Somatic Symptom Disorders

Somatic Symptom and Dissociative Disorders Overview

Objectives

  • Identify distinguishing features of somatic symptom and dissociative disorders.

  • Describe contributing factors to these disorders.

  • Develop care plans for clients with somatic symptom and dissociative disorders.

  • Explain the nurse's role in caring for clients with factitious disorder or malingering.

Somatic Symptom Disorders

  • Definition: Physical symptoms conveying emotional and psychological distress.

  • Interrelation: Physical health strongly impacts mental health.

  • Demographics: More prevalent in women, especially ages 16-25; affects nearly 4-6% of the population.

  • Prevalence in Youth: 20-25% of children experience abdominal pain, headaches, and musculoskeletal pain.

  • Contributing Factors:

    • Negative thought patterns.

    • Low resilience and self-compassion.

    • Adverse Childhood Experiences (ACEs).

    • Cultural stigmatization of psychological issues.

  • Psychoanalytic Perspective (Freud): Symptoms may serve as an acceptable outlet for unacceptable feelings. May lead to reinforced behavior by receiving care.

Types of Somatic Disorders

  • Somatic Symptom Disorder

  • Illness Anxiety Disorder

  • Functional Neurological Symptom Disorder

  • Factitious Disorder

  • Malingering

Somatic Symptom Disorder

  • Characteristics:

    • Real physical symptoms: pain (e.g. chest, abdominal), fatigue, dizziness, etc.

    • Persistent symptoms with preoccupation and fear regarding health.

    • Symptoms create excessive life disruption, leading to anxiety.

    • Patients without a physiological cause may feel dismissed or mislabeled.

Illness Anxiety Disorder

  • Formerly known as: Hypochondriasis.

  • Symptoms: Preoccupation with having a serious illness; mild or no symptoms.

  • Behavior: Frequent discussions about health, can either seek or avoid medical care; exacerbates under stress or media influence.

Functional Neurological Symptom Disorder

  • Also known as: Conversion disorder.

  • Symptoms: Neuro symptoms (paralysis, blindness) without neurological diagnosis; often acute and resolves quickly.

  • Associated Factors: Background of depression, anxiety, PTSD, and ACEs.

Assessment of Somatic Disorders

  • Key Assessment Tool: OLD CARTS framework (Onset, Location, Duration, Characteristics, Aggravating/relieving factors, Treatments, Severity).

  • Challenges: Psychological symptoms often go unreported; physical symptoms are frequently described dramatically.

  • Indicators to Evaluate: ADLs, coping skills, medications, doctor shopping, and secondary gains.

Interventions for Somatic Disorders

  • Approach: Provide positive regard and empathy, offer holistic care.

  • Techniques:

    • Identify secondary gains and alternate needs fulfilment.

    • Relaxation techniques (e.g., yoga, mindfulness).

    • Use of antidepressants and psychotherapy techniques like CBT.

    • Education on the disorders involved.

Factitious Disorder

  • Overview: Previously known as Munchausen syndrome; includes imposed self/another.

  • Behavior: Conscious control; compulsive nature, often coupled with medical knowledge.

  • Purpose: Not for financial gain; typically for attention or relationships.

  • Incidence: Ranges from 0.8% to 6%, and is challenging to treat and diagnose.

  • Nursing Role: Emphasize good documentation, avoid confrontation; mandated reporting for factitious disorder imposed on others.

Malingering

  • Difference: Not classified as a mental health disorder.

  • Characteristics: Associated with personality disorders; complaints are vague or stereotypical.

  • Motive: Deliberate actions taken for secondary gains, such as escaping work or gaining disability payments.

Dissociative Disorders

  • Definition: Disconnection from thoughts, memories, or feelings.

  • Impact: Can affect memory, perception, consciousness, identity, and behavior.

  • Association: High correlation with ACEs/trauma (90%); serves as a defense mechanism.

  • Symptoms: Positive symptoms include depersonalization and derealization, while negative symptoms indicate a lack of control over mental functions.

Types of Dissociative Disorders

  • Depersonalization/Derealization Disorder: Self-detachment, feelings of robotic or out-of-body experiences; common transient episodes.

    • Statistics: ~50% of adults report lifetime experiences of these symptoms.

  • Dissociative Amnesia Disorder: Memory loss tied to trauma; can be localized or generalized.

  • Dissociative Identity Disorder (DID): Presence of two or more distinct personality states; often linked to traumatic experiences and high risk for suicidality (70% attempt).

Assessment and Interventions for Dissociative Disorders

  • Care Approach: Emphasis on awareness, empathy, and trauma-informed care.

  • Interventions:

    • Therapeutic approaches like CBT, DBT, EMDR.

    • Mindfulness and grounding techniques to aid coping and reduce stress.

    • Medications for managing symptoms, including SSRIs and anxiolytics.