SOMATOFORM DISORDERS

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In early 1800s,- the medical began to considert the various social and psychologic factors that influence illness Psychomatic used to convey the connection between the mind (psyche) and the body (soma)

Hysteria- multiple physical complaints with no organic basis - Associated with witchcraft, demons and sorcerers
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Somatization- transference of mental experiences and states into bodily symptoms. Somatoform Disorder presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for them

3 features of Somatoform Disorders Physical complaints suggest major medical illness but have no demonstrable organic basis Psychological factors and conflicts seen important in initiating, exacerbating, and maintaining the symptoms Symptoms or magnified health concerns are not under the clients conscious control Free Powerpoint Templates Page 3

Symptoms of Somatization Disorders Pain Symptoms - complaints of headache, pain in the abdomen, head, joints, back, chest,rectum; pain during urination, menstruation, sexual intercourse Gastrointestinal Symptoms- nausea, bloating, vomiting, diarrhea or intolerance of several foods Sexual Symptoms sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy Pseudoneurologic symptoms conversion symptoms such as ipaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, Freehallucinations Powerpoint Templates Page 4

5 specific Somatoform Disorders 1. Somatization disorder- characterized by multiple physical symptoms Begins by 30 years of age , includes combination of pain and gastrointestinal, sexual, and pseudoneurologic symptoms

2. Conversion Disorder- also called conversion reaction, involves unexplained, usually sudden deficits in sensory or motor action (blindness, paralysis)
3. Pain Disorder- has a primary physical symptom of pain, which is generally unrelieved by analgesics and greatly affected by psychologic factors interms of onset, severity, exacerbation, and maintenance
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4. Hypochondriasis- preoccupation with the fear that one has serious disease (disease conviction) or will get a serious disease (disease phobia)
5. Body dysmorphic Syndrome- preoccupation with an imagined or exaggerated defect in physical appearance such s thinking ones nose is too large or teeth are crooked and unattractive

Onset and Clinical Course Clients with somatization disorder and body dysmorphic disorder often experience symptoms in adolescence Conversion disorder usually occurs between 10 35 years of age. Pain disorder and Hypochondriasis can occur at any age
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 Pain disorder and Hypochondriasis can occur at any age

Related disorder 1. Malingering intentional production of false or grossly exaggerated physical or psychologic symptoms; it is motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation. People with Malingering disorder have no real physical symptoms or grossly exaggerate relatively minor symptoms They can stop the physical symptoms as soon as they have gained what they wanted
2. Factitious Disorder occurs when a person intentionally produces or feigns physical or psychologic symptoms solely to gain attention, they even inflict injury to themselves to receive attention. Maunchausen Syndrome by proxy occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a hero for saving Free Powerpoint Templates Page 7 the victim

Body Identity integrity Disorder (BIID) people who feel alienated from a part of their body and desire amputation. Also called as amputee identity disorder and apotemnophila amputation love

ETIOLOGY PSYCHOSOCIAL THEORIES Internalization people with somatoform disorders keep stress, anxiety, or frustrations inside rather than expressing them outwardly client express this internalized feelings through physical symptoms. Primary gains- direct external benefits that being sick provides, such as relief of anxiety , conflict, or distress Secondary gains internal or personal benefits received from others because one is sick, such as attention from the family members and comfort measures, theFree person soon learns that he or she needs Powerpoint Templates Page 8 to be sick to have their emotional needs met.

Body Identity integrity Disorder (BIID) people who feel alienated from a part of their body and desire amputation. Also called as amputee identity disorder and apotemnophila amputation love ETIOLOGY PSYCHOSOCIAL THEORIES Internalization people with somatoform disorders keep stress, anxiety, or frustrations inside rather than expressing them outwardly client express this internalized feelings through physical symptoms. Primary gains- direct external benefits that being sick provides, such as relief of anxiety , conflict, or distress Secondary gains internal or personal benefits received from others because one is sick, such as attention from the family members and comfort measures, the person soon learns that he or she needs to be sick to have their emotional needs met.
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BIOLOGIC THEORIES Too little inhibition of sensory input amplifies awareness of physical symptoms and exaggerates response to bodily sensations. The amplified sensory awareness causes the person to experience somatic sensations as more intense, noxious, and disturbing.

