1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

2. Chapter 13Somatoform Disorders

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatization Soma: refers to the body Physical complaints and symptoms expressed as a result of psychological stress Considered a defense mechanism Physical symptoms are considered psychophysiologic or somatoform –Can not be explained by diagnostic findings –Becomes a problem when interfears with daily living

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Characteristics of Somatoform Disorders Somatization –Not consciously aware of underlying psychologic factors Does not intentionally continue complaints –Not in control of symptoms –Somatic symptoms provide a psychologic or primary gain as the anxiety is relieved and focus is diverted to the physical problem –Secondary gain from attention from physician and family

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatization Disorder Multiple symptoms prior to age 30 that extend over a period of years Complaints involve pain in at least 4 body locations (head, joints, chest, back) 2 gastrointestinal symptoms (N/V, abdominal pain, bloating) 1 sexual or reproductive complaint (menstrual irregularities) 1 neurological complaint (loss of coordination in limb, weakness, or visual problems) Moderate to severe anxiety with depression

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatization Disorder (cont.) Incidence and etiology –0.2% of adult U.S. population –More prominent in women –Chronic condition, tends to recur throughout life –Symptoms may appear as early as adolescence –Tends to run in families Common s/s of Somatization Disorder Box 13.1 Page 193

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Conversion Disorder Neurologic or sensory impairment –Balance, paralysis, swallowing, speech, senses Not supported by results of diagnostic testing Related to stress or trauma factors that have occurred concurrent with the onset of symptoms Primary gain - transfer psychologic conflict or stressors into perceived impairment Secondary gain of avoiding unpleasant tasks during temporary disability La belle indifference –Little anxiety or concern over implications of symptoms

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Conversion Disorder (cont.) Incidence and etiology –May begin at any age –1/3 of population experiences symptoms sometime –More common in women, lower socioeconomic status, rural areas –Usually short-term, 2-4 weeks –http://www.youtube.com/watch?v=jV0szS02PGE Common s/s of Conversion Disorder Box 13.2 Page 194

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Disorder Severe pain that covers a variety of different complaints Pain impairs ability to function in social and work settings Psychologic issues primary in onset, severity, and continuance of the pain symptoms Unchanging location, severity, or description of pain symptoms Use of excessive analgesia without pain relief Depression Social isolation Substance dependence Physician Shopping Common s/s of Pain Disorder Box 13.3 Page 195

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Hypochondriasis Fear or preoccupation with having serious illness based on misinterpretation of somatic symptoms Concerns continue despite medical testing and reassurance that a disease does not exist Symptoms reported in specific detail but do not follow typical pattern for disorder Persists over time but occurs in sporadic episodes associated with stressful events Fear creates enough distress to cause difficulties in functioning over a period of 6 months or more

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Hypochondriasis (cont.) Munchausen Syndrome – faking illness for attention – not a somatoform disorder –Deliberately claim fake healthcare problems –Knowledge of fake illness is often quite deliberate and their ability to mimic the disorder is planned Incidence and etiology –Etiology unknown –Thought to be related to strong dependency needs –Peak incidence is in late 30s for men, late 40s for women –Chronic in nature –Depression common http://www.youtube.com/watch?v=8UxK1rcU2gk Common s/s of Hypochondriasis Box 13.4 Page 196

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Somatoform Disorders Varies depending on the type of disorder Trusting relationship with primary care physician –Often prevents the pattern of repeat medical treatment by a series of physicians Medication unlikely to alleviate problem Alternative therapies helpful for some Cognitive-behavioral therapy used sometimes

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied AssessmentPg. 198 –Create nurturing environment –Focus on the whole person –Consider physical complaints and manner expressed –Note inconsistencies in symptom description –Assess the client’s level of stress or anxiety

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) Nursing diagnosesPg. 198 –The client is often frustrated and angered by the implication that the symptoms are psychologic –Example diagnoses Anxiety, severe, related to trauma or unmet dependency needs Social isolation, related to preoccupation with self and chronic state of perceived illness

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) Expected outcomes  ExamplesPg. 198 –Expresses feelings of anxiety and effective means of dealing with illness –Participates in developing plan for pain control –Reduces statements that demand a focus on self and physical symptoms

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) Nursing interventions  may includePg. 199 –Avoid confrontation related to the psychologic nature of symptoms –Encourage discussion of life history, recent emotional events, and fears –Continue to monitor physical complaints to rule out actual cause for symptoms –Help the client identify more effective coping mechanisms

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) EvaluationPg. 200 –The client’s ability to recognize underlying psychologic stress and anxiety that contribute to physical symptoms –Disorders can reappear if psychologic defenses and coping strategies fail

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The attention gained from a physician or family member as a result of somatic complaints is called A. Primary gain B. Secondary gain C. La belle indifference D. Conversion

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Secondary gain Rationale: Somatic symptoms allow a person to divert focus to the physical problem, thus alleviating anxiety and providing a primary gain. Secondary gain comes from the attention the person receives from a physician or family member.

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Somatoform disorders are characterized by physical symptoms that can be explained by diagnostic findings and attributed to a medical condition.

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Somatoform disorders are characterized by physical symptoms that cannot be explained by diagnostic findings and are not attributed to a specific medical condition. Instead, somatoform disorders occur when anxiety or psychologic conflicts are transferred into somatic or physical symptoms.

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is not a common psychologic factor in somatoform disorders? A. History of emotional conflict B. Trauma about the time the symptoms originated C. Unmet dependency needs D. Family history of medical conditions

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. Family history of medical conditions Rationale: Though somatoform disorders involve physical complaints and symptoms, their origins are related to psychologic factors, such as the history of emotional conflict or trauma and unmet dependency needs. The physical symptoms of somatoform disorders are not attributed to a medical condition.

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following disorders often involves “physician-shopping”? A. Pain disorder B. Conversion disorder C. Hypochondriasis D. Body dysmorphic disorder

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Hypochondriasis Rationale: People with symptoms of hypochondriasis seek out physicians who will substantiate their illnesses. Because they often believe that they are being given incompetent medical attention, they may visit several different doctors. This behavior is called “physician- shopping.”