Somatic symptom disorders are characterized by physical symptoms

suggesting medical disease but without demonstrable organic

pathology or known pathophysiological mechanism to account
for them.

The term psychosomatic began Hysteria refers to multiple

to be used to convey the physical complaints with no
connection between the mind organic basis; the complaints
(psyche) and the body (soma) are usually described
in states of health and illness. dramatically

SOMATIZATION
Somatization is defined as the transference of mental experiences and
states into bodily symptoms.

3 CENTRAL FEATURES OF
SOMATIC SYMPTOM
ILLNESSES

Physical complaints suggest major medical

illness but have no demonstrable organic
basis.
Psychological factors and conflicts seem
important in initiating, exacerbating, and
maintaining the symptoms.
Symptoms or magnified health concerns are
not under the client’s conscious control.

Somatic symptom and related disorders are

classified as mental disorders, by the DSM-5, when
the excessive focus on somatic symptoms is
beyond any medical explanation and it causes
significant distress and impairment in one’s
functioning.

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Somatic symptom disorders include:

Somatic symptom disorder is Conversion disorder, sometimes called

characterized by one or more physical
symptoms that have no organic basis.
Individuals spend a lot of time and energy
focused on health concerns, often believe
symptoms to be indicative of serious illness,
and experience significant distress and
anxiety about their health.
conversion reaction, involves unexplained,
usually sudden deficits in sensory or motor
function (e.g., blindness, paralysis).
There is usually significant functional
impairment. There may be an attitude of
la belle indifférence, a seeming lack of
concern or distress, about the functional
loss.

Pain disorder has the primary physical

symptom of pain, which is generally
unrelieved by analgesics and greatly
affected by psychological factors in
terms of onset, severity, exacerbation,
and maintenance.
Illness anxiety disorder, formerly
hypochondriasis, is preoccupation with the fear
that one has a serious disease (disease
conviction) or will get a serious disease
(disease phobia). It is thought that clients with
this disorder misinterpret bodily sensations or
functions.

Related Disorders:
Fabricated or induced illness
body-related mental disorders, in which people
feign or intentionally produce symptoms for
some purpose or gain.
In malingering and factitious disorders, people
willfully control the symptoms.
In somatic symptom illnesses, clients do not
voluntarily control their physical symptoms.

Malingering is the intentional production of

false or grossly exaggerated physical or
psychological symptoms; it is motivated by
external incentives such as avoiding work,
evading criminal prosecution, obtaining
financial compensation, or obtaining drugs.

Factitious disorder, imposed on self,

occurs when a person intentionally
produces or feigns physical or
psychological symptoms solely to gain
attention.
The common term for factitious disorder
imposed on self is Munchausen syndrome
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ETIOLOGY
Psychosocial theorists believe that people with somatic symptom illnesses keep
stress, anxiety, or frustration inside rather than expressing them outwardly, which is
called internalization.
Both internalization and somatization are unconscious defense mechanisms.

Psychosocial theorists posit that increased

BIOLOGICAL THEORIES
incidence of somatization in women may be
Research has shown differences
related to various factors:
in the way clients with
Boys in the United States are taught to be stoic
somatoform disorders regulate
and to “take it like a man,” causing them to offer
and interpret stimuli.
fewer physical complaints as adults.
In other words, they may
Women seek medical treatment more often
experience a normal body
than men, and it is more socially acceptable for
sensation such as peristalsis and
them to do so.
attach a pathologic rather than a
Childhood sexual abuse, which is related to
normal meaning to it.
somatization, happens more frequently to girls.
The presence of a host of
Women more often receive treatment for
somatic symptoms can also be
psychiatric disorders with strong somatic
associated with other diagnoses.
components such as depression.

