SOMATOFORM DISORDERS

 OVERVIEW

 Characterized as the presence of physical symptoms that suggest a medical

condition without a demonstrable organic basis to account fully for them
 Defense mechanism used is somatization or conversion: anxiety is transformed to
a physical symptom

 Theories about Etiology:

 Internalization – stress, anxiety, or frustration are kept inside are not
expressed outwardly; internalized feelings & stress are expressed through
physical symptoms (dinidibdib)
 Primary Gain – direct external benefits that being sick provides such as
relief of anxiety, conflict or distress
 Secondary Gain – internal or personal benefits received from others because
one is sick such as attention from family members & comfort measures (being
brought soup, receiving back rub)

 CENTRAL FEATURES
 Physical complaints suggest major medical illness but have no demonstrable
organic basis
 Psychological factors & conflicts seem important in initiating, exacerbating &
maintaining the symptoms
 Symptoms or magnified health concerns are not under conscious control

 SPECIFIC DISORDERS

 SOMATIZATION DISORDER
 Characterized by multiple, recurrent somatic complaints (fatigue, headache,
nausea, menstrual cramps)
 Usually has a history of seeking medical attention for many years
 Symptoms of Somatization Disorder:
 Pain Symptoms – complaints of headache; pain in the abdomen, head,
joints, back, chest, rectum; pain during urination, menstruation or sexual
intercourse
 GI 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 – impaired coordination & balance, paralysis
or localized weakness, difficulty swallowing or lump in the throat, urinary
retention, loss of touch or pain sensation, double vision, blindness, deafness,
seizures, amnesia, loss of consciousness

 CONVERSION DISORDER
 Sometimes called “Conversion Reaction”
 Characterized by sudden onset of impairment in sensory or motor function
without physiologic cause
 Defense used are repression & conversion
 Symptoms of Conversion Disorder:
 Sudden paralysis, blindness, deafness, etc.
  “La belle indifference” attitude – inappropriately calm when describing
symptoms
 Symptoms not under voluntary control
 Usually short term; symptoms will abate as emotional distress diminishes

 PAIN DISORDER
 Has the primary physical symptoms of pain which generally is unrelieved by
analgesics & greatly affected by psychological factors in terms of onset,
severity, exacerbation & maintenance
 Pain impairs social/occupational function
 Pain often severe
 Sleep may be interrupted by experience of pain

 HYPOCHONDRIASIS
 Disease Conviction – preoccupation with the fear that one has a serious disease
 Disease Phobia – preoccupation with the fear that one will get a serious disease
 Belief persists despite medical reassurance
 Defenses used are regression & somatization
 History of seeing many doctors & many diagnostic tests
 Dependent behavior: desires/demands great deal of attention

 BODY DYSMORPHIC DISORDER

 A preoccupation with an imagined or exaggerated defect in physical appearance
such as thinking one’s nose is too large or teeth are crooked & unattractive

 NURSING INTERVENTIONS:
 Rule out presence of actual disease
 Focus on anxiety reduction, not physical symptoms
 Establish a daily routine including adequate rest, exercise & nutrition
 Do not argue with the client about the somatic complaints but encourage
expression of emotional feelings:
 Recognize relationship between stress & physical symptoms
 Encourage the client to keep a journal
 Minimize the amount of time & attention given to complaints
 Limit primary & secondary gains
 Teach coping strategies:
 Emotion-focused coping strategies such as relaxation techniques, deep
breathing, guided imagery, distraction
 Problem-focused coping strategies
 Encourage family to provide attention & encouragement when the client has
fewer complaints
 Encourage family to decrease special attention when client is in “sick” role

 RELATED DISORDERS
 A person feigns or intentionally produces symptoms for some purpose or gain
 People willfully control the symptoms

 MALINGERING
 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
 People who malinger can stop the physical symptoms as soon as they have
gained what they wanted
 FACTITIOUS DISORDER
 Aka “Munchausen’s Syndrome”
 Occurs when a person intentionally produces or feigns physical or
psychological symptoms solely to gain attention
 A person may even inflict injury to himself to receive attention
 Munchausen’s By Proxy – a variation of factitious disorder; 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 the victim
 Example: A nurse who gives excess IV potassium to a client & then “saves
his life” by CPR