They
  actually experience the physical symptoms, as
  well as the accompanying distress and functional
  limitations. They seek help from health care
  professionals but often are told its all in
  your head. It is important to remember that
  their symptoms and distress are real. the pain
  in their head is very real!!

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• Five specific somatoform disorders
• Somatization disorder multiple physical
  symptoms combination of pain, GI, sexual, and
  pseudoneurologic symptoms
• Conversion disorder unexplained deficits in
  sensory or motor function such as blindness or
  paralysis associated with psychological factors
  attitude of la belle indifference (lack of
  concern or distress about physical symptom) EX
  graduate nurse to take NCLEx exam in 3 days woke
  up today could not see anything at all but tells
  classmates Oh dont worry it will work out
• Primary gain for a client with conversion
  disorder relief from emotional conflict

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• Pain disorder pain unrelieved by analgesics
  psychological factors influence onset, severity,
  exacerbation, and maintenance
• Hypochondriasis persistant preoccupation with
  fear that one has or will get a serious disease
  they may interpret normal body functions as signs
  of disease
• Body dysmorphic disorder preoccupation with
  imagined or exaggerated defect in physical
  appearance. Ex nose is too big for their face
  My hair is so thin that I always wear a hat.

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Somatization disorder cont

• Somatization disorder, conversion disorder, and
  pain disorder are more common in women.
  Hypochondriasis and body dysmorphic disorders
  occur equally in men and women. All somatoform
  disorders are either chronic or recurrent,
  lasting for decades.
• Onset somatization and body dysmorphic disorder,
  25 years conversion disorder, 10 to 35 years
  pain disorder and hypochondriasis occur at any
  age.

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Related Disorders

• Malingering
• Intentional production of false or grossly
  exaggerated physical or psychological symptoms
  motivated by avoiding work, evading criminal
  prosecution, or obtaining financial compensation
  or drugs. Client has no real symptoms. Once
  gain what they want-physical symptoms
  disappear-such as receiving compensation from a
  law suit settlement
• Factitious Disorder-is an example of Malingering
• Occurs when a person intentionally causes or
  feigns symptoms to gain attention commonly
  called Munchausens syndrome
• A variation is inflicting injury or causing
  symptoms in someone else, thereby gaining
  attention from medical personnel or for saving
  the persons life. Munchausens by proxy rare
  most commonly seen when parents injure their
  children or medical personnel injure patients
  these people are usually prosecuted for criminal
  behavior.

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Etiology

• Psychosocial theories anxiety, frustration
  feelings are expressed through physical symptoms
  rather than verbally internalization primary
  gain(relief of anxietyEX piano recital client
  hand becomes numb so no unable to play at
  recital(anxiety/stress) and secondary
  gains-client becomes ill now the family has to do
  all the chores, cook, etc.
• Biologic theories familial tendencies
  differences in the way body stimuli are regulated
  and interpreted

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Cultural Considerations

• There are many culture-bound syndromes associated
  with physical symptoms the meaning of physical
  symptoms varies greatly from one culture to
  another.
• Table 19-1

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Treatment

• Treatment is focused on managing symptoms,
  improving quality of life, and improving coping
  skills. The client who indicates
  understanding-will say How the client handles
  the stress and emotions can affect their physical
  health.
• Long term outcome-the client will develop
  alternative methods of coping mechanism.
• Antidepressants are sometimes used for
  accompanying depression. Check side effects.
  Table 19-2
• 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 just by talking/expressing self to others.

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Application of the Nursing Process Somatization

• Assessment
• It is important to investigate the clients
  physical health status thoroughly to rule out
  underlying pathology requiring treatment.
• History Client likely provides a detailed
  medical history may state, they cant find out
  whats wrong most clients are quite distressed
  about their health status, except the client with
  conversion disorder, who seems indifferent to the
  symptoms

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• Assessment (contd)
• General appearance and motor behavior overall
  appearance not remarkable client may walk slowly
  or have distressed facial expression

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• Assessment (contd)
• Mood and affect Mood may be labile, shifting
  from sad and depressed (when describing physical
  ailments) to bright and excited (describing trips
  to the hospital by ambulance). Clients often
  brighten and look better while they have the
  nurses undivided attention

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• Assessment (contd)
• Thought processes and content Clients with
  somatization disorder may be vague in their
  description but use colorful, exaggerated terms.
  Thought process is intact majority of content is
  about physical symptoms. When asked about
  feelings, clients respond in physical, not
  emotional terms. Clients with hypochondriasis
  also voice concerns that they are gravely ill and
  worry about dying.
• Sensorium and intellectual processes alert and
  oriented

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• Assessment (contd)
• Judgment and insight intellectual functions
  intact, little or no insight into their behavior
  judgment may be affected by exaggerated responses
  to physical health concerns
• Self-concept low self-esteem but likely to focus
  only on the physical self, lack of confidence,
  difficulty coping, not likely to be employed (due
  to poor health)

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• Assessment (contd)
• Roles and relationships difficulty fulfilling
  family roles (too sick) probably few friends or
  social activities, may report lack of family
  support family may be very tired and frustrated
  with client
• Physiologic and self-care concerns Clients who
  somatize may have legitimate health concerns,
  such as disturbed sleep patterns, poor nutrition,
  lack of exercise, overuse of prescription
  medications.

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• Data Analysis
• Nursing diagnoses include
• Ineffective Coping
• Ineffective Denial
• Impaired Social Interaction
• Anxiety
• Disturbed Sleep Pattern
• Fatigue
• Pain

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• 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

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• Intervention
• Providing health teaching-effective when you hear
  I will feel better when I begin handling stress
  more effectively.
• Emotion-focused coping strategies-designed-helping
  the client manage the intensity of symptoms
• Assisting client to express emotions-the client
  feels better physically just from getting a
  chance to talk.
• Teaching coping strategies

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• Evaluation
• Changes are likely to occur slowly.
• Using fewer medications, making fewer visits to
  physicians, improved coping skills, increased
  functional abilities would be indicators of
  treatment success.

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Self-Awareness Issues

• Deal with feelings of frustration
• Be realistic about small successes
• Validate clients feelings
• Deal with feeling that client could do better if
  he tried