Somatic Symptoms Disorders

Psychological stress manifests as physical disorders

somatic symptoms disorder

illness anxiety disorder

functional neurological symptoms disorder

factitious disorder

no clear etiology but there are probably risk factors and comorbidities

• cannot be associated with another medication condition

• also associated with personality disorders

SSD

• one or more distressing symptoms

• excessive thoughts, anxiety and behaviors around symptoms or health concerns

• without significant physical findings and medical diagnosis

• suffering is authentic

• patients experience a high level or functional impairment

• more common to be women

Illness anxiety disorder

• misinterpretation of physical sensations

• preoccupation with having or acquiring a disease

• high health anxiety

• excessive health related behaviors or maladaptive avoidance

• may be care-seeking or care-avoidant

• risk factors

  • cognitive

    • may be defense against guilt or low self-esteem

    • may perceive as a deserved punishment

  • environmental

    • ACE predispose patients

FND

• was called conversion disorder

• neurological symptoms in the absence of a neurological diagnosis

• experience deficits in voluntary motor or sensory functions

• common symptoms

  • paralysis

  • blindness

  • movement and gait disorders

  • inability to swallow

  • episodes resembling epilepsy

Factitious Disorder

• artificially, deliberately, and dramatically fabricate symptoms or self-infect injury

• goal of assuming a sick role

• can be imposed by self or another

• could be physical or psychiatric

• Malingering

  • related to factitious disorder

  • conscious fabrication or illness or exaggerating symptoms for secondary gain such as insurance fraud, prescription medication, avoidance of prison or military service

  • no specific treatment

Nursing process

assessment

• are they under their voluntary control

• what are the psychosocial factors

  • the way they think or feel

• coping skills

  • how they handle adversity

  • positive skills

  • negative skills

• spirituality and religion

  • support can be a source of comfort and peace

• secondary gains

  • benefits a patient gets from the symptoms alone

  • do they like the attention they are getting

• cognitive style

  • may misinterpret physical stimuli and distort reality of symptoms

• usually, have a difficult time communicating their emotional needs

• dependence on medication

  • assess medication types and amounts used by the patient

  • patients will use excessive amounts of medications

• self-assessment

  • be aware of our own feelings surrounding these disorders

Nursing diagnoses

• ineffective coping

• anxiety

• risk for loneliness

• powerlessness

• hopelessness

• social isolation

• pain

• altered family process

• risk for suicide

Treatment and management

• goal is to develop positive approaches to coping with the physical manifestations

  • SSD

    • learn the difference between normal sensations and symptoms of a harmful illness

    • schedule them for appointments with short interval between

  • illness anxiety disorder

    • SSRI

    • CBT

  • FND

    • CBT

    • physical therapy for motor or gait disturbances

    • antidepressants

    • develop positive coping skills

  • factitious disorders

    • develop new coping skills

    • safety

    • SSRI to manage comorbidities

    • manage unnecessary treatments or tests

Interventions

• utilize effective therapeutic communication

• long term treatment is outpatient based unless severe safety issue

• healthy coping strategies and skills

• encourage a healthy lifestyle

• provide psychosocial education

• relaxation techniques

• adequate sleep and engage in hobbies

Six key elements of effects relationships and treatment

• provide continuity or care

• avoid unnecessary procedures

• provide frequent, brief, and regular visits

• always do a physical exam

• avoid disparaging comments

• set reasonable therapeutic goals

Evaluation

• clear realistic and measurable outcomes

• goals may be partially met

  • may end of non-compliant because goals were not fully met

  • diminished