1. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Chapter 15 Somatoform and Dissociative Disorders

2. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Somatoform Disorders Physical symptoms suggest a physical disorderPhysical symptoms suggest a physical disorder Diagnostic tests are negative for physical illnessDiagnostic tests are negative for physical illness Symptoms are linked to psychobiological factorsSymptoms are linked to psychobiological factors

3. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Dissociative Disorders Disturbances in the normally well- integrated continuum of consciousness, memory, identity, and perceptionDisturbances in the normally well- integrated continuum of consciousness, memory, identity, and perception

4. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Somatoform Disorders Differentiated from MalingeringMalingering –Intentionally producing symptoms to achieve an environmental goal Factitious disorderFactitious disorder –Fabrication of symptoms or self-inflicted injury to assume the sick role Psychosomatic illnessPsychosomatic illness –A general medical condition affected by stress or psychological factors

5. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Somatoform Disorders Somatization disorderSomatization disorder HypochondriasisHypochondriasis Pain disorderPain disorder Body dysmorphic disorderBody dysmorphic disorder Conversion disorderConversion disorder

6. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Somatization Disorder Most frequent symptomsMost frequent symptoms –Pain, dysphagia, nausea, bloating, constipation, palpitations, dizziness, shortness of breath Significant functional impairmentSignificant functional impairment Course of illness chronic and relapsingCourse of illness chronic and relapsing Suicide threats and gestures commonSuicide threats and gestures common

7. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Hypochondriasis Misinterpretation of physical sensationsMisinterpretation of physical sensations Diagnostic tests are negativeDiagnostic tests are negative Depression or anxiety disorders commonDepression or anxiety disorders common History of childhood trauma possibleHistory of childhood trauma possible

8. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Pain Disorder Diagnostic testing rules out organic causeDiagnostic testing rules out organic cause Discomfort leads to impairmentDiscomfort leads to impairment Suicide a serious risk factorSuicide a serious risk factor Usual sites of pain: head, face, lower back, pelvisUsual sites of pain: head, face, lower back, pelvis

9. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Body Dysmorphic Disorder Preoccupation with an imagined defective body partPreoccupation with an imagined defective body part Obsessional thinking and compulsive behaviorObsessional thinking and compulsive behavior Impaired social, academic, or occupational functioningImpaired social, academic, or occupational functioning Major depression, OCD, and social phobia commonMajor depression, OCD, and social phobia common

10. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Conversion Disorder Presence of deficits in voluntary motor or sensory functionsPresence of deficits in voluntary motor or sensory functions Common symptoms: involuntary movements, seizures, paralysis, abnormal gait, anesthesia, blindness, deafnessCommon symptoms: involuntary movements, seizures, paralysis, abnormal gait, anesthesia, blindness, deafness "La belle indifférence" versus distress"La belle indifférence" versus distress Comorbid conditions: depression, anxiety, other somatoform disorders, personality disordersComorbid conditions: depression, anxiety, other somatoform disorders, personality disorders

11. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Somatoform Disorders: Assessment Symptoms and unmet needsSymptoms and unmet needs Voluntary control of symptomsVoluntary control of symptoms Secondary gainsSecondary gains Cognitive styleCognitive style Ability to communicate feelings and emotional needsAbility to communicate feelings and emotional needs Dependence on medicationDependence on medication

12. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Somatoform Disorders: Basic Level Nursing Interventions Promotion of self-care activitiesPromotion of self-care activities Health teachingHealth teaching Case managementCase management Psychobiological interventionsPsychobiological interventions

13. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Somatoform Disorders: Advanced Practice Interventions PsychotherapyPsychotherapy

14. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Dissociative Disorders Depersonalization disorderDepersonalization disorder Dissociative amnesiaDissociative amnesia Dissociative fugueDissociative fugue Dissociative identity disorderDissociative identity disorder

15. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Depersonalization Disorder Alteration in perception of selfAlteration in perception of self Disturbing experiences ofDisturbing experiences of –Feeling a sense of deadness of the body –Seeing oneself from a distance –Perceiving limbs to be larger or smaller than normal Reality testing remains intactReality testing remains intact

16. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Dissociative Amnesia Inability to recall important personal informationInability to recall important personal information –Generalized amnesia –Localized amnesia –Selective amnesia

17. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Dissociative Fugue Sudden unexpected travel away from the customary localeSudden unexpected travel away from the customary locale Inability to recall one's identity and some or all of the pastInability to recall one's identity and some or all of the past During fugue state tend to live simple, quiet livesDuring fugue state tend to live simple, quiet lives When remember former identity, become amnesic for time spent in fugue stateWhen remember former identity, become amnesic for time spent in fugue state

18. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Dissociative Identity Disorder Presence of two or more distinct personality statesPresence of two or more distinct personality states Primary personality (host) usually not aware of altersPrimary personality (host) usually not aware of alters Alternate personality (alters) or subpersonalities take control of behaviorAlternate personality (alters) or subpersonalities take control of behavior Alters often aware of each otherAlters often aware of each other Each alter thinks and behaves as a separate individualEach alter thinks and behaves as a separate individual

19. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Dissociative Disorders: Assessment Identity and memoryIdentity and memory Client historyClient history MoodsMoods Use of alcohol and other drugsUse of alcohol and other drugs Impact on client and familyImpact on client and family Suicide riskSuicide risk

20. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Dissociative Disorders: Basic Level Nursing Interventions Milieu therapyMilieu therapy Health teachingHealth teaching Psychobiological interventionsPsychobiological interventions

21. Elsevier items and derived items © 2006 by Elsevier Inc. All rights reserved. Dissociative Disorders: Advanced Practice Interventions Cognitive-behavioral therapyCognitive-behavioral therapy Psychodynamic psychotherapyPsychodynamic psychotherapy