Somatoform Disorders Powerpoint
Stiffness and Gender Identity in Health
Stiffness can be related to various medical conditions, including those affecting gender identity and health conditions.
Overview of Conditions and Disorders
Accumulation of Symptoms: Stressors can result in diagnosed disorders where the sense of control is crucial for treatment success.
Varied Factors in Disorders:
Neurological components (neurons, central nervous system issues).
Emotional problems and anxiety disorders affecting cognitive function and behaviour.
The interplay between biology and environment in psychological disorders.
Mental Health and Well-Being
Factors Affecting Mental Wellness:
Emphasis on controlling cognitive and emotional difficulties through effective treatment systems.
Importance of therapeutic systems for alleviating symptoms related to both physical and mental health.
Somatoform Disorders
Definition: A group of disorders characterized by the expression of unexplained physical symptoms without an identifiable medical condition.
Origin of the Term: "Soma" means body.
Significant prevalence in women, with onset typically before 30 years of age.
Hypochondriasis
Definition: An overwhelming belief and fear of having a serious disease, often characterized by misinterpretation of physical signs.
Symptoms include severe anxiety regarding potential serious illness and strong conviction despite medical reassurance being ineffective.
Example: A client may have a minor rash but believes they have a serious condition like lupus.
Causes: Cognitive perceptual distortions and familial history of illness.
Treatment Strategies:
Challenge and reinterpret illness-related misinterpretations.
Provide reassurance and manage stress through coping strategies.
Somatization Disorder
Definition: Characterized by recurrent complaints leading to frequent medical attention without medical pathology.
Impairment in occupational or social functioning, with symptoms becoming intertwined with personal identity.
Example: A client may regularly complain of chest pains despite normal medical tests (like an EKG).
Treatment: No effective treatments exist; aim to reduce visits to multiple specialists and introduce a “gatekeeper” physician.
Conversion Disorder
Definition: The transformation of psychological conflict into physical symptoms, lacking any organic basis.
Generally involves sensory-motor dysfunctions without awareness of the physical ailment (termed "la belle indifference").
Examples of Symptoms: Blindness, paralysis, seizures, deafness, or pseudocyesis (false pregnancy).
Causes: Often linked to Freudian views emphasizing trauma and the gains derived from exhibiting symptoms (primary: anxiety relief; secondary: sympathy or avoidance of responsibility).
Treatment: Similar strategies as somatization disorder, focusing on trauma resolution and minimizing secondary gains.
Factitious Disorder
Definition: Previously known as Munchausen syndrome, it entails the conscious fabrication of symptoms for emotional fulfillment and attention.
Symptoms presented without personal gain; clients often display high intelligence and sophisticated medical knowledge.
Behavioral Traits:
Dramatic illness descriptions and reluctance to allow external communication.
Often new symptoms arise after negative test results.
Factitious Disorder Imposed on Another: When a client intentionally harms a vulnerable individual to gain attention, differs from malingering, which is motivated by personal gain (like benefits).
Risk Factors:
Emotional and physical distress, childhood abuse, and history of hospitalizations.
Body Dysmorphic Disorder
Definition: A preoccupation with perceived defects in appearance leading to frequent mirror-checking behaviors and suicidal ideation.
More prevalent than recognized, affecting both genders, with onset typically in early adulthood.
Cultural Reference: Barbie Syndrome, emphasizing the influence of beauty ideals, often impacting females and extending into adulthood.
Example: Cindy Jackson, who underwent numerous surgeries to resemble her ideal image.
Causes: Familial tendencies and societal pressures, sharing similarities with OCD.
Treatment Methods:
Parallels OCD treatment including SSRIs and response prevention strategies.
Caution advised regarding the effectiveness of plastic surgery.
Nursing Interventions for Somatoform Disorders
Nonjudgmental Attitude: Acceptance and acknowledgment of the patient's symptoms.
Documentation: Careful record-keeping of complaint details, duration, and factors influencing symptom expression.
Encouragement of Emotional Expression: Helping clients identify the emotional connections of their symptoms, and implementing interventions to reduce anxiety and support wellness strategies.
Patient Education: Teach relaxation techniques such as deep breathing and visualization techniques to manage stress and anxiety associated with symptoms.
Chapter 20: Somatic Symptom and Related Disorders
Clients who have somatic symptom and related disorders are often encountered in primary care settings. It is important that nurses are familiar with these disorders, as well as their role when caring for these clients. Somatic symptom and related disorders include somatic symptom disorder, illness anxiety disorder, functional neurological symptom disorder, factitious disorder, and psychological factors affecting other medical conditions.
