Somatic Symptom Disorders Overview

Somatization

Expression of stress through physical symptoms; often substitutes for anxiety, depression, or irritability.

Cultural Considerations in Somatization

Symptoms and frequency vary across cultures; may involve beliefs like spells or trauma responses in immigrant populations.

Somatic Symptom Disorder (SSD)

One or more distressing symptoms with excessive thoughts or behaviors. No significant medical findings, but symptoms are real and impair function.

Illness Anxiety Disorder

Fear of serious illness for >=6 months, mild or absent symptoms, excessive health behaviors or avoidance, may be care-seeking or care-avoidant.

Conversion Disorder

Neurological symptoms without a neurological diagnosis (e.g., blindness, paralysis). Often marked by 'la belle indifférence.'

Cognitive Factors Affecting Medical Condition

Mental states (depression, stress) worsen physical conditions or interfere with treatment (e.g., cardiovascular disease, cancer).

Factitious Disorder

Deliberate faking or creation of symptoms for the sick role. Can be imposed on self or another. Associated with compulsivity and deception.

Malingering

Intentional symptom exaggeration for external gain (e.g., avoiding military, gaining money, prescriptions).

SSD Prevalence

5-7% among adults; often comorbid with anxiety, depression, and chronic illness.

Illness Anxiety Comorbidities

Anxiety, depression; influenced by cognitive and environmental factors.

Conversion Disorder Risk Factors

Biological, environmental, and neurobiological influences.

SSD Nursing Care

Build therapeutic relationship, education, consistent reassurance, support family, encourage healthy lifestyle.

Illness Anxiety Nursing Care

Allow discussion of health fears, reassure psychiatric care complements medical care, promote socialization.

Conversion Disorder Nursing Care

Avoid direct symptom confrontation, support patient's beliefs and feelings, encourage socialization, promote adaptive coping.

Cognitive-related Condition Nursing Care

Teach positive coping, assess trauma history, encourage community connection to combat loneliness.

SSD Treatment

CBT + medication, avoid unnecessary diagnostics, offer support.

Illness Anxiety Treatment

CBT/iCBT, pharmacotherapy, ECT (in select cases).

Conversion Disorder Treatment

BOPT, DBT, psychodrama, physical therapy.

Factitious Disorder Treatment

CBT focused on childhood trauma.

Assessment for SSDs

Medical and psychosocial history, coping skills, spirituality, communication, nutrition, self-assessment.

Nursing Diagnoses

Anxiety, risk for loneliness, hopelessness, impaired socialization, pain, suicide risk.

Outcome Goals

Patient involvement, small achievable steps, focus on measurable progress.

Implementation

Integrated care, education, psychosocial support, coping skills, self-care, support groups, assertiveness training.

6 Key Treatment Elements

Continuity, avoid unnecessary procedures, regular brief visits, physical exams, avoid negative remarks, set therapeutic goals.

Evaluation

Based on realistic outcomes, patients may still report symptoms but with reduced concern.

SSD vs. Factitious vs. Malingering

SSD: genuine distress without medical findings; Factitious: symptoms created for attention; Malingering: symptoms faked for gain.