Chapter 17 Somatic Symptom Disorders Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Describe clinical manifestations of each of the somatic symptom disorders.  Discuss biological, psychological, behavioral, cognitive, environmental, and cultural factors influencing the onset and course of the somatic symptom disorders.  Analyze the impact of childhood trauma on adult somatic preoccupation.  Apply the nursing process to individuals with somatic symptom disorders.  Evaluate the importance of a assessing the patient's coping skills and strengths.  Describe five psychosocial interventions for the care of the patient who has a somatic symptom disorder. Objectives 2 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 conversion disorder  factitious disorders  functional neurological disorder  holistic approach  illness anxiety disorder  la belle indifference  psychological factors affecting medical condition  secondary gain  somatic symptom disorder  somatization Key Terms 3 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Clinical Picture Somatic symptom disorder (SSD) Illness anxiety disorder (previously hypochondriasis) Conversion disorder Psychological factors affecting medical condition Factitious disorder Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.4

Somatic Symptom Disorder Distressing symptoms Maladaptive response Without significant physical findings and medical diagnosis Suffering is authentic High level of functional impairment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.5

Illness Anxiety Disorder Misinterpretation of physical sensations Overconcerned for health and preoccupied with symptoms Extreme worry and fear Course of illness chronic and relapsing Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.6

Conversion Disorder Neurological symptoms in the absence of a neurological diagnosis Presence of deficits in voluntary motor or sensory functions Common symptoms—paralysis, blindness, movement and gait disorders, numbness, paresthesias, loss of vision or hearing, or episodes resembling epilepsy “La belle indifférence” versus distress Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.7

Psychological Factors Affecting Medical Condition Psychological factors present risk for medical diseases Depression Cardiovascular diseases and cancer Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.8

Etiology Biological factors Genetic Psychological factors Psychodynamic theories Behavioral theories Cognitive theories Environmental factors Cultural considerations Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.9

Application of the Nursing Process Assessment Psychosocial factors Coping skills Spirituality and religion Secondary gains Cognitive style Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.10

Application of the Nursing Process (Cont.) Assessment (cont.) Ability to communicate feelings and emotional needs Dependence on medication Self-assessment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.11

Application of the Nursing Process (Cont.) Nursing diagnosis Ineffective coping Outcomes identification Interventions Psychosocial interventions Promotion of self-care activities Assertiveness training Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.12

Application of the Nursing Process (Cont.) Interventions (cont.) Psychobiological interventions Pharmacological interventions Health teaching and health promotion Case management Advanced nursing practice interventions Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.13

Factitious Disorders Artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury Goal of assuming a sick role Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.14

Examples of Factitious Disorders Self-directed Other-directed Malingering Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.15

Audience Response Questions 1.Which problem does NOT fit the group? A.Conversion disorder (functional neurological disorder) B.Illness anxiety disorder (hypochondriasis) C.Munchausen syndrome by proxy D.Somatic symptom disorder Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16