Somatic Symptom Disorder
Somatization is the expression of psychological stress through physical symptoms. The physical manifestations of somatic symptom disorder cannot be explained by underlying pathology.
Somatic symptoms cause distress for clients and often lead to long-term use of health care services. Symptoms can be vague or exaggerated. The course of the disease can be acute, but is often chronic, with periods of remission and exacerbation.
Clients who have somatic symptom disorder spend a significant amount of time worrying about their physical symptoms to the point where it assumes a central role in the client’s life and relationships. Clients often reject a psychological diagnosis as the cause for their physical symptoms. They seek care from several providers, increasing medical costs.
Clients are usually seen initially in a primary or medical care setting rather than a mental health setting.
Anxiety and depression are often comorbidities.
Data collection
Risk Factors
First-degree relative who has somatic symptom disorder
Decreased levels of neurotransmitters: serotonin and endorphins
Depressive disorder, personality disorder, or anxiety disorder
Low socioeconomic status
Adverse childhood experiences
Learned helplessness
Expected findings
Somatic symptoms that disrupt the client’s daily life
Excessive preoccupation with somatic symptoms
Increased level of anxiety about somatic symptoms
Somatic symptoms are usually present (though actual symptoms can vary) for longer than 6 months
Remissions and exacerbations of somatic symptoms
Probable alcohol or other substance use
Client overmedication with analgesics and antianxiety medications
High utilization of health services and multiple health care providers
Laboratory and Diagnostic Tests
CT scans and MRIs can be performed to rule out underlying pathology.
Data Collection Tools
Patient Health Questionnaire 15 (PHQ-15): Used to identify the presence of the 15 most commonly reported somatic symptoms QEBP
Abdominal pain
Back pain
Pain in the extremities/joints
Menstrual problems or cramps
Headaches
Chest pain
Dizziness
Fainting
Heart pounding or racing
Dyspnea
Problems or pain with sexual intercourse
Problems with bowel elimination (constipation/diarrhea)
Nausea, indigestion, or gas
Lethargy
Problems sleeping
A nurse is discussing the risk factors for somatic symptom disorder with a newly licensed nurse. Which of the following risk factors should the nurse include?
Select all that apply.
A
Age older than 65 years
B
Anxiety disorder
C
Childhood trauma
D
Coronary artery disease
E
Obesity
A nurse is reviewing the medical record of a client who has functional neurological symptom disorder. Which of the following findings should the nurse identify as placing the client at risk for functional neurological symptom disorder?
A
Death of a child 2 months ago
B
Recent weight loss of 30 lb
C
Retirement 1 year ago
D
History of migraine headaches
A nurse is collecting data for a client who has illness anxiety disorder. Which of the following findings are expected for this disorder?
Select all that apply.
A
Obsessive thoughts about disease
B
History of childhood maltreatment
C
Avoidance of health care providers
D
Depressive disorder
E
Narcissistic personality
Patient-Centered Care
Nursing Care
Accept somatic symptoms as being real to the client.
Monitor for suicidal ideation and thoughts of self-harm.
Identify the cultural impact on the client’s view of health and illness.
Identify secondary gains from somatic symptoms (attention, distraction from personal obligations or problems).
Report new physical symptoms to the provider.
Limit the amount of time allowed to discuss somatic symptoms.
Encourage independence in self-care.
Encourage verbalization of feelings.
Reinforce teaching with the client on alternative coping mechanisms.
Reinforce teaching with the client on assertiveness techniques.
Encourage daily physical exercise.
Reattribution treatment
Work with the provider to provide reattribution treatment, which assists clients to identify the link between physical symptoms and psychological factors while promoting a sense of caring and understanding.
Four stages of reattribution treatment QTC
Stage 1: Feeling understood: Use therapeutic communication, active listening, and empathy to obtain a thorough history of symptoms while focusing on the client’s perception of the symptoms and their cause. This stage also includes a brief physical data collection.
Stage 2: Broadening the agenda: Provide acknowledgment of the client’s concerns and provide feedback about data collection findings.
Stage 3: Making the link: Use therapeutic communication to acknowledge the lack of a physical cause for the symptoms while allowing the client to maintain self-esteem.
Stage 4: Negotiating further treatment: Work with the provider and client to develop a treatment plan that allows for regular follow-up visits.
Medications
Administer medications as prescribed.
Analgesics
Antidepressants
Anxiolytics
Client Education
Participate in individual and group therapy.