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ASSESSMENT FOR INDIVIDUAL WITH SOMATOFORM DISORDERS A. General Appearance and Motor Behavior Clients walks slowly or with an unusual gait because of pain or disability caused by the symptoms Exhibit facial expression of discomfort or physical distress They brighten and look much better as the assessment interview begins because they have the nurse undivided attention
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B. Mood and Affect

Mood is often Labile, shifting from seeming epressed and sad when describing physical problems to looking bright and excited when talking about how they had to go to the hospital. Emotions are often exaggerated
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C. Thought Process and Content

Client do not experience disordered thought processes.

Content of their thinking is primarily about often exaggerated physical concerns Clients are unlikely to be able to think about or respond to questions about emotional feelings, they will answer questions about how they feel in terms of physical health or sensations
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D. Sensorium and Intellectual Processes.

Clients are alert and oriented, intellectual functionsa are unimpaired E. Judgment and Insight Exaggerated responses to their physical health may affect clients judgment They are firmly convinced their problem is entirely physical and often believe that other dont understand

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F. Self Concept

Clients have low self esteem and seem to deal with it totally focusing on physical concerns
They lack confidence , have little success in their work situations and have difficulty in managing life issues

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F. Roles and Relationship

Client often lose jobs because of excessive absenteeism or inability to perform work, because of poor physical health They have few friends and spend little time in social activities Client may report lack of family support
G. Physiologic and Self Care Concerns Client have sleep pattern disturbance, lack of basic nutrition, and get no exercise They may be taking multiple prescriptions for pain or other complaints
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CULTURAL CONSIDERATIONS Culture Bound Syndrome

Syndrome

Culture India

Characteristics Hypochondriacal concern about semen loss Belief that penis is shrinking and will disappear into the abdomen, resulting in death

Dhat
Southeast Asia

Koro

Southern United States, Sudden collapse; person cannot see or Falling-out episodes Caribbean Islands move
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Suppressed anger causes insomnia, Hwa-byung fatigue, panic, indigestion, and generalized aches and pains Portuguese Cape Pain, numbness, Verde Islands tremors, paralysis, seizures, blindness, Sangue dormido heart attack, (sleeping blood) miscarriage China Physical and mental fatigue, dizziness, headache, pain, sleep Shenjing shuariuo disturbance, memory loss, GI problems, Free Powerpoint Templates Page 18 sexual dysfunction

Korea

ANTI DEPRESSANTS USED TO TREAT SOMATOFORM DISORDERS

DRUG USUAL DOSAGE (mg/day) NURSING CONSIDERATIONS Monitor for rash, hives, insomnia, headache, 20-60 anxiety, drowsiness, nausea, loss of appetite; avoid alcohol

Fluoxetine (Prozac)

Paroxetine (Paxil)

20-60

Monitor for nausea, loss of appetite, dizziness, dry mouth, somnolence or insomnia, sweating, sexual dysfunction

Sertraline (Zoloft)

Monitor for nausea, loss of appetite, diarrhea, 50-200 Free Powerpoint Templatesheadache, insomnia, Page 19 sexual dysfunction

Nursing Diagnosis Ineffective coping Impaired social interaction Anxiety Disturbed Sleep Pattern Fatigue Pain

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Intervention Providing Health Teaching Client Family Education Establish daily routine, including adequate rest, exercise and nutrition Teach about relationship of stress and physical symptoms and mind-body relationship Educate about proper nutrition, rest, and exercise Educate client in relaxation techniques: progressive relaxation, deep breathing, guided imagery, and distraction such as music or other activities Educate client by role playing social situations and interactions Encourage family to provide attention and encouragement when client has fewer complaints Encourage family to decrease special attention when client is in sick role
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TREATMENT Treatment focuses on managing symptoms and improving quality of life. The health care provider must show empathy and sensitivity to the clients physical complaints. For many clients, depression may accompany or result from somatoform disorders Antidepressants help in many case For clients with pain disorder, referral to a chronic pain clinic may be useful. Clients learn methods of pain management such as visual imaging and relaxation Clients can use non steroidal anti-inflammatory agents to help reduce pain
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