Somatic Symptoms Illnesses

•Connection between mind (psyche) and body (soma)

psychosomatic

Unconscious expression of psychological distress into physical manifestations; symptoms suggest medical illness but cannot be explained by underlying pathology

somatization

Somatic symptoms disorders are characterized by a preoccupation with worrying about their __________ to the point where it assumes a central role

physical manifestations

By manifesting the psychological distress as physical symptoms, a __________ is obtained in that pressure is relieved, anxiety/stress is decreased, etc.

primary gain

When people manifest psychological distress as physical symptoms, sometimes unintended “gains” occur because of these physical symptoms such as the person gets to call-in sick and get out of work or maybe they get out of taking an exam at school because they have a doctor’s note for a medical reason

secondary gain

General Characteristics of Somatic Symptom Disorders

seen in medical vs mental health settings, difficulty accepting diagnosis

chronic or recurrent

go to one provider to another (angry at medical community)

anxiety and depression common

more women than men

genetics, environment, internalization

somatic symptom disorder

May involve any body system, often more than ____ (e.g., GI, neurologic, cardiopulmonary, reproductive, pain);

may be acute but often chronic with periods of ____________

one

remission and exacerbation

somatic symptoms disorder

Contributes to significant distress and anxiety about

health

somatic symptoms disorder

interferes with

daily functioning

somatic symptoms disorder

symptoms under patients voluntary control or no?

no

somatic symptoms disorder

Seek care from ___________ (“doctor shopping”) – usually seen initially in medical or primary care settings

multiple providers

somatic symptoms disorder

Often reject ____________ as the cause

psychological diagnosis

Pain is primary physical symptom; generally unrelieved by analgesics

Greatly affected by psychological factors 

pain disorder

Belief in/fear of having (disease conviction) or developing (disease phobia) a serious disease, including misinterpretation of physical signs as “proof” of the disease, despite negative findings and clinician reassurances; very high anxiety; obsessive thoughts and fears about illness

e.g., having a minor rash but insisting one has lupus

Illness Anxiety Disorder

Illness Anxiety Disorder is a ____ and _____ condition

chronic and relapsing

with Illness Anxiety Disorder you may seek care from

multiple providers or avoid seeking health care

Characterized by transferring mental conflict into a physical symptom for which there is no organic cause

Functional Neurological Symptom Disorder

what are the symptoms of Functional Neurological Symptom Disorder

sudden deficits in voluntary, motor, or sensory functions (e.g., blindness, paralysis, seizures, hearing loss, gait disorders

not under patients control

with Functional Neurological Symptom Disorder may cause anxiety but often exhibit

la belle indifference

Functional Neurological Symptom Disorder duration

short, rarely chronic but does disrupt functioning

-More focused on the fear of having or developing a specific illness versus focusing on multiple, vague, exaggerated symptoms (as with Somatic Symptom Disorder).

Illness Anxiety Disorder

someone with a rapid heart rate insists they have heart disease; someone with a small sore on their arm insists they have skin cancer (despite diagnostic tests ruling these conditions out).

Illness Anxiety Disorder

-Involves a loss or change in neurological manifestations (usually sudden)

Most likely has a psychological basis/stressor; often reflects stress or response to a traumatic event

Functional Neurological Symptom Disorder

may lose voice right before having to give a presentation in front of a huge audience due to fear of speaking;

may lose vision after seeing spouse cheat on them;

a soldier may experience paralysis to keep self out of combat on the field

Functional Neurological Symptom Disorder:

apathy; a calm, indifferent attitude and a seeming lack of concern or distress about the functional loss 

La belle indifference

Functional Neurological Symptom Disorder: generally improves within ___ and recover within ___

2 weeks, 1 month

which disorder has la belle indifference, where the patient does not seem to care much about the manifestation

Functional Neurological Symptom Disorder

in which disorders is the patient is intentionally producing symptoms for a purpose or gain.

malingering and factitious disorder

•Intentional production of false or grossly exaggerated physical or psychological symptoms

malingering

•No real physical symptoms, OR grossly exaggerate minor symptoms

malingering

in malingering, it is motivated by __________ and they are able to stop as soon as _______ received

external incentives/secondary gains

secondary gain

-Examples of external incentives desired:

avoid work;

evade criminal prosecution;

obtain financial compensation;

obtain drugs;

avoid being discharged

malingering

Characterized by somatization in which the person intentionally causes (i.e., “fakes”) an illness or exaggerates symptoms for the purpose of assuming “sick person” role or to be viewed as a ‘hero’

factitious disorder

•Willfully controls the physical symptoms (not unconscious)

•Uses various methods (some extreme) to create symptoms

factitious disorder

inject self with bacteria, contaminate own urine with blood, take a hallucinogen, deliberately infect own wound, take a medication you are allergic to

factitious disorder imposed on self

Vulnerable people are the victims (e.g., children, older adults), so this is a type of abuse.

For example, lie about the child’s symptoms, change test results to make a child appear ill, or physically harm the child/older adult to produce symptoms

factitious disorder imposed on other

goal of care for somatic symptoms and related disorders

•help the patient manage or diminish physical symptoms (not “cure” them); improve quality of life

through assessment to rule out physical conditions

nursing interventions for somatic symptoms and related disorders

health teaching, expression of emotional feelings, teach coping strategies

health teaching includes

•Establish a daily routine, adequate nutrition and sleep

expression of emotional feelings includes

•Recognize relationship between stress and physical symptoms

•Keep a journal

•Limit time spent on physical symptoms

•Limit primary and secondary gains

teaching coping strategies includes

•Relaxation techniques, deep breathing, distraction, problem-solving, role-playing

•Other Interventions and Recommended Treatment

•Stress-management/relaxation training

•Pharmacological treatment (e.g., SSRIs)

•CBT

•Behavior modification

•Groups for patients and families

•Referrals (e.g., pain clinic; physical therapy)

•Set, regular appointments with healthcare provider

-Help the patient _____ or _______ their symptoms versus eliminate them.

manage, diminish

How do we know if treatment is successful for a patient with somatic symptom disorder?

•Recognizes the interaction of mind and body and the effects of stress

•Identifies conflicts or problems in his/her situations and relationships

•Copes adaptively

•Experiences diminished physical manifestations

•Assumes appropriate roles in work, family, and community

ways for them to cope adaptively

•Challenges irrational thoughts

•Corrects own misinformation

•Verbalizes thoughts and feelings

•Engages in regular physical activity

•Eats nutritiously

•Uses relaxation techniques