Utilize prescribed medications.
Assist a case manager to develop a follow-up appointment schedule with provider every 4 to 6 weeks. This strategy provides set appointments and decreases the need for unscheduled health care, as well as medical costs associated with laboratory and diagnostic tests if treatment from other providers is preferred. QEBP
Illness anxiety disorder
Misinterprets physical manifestations as evidence of a serious disease process. Illness anxiety disorder, previously known as hypochondriasis, can lead to obsessive thoughts and fears about illness.
Clients who have illness anxiety disorder are overly aware of bodily sensations and attribute them to a serious illness. Physical manifestations can be minimal or absent. However, clients still have a preoccupation about having an undiagnosed, serious illness.
Clients research their suspected disease excessively and examine themselves repeatedly, such as examining throat in the mirror.
Clients might either seek numerous medical opinions or avoid seeking health care so as not to increase their anxiety.
Clients continue to have anxiety despite negative diagnostic tests and reassurance from the provider.
Data collection
Risk Factors
First-degree relative who has illness anxiety disorder
Previous losses or disappointments resulting in feelings of anger, guilt, or hostility
Childhood trauma, maltreatment , or neglect
Depressive disorder or anxiety disorder
Major life stressor
Low self-esteem
Expected findings
Excessive anxiety that a serious illness is present or will be acquired. This anxiety is present for more than 6 months though the actual illness the client fears can change.
Preoccupation with performance of behaviors that are health-related (performing a daily breast self-exam due to fear of breast cancer).
Some clients have illness anxiety disorder that is the health-seeking type (frequently seeking medical care and diagnostic tests) while others exhibit the care-avoidant type (avoids all contact with providers due to the correlation with increased levels of anxiety).
Laboratory and Diagnostic Tests
CT scans and MRIs can be performed to rule out underlying pathology.
Patient-Centered Care
Nursing Care
Build rapport and trust with client.
Encourage independence in self-care.
Medications
Administer medications as prescribed.
Antidepressants
Anxiolytics
Client Education
Participate in individual and group therapy.
Attend community support groups.
Utilize prescribed medications.
Collaborate with the provider to receive brief, frequent office visits.
Verbalize any feelings.
Utilize alternative coping mechanisms.
Perform stress management techniques.
Functional neurological symptom disorder
Functional neurological symptom disorder, previously known as conversion disorder, results when a client exhibits neurologic manifestations in the absence of a neurologic diagnosis. Clients who have functional neurological symptom disorder transmit emotional or psychological stressors into physical manifestations.
Neurologic manifestations can cause extreme anxiety and distress in some clients while others can exhibit a lack of emotional concern (la belle indifference).
The neurologic manifestation causes a significant impairment in multiple aspects of the client’s life.
Clients who have functional neurological symptom disorder have deficits in voluntary motor or sensory functions (blindness, paralysis, seizures, gait disorders, hearing loss).
Data Collection
Risk Factors
First-degree relative who has functional neurological symptom disorder
Childhood physical or sexual abuse
Comorbid psychiatric conditions
Depressive disorder
Anxiety disorder
Posttraumatic stress disorder
Personality disorder
Other somatic disorder
Comorbid medical or neurologic condition
Recent acute stressful event
Female sex
Adolescent or young adult
Low socioeconomic status, low educational status
Expected findings
Manifestations of an alteration in voluntary motor or sensory function
Motor: Paralysis, movement/gait disorders, seizure-like movements
Sensory: Blindness, inability to speak (aphonia), inability to smell (anosmia), numbness, deafness, tingling/burning sensations
Clients who have an extreme desire to become pregnant can manifest a false pregnancy (pseudocyesis).
Laboratory and Diagnostic Tests
CT scans and MRIs can be performed to rule out underlying pathology.
Patient-Centered Care
Nursing Care
Build rapport and trust with clients.
Ensure safety of clients.
Encourage verbalization of feelings. Assist the client to identify the psychological trigger of the manifestation. For example, a client’s sudden blindness can be a functional neurological symptom manifestation in response to seeing their partner being intimate with someone else.
Instruct client on alternative coping mechanisms.
Instruct client on stress management techniques.
Understand the incidence of remissions and recurrence. Remission occurs without intervention in approximately 95% of clients, especially if the onset of manifestations is due to an acute stressful event.
Relapse rate is approximately 20% usually within 1 year of initial diagnosis.
Medications
Administer medications as prescribed.
Antidepressants
Anxiolytics
Client Education
Participate in individual and group therapy.
