Somatic Symptom and Related Disorders

What is somatization?

an unconscious conversion of emotional or mental states into physical, bodily symptoms (primary gain).  People internalize their distress (e.g., anxiety, stress, frustration) and instead of confronting this distress directly, they express it unconsciously through physical symptoms. Somatization is a psychological process in which emotional distress manifests as physical symptoms without a medical explanation.

What is a primary gain?

The benefit obtained by an individual when a psychological conflict is expressed through physical symptoms, providing relief from emotional distress.

What is a secondary gain?

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. The gains/rewards probably wouldn’t have occured w/o somatization

Are somatic sx disorders typically more common in men or women

women

What are common comorbidities of somatic sx disorders?

anxiety and depression

Why are somatic sx disorders often seen in medical vs. mental health settings?

difficulty accepting a psychological dx

What are the general etiology of somatic sx disorders?

genetics, environment, internalization

What is somatic sx d/o?

sx can’t be explained by underlying pathology; sx diffuse, complex, and move from one body sys. to another; pt is typically not fixed on fear of just one specific d/o but focused on general sx/complaints from multi body systems; often complains of vague, non-specific, exaggerated physical sxs; pt spends lot of time worrying about their sxs

What is pain d/o?

pain is primary physical sx; generally unrelieved by analgesics; greatly affected by psychological factors

What is illness anxiety d/o?

belief in/fear of having or developing a serious disease including misinterpretation of physical signs as proof of disease despite negative findings and clinician reassurances; very high anxiety; obsessive thoughts and fears about illness; chronic and relapsing; may seek care from multi providers or not at all

What is functional neurological symptom disorder?

transferring mental conflict into a physical symptom for which there’s not organic cause; usu. short term & rarely chronic

What are the symptoms of Functional Neuro Symptom d/o?

usually sudden defecits in voluntary motor or sensory functions like blindness, paralysis, seizures, hearing loss or gait disorders; not under pt’s voluntary control; may cause anxiety but often exhibit la belle indifference

What is malingering?

intentional production of false or grossly exaggerated physical or psychological symptoms; no real physical sxs OR grossly exaggerated minor sxs; motivated by external incentives/secondary gain; able to stop sxs as soon as secondary gain received

What is factitious d/o?

somatization in which person intentionally causes an illness or exaggerates sxs for purpose of assuming “sick person” role or to be viewed as a “hero”

What is factitious syndrome imposed on self?

formerly known as Munchausen syndrome; falsifies physical or psychological symptoms or induces illness on self (fabricated, self-inflicted/induced); recurrent hospitalizations; goes from one provider to another
ex: inject self w/bacteria, contaminate own urine w/blood, take hallucinogen, take med you’re allergic to

What is factitious d/o imposed on another?

previously known as Munchausen by proxy; vulnerable ppl are the victims (children, older adults); type of abuse;
ex: lie about child’s sxs, change test results to make child appear ill, or physically harm child/older adult to produce sxs

What is the goal of car for somatic symptom & related disorders?

help pt manage or diminish physcial symptoms (not cure them); improve QOL

What are the nursing interventions for somatic symptom disorders and related disorders?

• thorough assessment (r/o physical conditions); important to recognize somatization and manage it (failure can l/t frustrating & costly tests and tx)

• health teaching: estab daily routine, adeq nutrition, sleep

• express emotional feelings: recognize relationship b/t stress and physical sxs; keep journal; limit time spent on physical sxs; limit primary and secondary gains

  • teach coping strategies: relaxation, deep breathing, distraction, problem-solving, role-playing

What are some other nursing interventions & recommended treatments for somatic symptom & related disorders?

stress mgmt/relaxation training
meds
CBT
behavior modification
groups for pts and families
referrals
set regular appts w/healthcare provider (4-6 weeks)

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

recognized interactions of mind & body and effects of stress
IDs conflicts or probs in their situations and relationships
copes adaptively
experiences diminished physical manifestations
assumes appropriate roles in work, family, and community