SOMATOFORM DISORDERS Complaints of physical symptoms that cannot be explained by diagnostic testing

CHARACTERISTICS OF DISORDERS Somatization –Not consciously aware of underlying psychologic factors –Does not intentionally continue complaints –Not in control of symptoms (involuntary expression of psychologic conflicts) –Primary gain from somatic symptoms –Secondary gain from subsequent attention from physician and family

SOMATIZATION DISORDER –Multiple symptoms prior to age 30 that extend over a period of years –Cannot be controlled by person –Complaints involve pain in at least 4 body locations such as chest, head, joints, back –2 gastrointestinal symptoms such as bloating, constipation, diarrhea –1 sexual or reproductive complaint –1 neurological complaint –Moderate to severe anxiety with depression

CONVERSION DISORDER Pseudoneurologic or sensory impairment –Balance, paralysis, swallowing, speech, senses Transfer psychologic conflict or stressors into perceived impairment Anxiety Secondary gain of avoiding unpleasant tasks or responsibilities during temporary disability La belle indifference –Little concern over implication of symptoms

PAIN DISORDER Psychologic issues primary in onset Unchanging location, severity or description of pain symptoms Use of excessive analgesia without receiving pain relief Depression Social isolation Substance dependence

HYPOCHONDRIASIS Fear or preoccupation with having serious illness based on misinterpretation of minor somatic complaints Symptoms reported in specific detail, but do not follow typical pattern for disorder Concerns continue despite medical testing and reassurance that disease non-existent Physician-shopping Perceived illness focal point of existence

BODY DYSMORPHIC DISORDER Preoccupation with imagined defect in appearance or slight physical defect Constant magnified view of flaw Use of excessive means to conceal flaw Comparisons to perfection in others Feelings of inadequacy/self-consciousness Poor insight into problem Reassurance not convincing

NURSING PROCESS APPLIED Assessment Nursing Diagnoses Expected Outcomes Nursing Interventions Evaluation

Dissociative Disorders Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder Depersonalization Disorder

Dissociation Allows mind to separate certain memories from conscious awareness to decrease anxiety that accompanies them Repressed parts in unconsciousness May resurface spontaneously when situation similar to original trauma occurs

DISSOCIATIVE AMNESIA Inability to remember important personal information beyond ordinary forgetfulness –Localized - occurs within a few hours –Selective - retains portions of event –Generalized - unable to recall any of life –Continuous - present and past is lost

ASSOCIATED SYMPTOMS Inability to recall portions or all of memory/identity Depression Anxiety Depersonalization Trance state Loss of sensation Regression Self-mutilation Aggression Suicidal acts

OTHER CHARACTERISTICS Unconscious mind contains learned behaviors –continue to read, write, cook, drive cars, on “automatic pilot” without really concentrating Abused individuals may learn to dissociate –to defend against feeling pain or to avoid remembering Severe sexual, physical, or psychological abuse in childhood –predisposes to development of severe depersonalization

Just the Facts Using the mental mechanism of dissociation can change our ability to look at ourselves and our actions objectively and prevent us from making positive changes in our behavior

DISSOCIATIVE FUGUE Sudden, unexpected travel away from home or place of work with inability to remember the past –Confusion about personal identity or assumption of new identity –Law enforcement may find person confused when questioned –Usually of short duration with treatment

DEPERSONALIZATION DISORDER Persistent or recurrent experience of feeling detached from mental processes or body without disorientation –Unsure of personal identity or information –Derealization – perceive external environment as unreal or changing (mechanical) –Unable to recognize illogical nature of feelings –Anxiety, depression, somatic complaints –Report feeling like robots or being an outside observer of their body and thoughts

DISSOCIATIVE IDENTITY DISORDER (MPD) Existence of two or more distinct subpersonalities, each with its own patterns of relating, perceiving, and thinking (2-100) –One manifested at a time (aware of each other) –“Host” or primary personality dominant – assumes given name, is passive and self-blaming, usually seeks treatment –Host unaware of other states during their dominance –Changing of personalities – switching process –Unable to connect aspects of identity with past/present ** Often associated with severe childhood abuse

NURSING PROCESS APPLIED Assessment Nursing Diagnoses Expected Outcomes Nursing Interventions Evaluation