Attend community support groups.
Utilize prescribed medications.
A nurse is assisting with developing a plan of care for a client who has functional neurological symptom disorder. Which of the following actions should the nurse include?
A
Encourage the client to spend time alone in their room.
B
Monitor the client for self-harm once per day.
C
Allow the client unlimited time to discuss physical manifestations.
D
Discuss alternative coping strategies with the client.
Psychological factors affecting other medical conditions
Psychological and behavioral factors can play a role in any medical condition. The mind-body connection has been the subject of research, proving a link between a client’s psychological state and their physical condition.
The development of certain medical conditions (heart disease, cancer) has been linked to clients who have depressive and anxiety disorders.
Other medical conditions have been found to be is caused or perpetuated by a psychological or behavioral factor.
Data collection
Risk Factors
Chronic stressors
Depressive disorder or anxiety disorder
Malfunction of neurotransmitters
Expected findings
A confirmed medical diagnosis
A psychological or behavioral factor that is linked to the medical diagnosis in one of the following ways
Contributes to the development, exacerbation, or delayed recovery of the medical diagnosis
Interferes with the client’s adherence to the treatment of the medical diagnosis
Places the client at increased risk for physical health problems
Causes or exacerbates physical manifestations or the client’s need for medical treatment
Patient-Centered Care
Nursing Care
Discuss the client’s physical exam findings.
Monitor for suicidal ideation, thoughts of self-harm. QS
Explore the client’s feelings and fears.
Allow the client time to express feelings.
Instruct the client on alternative coping mechanisms.
Instruct the client on assertiveness techniques.
Address both physical and psychological needs.
Administer prescribed medications.
Provide care that meets both the physical and psychological needs of the client.
Client Education
Participate in treatment plan.
Utilize prescribed medications.
Factitious disorder
Factitious disorder (previously known as Munchausen syndrome) is the conscious decision by the client to report physical or psychological manifestations. The falsification of manifestations is done in the absence of personal gain by the client other than possible fulfillment of an emotional need for attention. In some cases, clients inflict self-injury.
Factitious disorder imposed on another (previously known as Munchausen syndrome by proxy) is present when the client deliberately causes injury or illness to a vulnerable person. The emotional need for attention or relief of responsibility remains a possible motivating factor.
Clients often have an average or above-average IQ. The client is dramatic in the description of the illness, uses proper medical terminology, and is often hesitant for the provider to speak to family members or prior providers.
The client often reports new manifestations following negative test results.
Factitious disorder differs from malingering. Factitious disorder is a mental illness, while malingering is not. Malingering is consciously motivated and driven by personal gain (disability benefits, evading military service, etc.).
Data collection
Risk Factors
History of emotional or physical distress, child maltreatment , or frequent/chronic childhood illnesses requiring hospitalizations
Impaired neurologic ability for information processing
Dependent personality
Borderline personality disorder
Expected findings
Report of false physical and psychological manifestations
Possible evidence of self-injury (factitious disorder) or injury to others (factitious disorder imposed on another)
Laboratory and Diagnostic Tests
CT scans and MRIs can be performed to rule out underlying pathology.
Patient-Centered Care
Nursing Care
Perform a self-assessment prior to care.
Avoid confrontation.
Build rapport and trust with client.
Ensure safety of client and vulnerable persons affected by the client.
Instruct client on alternative coping mechanisms.
Instruct client on stress management techniques.
Communicate openly with the health care team any suspicions of factitious disorder or factitious disorder imposed on another. This action can help reduce medical costs and possible unnecessary treatments/surgical procedures. QTC
Client Education
Participate in individual and group therapy.
Attend community support groups.
Utilize prescribed medications.
Verbalize any feelings.
A nurse is caring for several clients. Which of the following client statements should the nurse identify as expected for factitious disorder imposed on another?
A
“I had to pretend I was injured in order to get disability benefits.”
B
“I know that my abdominal pain is caused by a malignant tumor.”
C
“I needed to make my child sick so that someone else would take care of them for a while.”
D
“I became deaf when I heard that my partner was having an affair with my best friend.”
Active Learning Scenario
A nurse is caring for a client who has psychological factors affecting other medical conditions. Use the ATI Active Learning Template: System Disorder to complete the following.
Expected findings: Identify at least two.
Risk factors: Identify the risk factors of psychological factors affecting other medical conditions.
Nursing care: Identify at least three nursing interventions for this client.
Click to download this file.
Active Learning Scenario Key
Click to reveal sample responses.