Psych Exam 4: Somatic + Dissociative Disorders

Define psychosomatic:

when ur mind affects ur body

• stress or emotional conflict causes physical symptoms

4 somatic-related disorders:

1. Somatic Symptom Disorder

2. Illness Anxiety Disorder (hypochondria)

3. Functional Neurological (Conversion) Disorder

4. Factitious Disorder (self or another)

What is Somatic Symptom Disrder?

long-lasting physical symptoms (pain, fatigue, GI problems) with NO MEDICAL cause

• disrupts daily life

What is Illness Anxiety Disorder?

aka Hypochondriacs

• being constantly afraid of serious illness, even when tests are NORMAL and dr reassures them

What is Functional Neurological Disorder?

aka Conversion Disorder

• sudden motor/ sensory problems (paralysis, blindness, seizures) caused by stress

• NOT MEDICAL disease

Ex: Someone becomes blind after extreme stress but their eyes are physically fine.

What is Factitious Disorder?

aka Munchausen

• person fakes or creates symptoms to look sick

• WITHOUT external rewards like money

  • just wants attention!!

Why is diagnosing Somatic Disorders difficult?

• ppl may have real medical issues AND psychological symptoms @ same time

  • makes it hard to separate the two

Findings of Illness Anxiety Disorder: (4)

1. fear—will seek out Dr and medical care

2. persists despite medical tests and reassurance

3. exaggerated concern w/ physical health

4. not conscious (malingering is conscious)

Key clues for Conversion Disorder? (4)

1. shows up with impaired motor or sensory complaint

2. symptoms dont match real nerve pathways

3. symptoms arent under persons control

4. la belle indifference→ calm or not bothered abt symptoms

Memory aid for conversion disorder:

• s/s: (9)

CONVERTS anxiety into physical disorder:

1. paralysis

2. tremors

3. jerking

4. dystonic mvmt

5. gait problems

6. absent speech volume

7. altered speech articulation

8. diplopia

9. sensation of lump in throat (globus)

Factitious Disorder vs Malingering:

• Factitious:

  • fakes injury for attention or “sick role”

• Malingering:

  • fakes symptoms for money, drugs, avoiding work (conscious)

What is Factitious Disorder Imposed on Another (aka Munchausen by Proxy)?

• famous person?

• caregiver creates illness in child or dependent to gain attention for themselves

  • Gypsy Rose!!!!

What will the nurse Assess in somatic disorders? (4)

1. symptom hx

2. current physical + mental status

3. dependence on drugs (especially benzos)

4. secondary gains (what benefits do they get from being sick?)

What are examples of secondary gains?

• hidden “rewards” from being sick

1. attention

2. not working

3. avoiding responsibilities

Why do somatic pts get dependent on meds?

often given pain meds, anxiolytics (benzos), and sleep meds leading up to dependence and rebound anxiety

What are Psychosocial Interventions for somatic pts? (6)

1. avoid “doctor shopping” (mainly hypochondriasis) 

2. ask details abt symptoms (OLDCARTS)

3. assess safety/security needs

4. rule out medical cause

5. identify secondary gains

6. limit unnecessary medical tests

What is somatization?

turning emotional stress into physical symptoms

What is dissociation?

“checking out” mentally

• spacing out, zoning out, daydreaming, losing awareness to escape stress

Depersonalization:

• feeling “not real”

  • floating

  • watching urself from outside ur body

Derealization

The world around u feels strange, dreamlike, unreal

What is Dissociative Amnesia?

Sudden memory loss caused by psychological trauma NOT medical issue

• cant remember what led up to car crash

What is Dissociative Amnesia with Fugue?

• forgetting who u are and traveling away unexpectedly

What is DID?

Dissociative Identity Disorder

• having 2 or more personality states that take turns controlling behavior.

What should nurse assess in DID pt? (6)

1. trauma hx

2. recent stress

3. memory gaps

4. mood changes

5. depressed/suicidal?

6. drug/alcohol use

Nursing Interventions for DID? (6)

1. gentle and supportive

2. dont force them to face trauma fast

3. reduce stress

4. grounding techniques

5. journal to find trigger

6. dont deny their feelings