SIGNS AND SYMPTOMS

1. Any physical symptom for which there is
no organic basis but for which evidence
exists for the implication of psychological
factors.
2. Depressed mood is common.
3. Loss or alteration in physical
functioning, with no organic basis.
Examples include the following:
a. Blindness or tunnel vision
b. Paralysis
c. Anosmia (inability to smell)
d. Aphonia (inability to speak)
e. Seizures
f. Coordination disturbances
g. Pseudocyesis (false pregnancy)
h. Akinesia or dyskinesia
i. Anesthesia or paresthesia
4. “Doctor shopping.”
5. Excessive use of analgesics.
6. Requests for surgery.
7. Assumption of an invalid role.
8. Impairment in social or occupational
functioning because of preoccupation with
physical complaints.
9. Psychosexual dysfunction (impotence,
dyspareunia [painful coitus], sexual
indifference).
10. Excessive dysmenorrhea.
11. Excessive anxiety and fear of having a
serious illness.
12. Objective evidence that a general medical
condition has been precipitated by or is
being perpetuated by psychological or
behavioral circumstances.
13. Conscious, intentional feigning of physical
or psychological symptoms (may be
imposed on the self or on another person).

TREATMENT
Treatment focuses on managing
symptoms and improving quality of life.
A trusting relationship helps ensure
clients stay with and receive care from
one provider instead of “doctor
shopping.”
Antidepressants - selective serotonin
reuptake inhibitors (fluoxetine (Prozac),
sertraline (Zoloft), and paroxetine (Paxil)
are most commonly used among clients
with depression and anxiety disorders.
For clients with pain disorder, referral to
a chronic pain clinic may be useful.
Services such as physical therapy to
maintain and build muscle tone help
improve functional abilities.
Clients can use nonsteroidal anti-
inflammatory agents to help reduce pain.
Involvement in therapy groups is
beneficial for some people with somatic
symptom illnesses (cognitive–behavioral
group)
The overall goals of the group were
offering peer support, sharing
methods of coping, and perceiving
and expressing emotions.
Education or providing information has
also been effective for clients with
somatic illness or symptoms.
PATHOPHYSIOLOGY
JAD.3B
Client and Family
Education
• Establish daily health 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”
COMPLICATIONS
Somatic symptom disorder can
be associated with:
Poor health
Problems functioning in daily
life, including physical
disability
Problems with relationships
Problems at work or
unemployment
Other mental health
disorders, such as anxiety,
depression and personality
disorders
Increased suicide risk related
to depression
Financial problems due to
excessive health care visits
 JAD.3B

ASSESSMENT
Clients usually provide a lengthy and detailed account of previous physical problems,
numerous diagnostic tests, and perhaps even a number of surgical procedures.
Clients may express dismay or anger at the medical community with comments such as
“They just can’t find out what’s wrong with me” or “They’re all incompetent, and they’re
trying to tell me I’m crazy!”
Clients with somatization disorder usually describe their complaints in colorful, exaggerated
terms, but often lack specific information.
Mood is often labile. Emotions are often exaggerated, as are reports of physical symptoms.
Clients are unlikely to be able to think about or respond to questions about emotional
feelings.
Clients are alert and oriented. Intellectual functions are unimpaired.
Clients focus only on the physical part of themselves.
Clients may report a lack of family support and understanding
Clients who somatize often have sleep pattern disturbances, lack basic nutrition, and get no
exercise.

DIAGNOSIS PLANNING

Nursing diagnoses commonly used when working Treatment outcomes may include:
with clients who • The client will identify the
somatize include: relationship between stress and
• Ineffective coping physical symptoms.
• Ineffective denial • The client will verbally express
• Impaired social interaction emotional feelings.
• Anxiety • The client will follow an established
• Disturbed sleep pattern daily routine.
• Fatigue • The client will demonstrate
• Pain alternative ways to deal with stress,
Clients with conversion disorder may be at risk anxiety, and other feelings.
for disuse syndrome from having • The client will demonstrate
pseudoneurologic paralysis symptoms. In other healthier behaviors regarding rest,
words, if clients do not use a limb for a long time, activity, and nutritional intake.
the muscles may weaken or undergo atrophy
from lack of use.

IMPLEMENTATION
Encouraging them to focus on emotional feelings is important, though this can be difficult for
clients.
Two categories of coping strategies are important for clients to learn and to practice: emotion-
focused coping strategies, which help clients relax and reduce feelings of stress, and problem-
focused coping strategies, which help resolve or change a client’s behavior or situation or
manage life stressors.
The nurse can help the client plan social contact with others, can role-play what to talk about
(other than the client’s complaints), and can improve the client’s confidence in making
relationships.

Additional info: https://www.mayoclinic.org/diseases-conditions/somatic-symptom-disorder/symptoms-causes/syc-20377776