SOMATOFORM

DISORDERSPresented by: Eric F. Pazziuagan, RN,

MAN

SOMATOFORM DISORDERS

Major characteristic: patients have physical symptoms for which there is no known organic cause or physiologic mechanism.

Physical symptoms are connected to psychological factors or conflicts.

Patients are not in control of the symptoms, which are unconscious and involuntary.

Patients express conflicts through bodily symptoms and complaints using the defense of somatization.

They do not deal with anxiety or feelings emotionally but displace the anxiety into bodily symptoms.

Anxiety that focuses on health matters and will perhaps be classified differently in the DSM-V.

Patients generally see general practitioners and not mental health professionals or psychiatrists.

Repeatedly seek medical diagnosis and treatment, even though they have been told that there is no known physiologic or organic evidence to explain their symptoms or disability,

Defense mechanisms:Repression: occurs in reference to feelings,

conflicts, and unacceptable impulses.Denial of psychological problems

Genetic, developmental learning, personality, and sociocultural factors can predispose, precipitate, and maintain somatoform disorders.

Emotional and social stress can precipitate these disorders.

Patients often appear to be needy and dependent on others.

PAIN DISORDER

PAIN DISORDER Severe pain in one or more

anatomic sites that causes significant distress or impairment in functioning.

Location or complaint of the pain does not change.

No organic basis. There might be underlying

psychological factors related to pain disorder that the patients might not recognize consciously.

Amount of pain or impairment is greatly exaggerated or out of proportion.

Pain may allow patients to avoid something they do not want to do.

May be classified as: Pain disorder associated with psychological

factors. Pain disorder associated with associated with

both psychological factors and a general medical condition.

Patients are often “doctor shoppers” and might use analgesics excessively without experiencing any relief.

Patients are often anxious about their symptoms and depressed about giving better.

HYPOCHONDRIASIS

HYPOCHONDRIASIS Worried about having, or believe that they

have, a serious disease based on the misinterpretation of bodily signs and sensations.

Medical evaluation and reassurance do not help dispel the fear.

Displaces anxiety onto the body and misinterprets the bodily symptoms.

Hypersensitive to their symptoms of anxiety and think that they are physically ill, which then increases their anxiety and physical symptoms.

Hypochondriacs check for reassurance from physicians or friends similar to the compulsive behavior of patients with OCD.

CONVERSION DISORDER

CONVERSION DISORDER A deficit or alteration in voluntary motor

or sensory function that suggests a neurologic or medical condition.

Psychological factors, conflicts, or stressors are associated with or precede the development of this disorder.

Most common conversion symptoms (neurologic diseases): paralysis, blindness or seizures

Primary gain: alleviation of anxiety that the disorder provides, because conflict is kept out of conscious awareness.

Secondary gain: gratification received as a result of how people in these patient’s environment respond to their illness and can prolong conversion symptoms.

Another characteristic: symptom is often determined by the situation that produced it.

Might have an attitude of la belle indifference: Expresses little concern or anxiety about

the distressing disorder.Symptom binds the anxiety, so that it is

not behaviorally expressed.

BODY DYSMORPHIC DISORDER

BODY DYSMORPHIC DISORDER Characterized by a preoccupation with an

imagined defect in appearance that causes clinically significant distress or impairment in important areas of functioning.

If a slight physical anomaly is actually present, the person's concern with the anomaly is excessive and bothersome.

The cause of body dysmorphic disorder is unknown.

The most common concerns involve facial flaws, particularly those involving specific parts (e.g., the nose).

PSYCHOPHARMACOLOGY Medication for pain

should be used temporarily and sparingly.

SSRIs: helpful for treating anxiety and depression because of the high incidence of comorbidity of these disorders.

MILIEU MANAGEMENT Relaxation exercises, meditation, and

CBT. Physical therapy: to prevent muscle

atrophy for an individual with conversion disorder.

Groups: assertiveness, decision-making, goal-setting, stress management.

Family therapy for family conflict. Group interventions that focus on

psychosocial needs, not on physical needs.

NURSE-PATIENT RELATIONSHIP Focus: to improve patient’s overall levels of

functioning by helping them develop adaptive coping behaviors.

Teach ways of verbalizing feelings appropriately that help eliminate or diminish the need for physical symptoms.

Develop awareness and insight. Convey empathy and reassurance and teach

patients about the connection between emotions and physical symptoms.

Physician or psychiatric orders, tests, physical examination and laboratory work-ups for presence of any physiologic or organic disease or etiology.

KEY NURSING INTERVENTIONS

1. Use a matter-of-fact, caring approach when providing care for physical symptoms.

2. Ask patients how they feel are feeling and ask them to describe their feelings.

3. Assist patients with developing more appropriate ways to verbalize feelings and needs.

4. Use positive reinforcement and set limits by withdrawing attention from patients when they focus on physical complaints or make unreasonable demands.

5. Be consistent with patients, and have all requests directed to the primary nurse providing care.

6. Use diversion by including patients in milieu activities and recreational games.

7. Do not push awareness of or insight into conflicts or problems.