1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 20Somatoform and Dissociative Disorders

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins These disorders encompass mind–body interactions in which the brain, in ways still not well understood, sends various signals that impinge on the patient’s awareness, indicating a serious problem in the body. Sadock & Sadock, 2008

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins If worrying were harmless, it would not be much of a problem. But worrying does take its toll. And if you stress your system with excessive worry, it is likely to wear out earlier. Twerski, 1995

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Discuss the following factors or theories related to somatoform disorders: biological or genetic factors, organ specificity theory, Selye’s general adaptation syndrome (GAS), familial or psychosocial theory, and learning theory Explain the following theories related to dissociative disorders: state-dependent learning theory and psychoanalytic theory Compare and contrast the clinical symptoms of somatization and conversion disorders Distinguish between dissociative amnesia and dissociative fugue

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) ‏ Differentiate between anxiety disorder due to a general medical condition and psychological factors affecting a medical condition Relate the importance of addressing medical issues and cultural differences when assessing a client with a somatoform or dissociative disorder Articulate at least five common nursing diagnoses appropriate for clients exhibiting somatoform or dissociative disorders Formulate a nursing plan of care for a male client with clinical symptoms of an anxiety disorder due to a general medical condition (pneumonia) ‏

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Anxiety-Related Disorders Anxiety can occur under many guises that are not readily recognized by the nurse or practicing clinician. For example, clients may experience anxiety as the result of a specific medical condition (eg, hyperparathyroidism), as a result of treatment for a specific medical condition (eg, thyroid medication), or as a result of changes in employment or lifestyle due to a medical condition (eg, myocardial infarct).

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Somatoform and Dissociative Disorders Theories regarding somatoform disorders: –Biological and genetic factors –Organ specificity theory –Selye’s general adaptation syndrome (GAS) ‏ –Familial or psychosocial theory –Learning theory

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Somatoform and Dissociative Disorders (cont.) Theories regarding dissociative disorders: –State-dependent learning theory –Psychoanalytic theory –Other factors

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics Somatoform disorders: –Body dysmorphic disorder –Somatization disorder –Conversion disorder –Pain disorder –Hypochondriasis –Undifferentiated somatoform disorder –Somatoform disorder, not otherwise specified

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics (cont.) Dissociative disorders: –Dissociative amnesia –Dissociative fugue –Dissociative identity disorder –Depersonalization disorder –Dissociative disorder, not otherwise specified

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics (cont.) Anxiety disorder due to a general medical condition Psychological factors (anxiety) affecting medical condition

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Assessment of clients with a comorbid medical diagnosis Assessment of clients with somatoform disorders Assessment of clients with dissociative disorders

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Activity intolerance Acute confusion Adult failure to thrive Ineffective health maintenance Anxiety Impaired social interaction Ineffective coping Fatigue Impaired physical mobility

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcomes are based on the client’s ability to do the following: Recognize his or her own anxiety Identify stressors related to the present physical condition Identify ways to modify or eliminate the stressors Relate an increase in psychological and physiologic comfort Develop effective coping skills to avoid exacerbation of any comorbid medical conditions, somatoform disorders, or dissociative disorders

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions After the client’s medical condition is stabilized, interventions are planned to help the client: Develop insight into his or her condition Develop effective coping skills to reduce anxiety and avoid exacerbation of any coexisting medical condition Identify supportive therapies that will reduce anxiety

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Assistance in meeting basic needs Medication management –Medication management for somatoform disorders –Medication management for dissociative disorders Interactive therapies and behavioral interventions Holistic approach Project SMART

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Clients who respond to treatment are able to do the following: Identify anxiety-producing stressors Demonstrate insight into their specific disorder Exhibit effective coping skills

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Anxiety disorder due to a general medical condition Body dysmorphic disorder Conversion disorder Depersonalization disorder Dissociative amnesia Dissociative disorder Dissociative fugue Dissociative identity disorder Dysmorphobia General adaptation syndrome (GAS) ‏ Hypochondriasis La belle indifference Pain disorder Primary gain Pseudoneurologic manifestation Psychological factors affecting medical condition Secondary gain Somatization disorder Somatoform disorders

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Reflect on the chapter-opening quote by Sadock and Sadock. Explain the phrase “the brain…sends signals that may impinge on the patient’s awareness, indicating a serious problem in the body.” Cite at least three examples of possible stress- or anxiety-induced medical problems. What interventions would you provide for each of these medical problems to minimize the effect of further stress or anxiety? ?