Somatic

Conversion Disorder

Functional neurological symptom disorder, previously known as conversion disorder, results in neurologic manifestations without a neurologic diagnosis.

Neurologic manifestations in Conversion Disorder

Can cause extreme anxiety or la belle indifference (lack of concern).

Functional neurological symptom deficit

Deficits in voluntary motor or sensory functions (blindness, paralysis, seizures, gait disorders, hearing loss).

Expected findings in Conversion Disorder

Manifestations of altered voluntary motor or sensory function.

Motor manifestations in Conversion Disorder

Paralysis, movement/gait disorders, seizure-like movements.

Sensory manifestations in Conversion Disorder

Blindness, aphonia, anosmia, numbness, deafness, tingling/burning sensations.

Pseudocyesis

False pregnancy in clients with extreme desire to become pregnant.

Somatic Symptom Disorder

Expression of psychological stress through physical manifestations that cannot be explained by pathology.

Somatic Symptom Disorder expected findings

Somatic manifestations disrupting daily life, excessive preoccupation, anxiety, overmedication, high health service use.

Illness Anxiety Disorder

Misinterprets physical sensations as serious illness, previously known as hypochondriasis.

Illness Anxiety Disorder expected findings

Excessive anxiety about illness >6 months, preoccupation with health behaviors, may be health-seeking or care-avoidant type.

Primary gains

Direct relief of anxiety, conflict, or distress from being sick.

Secondary gains

Personal or external benefits received from others due to illness.

La Belle Indifference

Attitude of indifference or lack of concern about loss of function.

Factitious Disorder

Conscious decision to report false physical or psychological manifestations without personal gain.

Factitious Disorder imposed on another

Client deliberately causes injury or illness to a vulnerable person.

Malingering

Consciously motivated false symptoms for personal gain (e.g., disability, evading responsibility).

Somatic Symptom Disorder three central features

Physical complaints, psychological factors, symptoms magnified; not under client control.

Predisposing factors of Somatic Symptom Disorder

Primary and secondary gains.

Nursing care – Somatic Symptom Disorder

Accept symptoms, assess suicidal ideation, identify cultural impact, report new symptoms, limit discussion time, encourage independence, verbalization, alternative coping, daily exercise.

Nursing care – Illness Anxiety Disorder

Build rapport, encourage self-care, client education

Nursing care – Functional Neurological Symptom Disorder

Build rapport, ensure safety, verbalization of feelings, identify triggers, educate on coping and stress management, understand remission/relapse.

Nursing care – Factitious Disorder

Self-assessment before care, avoid confrontation, build rapport, ensure safety, educate on coping and stress management, communicate suspicions to healthcare team.

Client-centered care – Somatic Symptom Illness

Self-assessment, avoid confrontation, build rapport, ensure safety, educate on coping and stress management, communicate suspicions to healthcare team.

Client education – Somatic Symptom Illness

Participate in therapy, attend support groups, utilize prescribed medications, verbalize feelings.