Topic 4: Somatic Symptom Disorders

somatization

the psychological and emotional expression of stress through physical symptoms

somatic symptom disorders

Instead of feeling anxiety, depression, or irritability, some individuals experience head, back, and chest pain, paralysis, and unexplained skin rashes and more; those with this often don’t seek psychiatric care for their symptoms and physical symptoms often present without a physiological cause leading to excessive anxiety about illness but pain and physical symptoms are real

frequent medical visits and diagnostics with S/S of chest pain, fatigue, dizziness, HA, swelling, back pain, SOB, insomnia, abdominal pain, numbness

What are the S/S of someone with a somatic symptom disorder

illness anxiety disorder

Physical symptoms are mild or not present; preoccupation with having/acquiring an illness for 6+ months, accompanied by high levels of anxiety about disease and health, so the client performs excessive health-related behaviors; illness precaution has been present for months, but the specific illness that is feared can change over time

• allow time to discuss illness concerns, but limit the amount of time so education can be the focus

• emphasize and reassure the patient that psychiatric care will supplement medical care and not replace it

• encourage socialization in unit or program activities since loneliness is associated with this disorder

what are the nursing interventions for a client with illness anxiety disorder

conversion disorder

what is the other name for functional neurological disorder

functional neurological disorder

CNS deficits such as blindness, paralysis, gait problems, hearing loss, seizures, and numbness without a physiological cause; may present with La Belle Difference

La Belle Difference

a phenomenom in which clients presenting with functional neurological disorder do not express concern about the loss of neurological function

• avoid direct confrontation of the conversion symptom

• provide reassurance and support for the patient’s feelings and beliefs

• encourage socialization

• explore alternate and adaptive coping mechanisms

what are the nursing interventions for a patient with functional neurological disorders

Munchausen Syndrome

what is the other name for factitious disorder imposed upon self

factitious disorder imposed upon self

consciously pretend to be ill to have their emotional needs met and achieve the status of patient; artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury to assume the sick role; a compulsive problem in which individuals consciously conceal the true nature of their alleged illness through deception that results in disability and immeasurable costs to the healthcare system in which a contrived illness may be physical or psychiatric like bleeding, fever, hypoglycemia, seizures, hallucinations, and even cancer

may report depression and suicidality after the death of a spouse, even though the death never occurred, or they were never even married

Munchausen Syndrome by Proxy

the most insidious form of factitious disorder that occurs when a caregiver deliberately falsifies illness in a vulnerable dependent that people do to receive insurance money, other compensation, or due to the excitement and relationship with the HCP of the dependence; MC the parent/guardian is a healthcare worker or someone with knowledge of the healthcare system

malingering

not a specific mental disorder, but is a condition related to factitious disorders; a consciously motivated act of fabricating an illness or exaggerating symptoms that is done for secondary gain to become eligible for things such as disability compensation, committing fraud against insurance companies, obtaining prescription medications, evading military service, or receiving a reduced prison sentence

reported symptoms such as pain are vague and hard for clinicians to prove or disprove, MC in men and associated with antisocial, narcissistic, and borderline personality disorders