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Somatoform Disorders

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Page 1: Somatoform do

Somatoform DisordersSomatoform Disorders

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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.

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The three central features of somatoform disorders:

• 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

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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 associated with psychological factors; attitude of la belle indifference (lack of concern or distress)

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• 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

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Onset and Clinical CourseOnset and Clinical Course

• 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

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Related Disorders Related Disorders

• Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms; it is motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs

• Factitious disorder occurs when 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.)

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Related Disorders (cont’d)Related Disorders (cont’d)

• Munchausen 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

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EtiologyEtiology• Psychosocial theories:

– Unconsciously expressing internalized stress through physical symptoms (somatization)

– Primary gains are achieved when the direct external benefits of being sick provide 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

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TreatmentTreatment

• 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

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

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Intervention

• Providing health teaching

• Assisting client to express emotions

• Teaching 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)

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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?