SOMATOFORM

DISORDERS
NUR 444
FALL 2015
 LEARNING OBJECTIVES
• 1. Describe the common characteristics and dynamics of somatoform
disorders
– Somatization Disorder
– Pain Disorder
– Hypochondriasis
– Conversion Disorder
– Body Dysmorphic Disorder
– Somatoform Disorder NOS
• 2. Distinguish somatoform disorders from factitious disorders and
malingering
• 3. Identify predisposing factors in the development of somatoform
disorders
• 4. Apply the nursing process to the care of clients with somatoform
disorders
• 5. Describe treatment modalities relevant to somatoform disorders
 READING

• Reach Chapter 29
– *disregard sleep d/o content
• Townsend, M. (2015). Psychiatric mental health nursing:
Concepts of care in evidenced base practice (8th ed.).
Philadelphia: F.A. Davis.
 INTRODUCTION
• Somatoform Disorders - group of
disorders characterized by physical
symptoms suggesting medical disease
but without a known organic cause or
physiologic mechanism to account for
them.
COMMON CHARACTERISTICS OF
SOMATOFORM DISORDERS
• Physical symptoms worsen during crisis
• Physician shopping
• Unwarranted exploratory and unnecessary surgical
procedures
• Substance abuse
• Avoidance of work or social activities
• Refusal of referral to mental health
• Symptoms are not intentional
 PREDISPOSING
FACTORS
• Family Dynamics
• Defense against anxiety
• Cultural
 PREDISPOSING
FACTORS
• Learned Theory:
• a. Somatic complaints reinforced
when the sick person is excused from
unwanted duties (primary gain).
• b. The sick person becomes
prominent focus of attention
(secondary gain).
SOMATOFORM-RELATED
DISORDERS
• Malingering
• Factitious Disorders
– Munchausen’s Syndrome
• Intentionally produce symptoms for
some purpose or gain
SOMATOFORM DISORDERS

1. Somatization Disorder
2. Pain Disorder
3. Hypochondriasis
4. Conversion Disorder
5. Body Dysmorphic Disorder
6. Somatoform Disorder NOS
 SOMATIZATION
DISORDER
• A syndrome of multiple somatic symptoms
• cannot be explained medically
• associated with psychosocial distress
• long-term seeking of assistance from health care
professionals.
• develops during adolescence (majority women)
• may be connected to Antisocial personality
disorder
SOMATIZATION DISORDER (CONT.)

• History of physical complaints begins before

age 30
• The symptoms are not intentionally produced
• Anxiety and depression common
• Substance abuse common (analgesics and
antianxiety meds)
• Suicide risk
• Hx of multiple surgeries
• Goes from provider to provider
SOMATIZATION D/O

• Multiple physical complaints in multiple

body systems:
• 4 pain symptoms
• 2 gastrointestinal symptoms
• 1 sexual symptom
• 1 symptom suggesting a neurological d/o
• fatigue
 PAIN DISORDER
• The predominant disturbance in pain
disorder is severe and prolonged pain
that causes:
● Clinically significant distress
● Impairment in social, occupational, or

other areas of functioning

 PAIN DISORDER (CONT.)
• Psychological factors are judged to have an
important role in the onset, severity, exacerbation,
or maintenance of the pain
• The pain complaint may be evidenced by
correlation of a stressful situation with onset of
symptoms*
● Pain generally unrelieved by analgesics

● High risk for suicide

● Irritability and anger

 PAIN DISORDERS ASSOCIATED WITH A
GENERAL MEDICAL CONDITION

• Low back pain

• Migraine
• Facial pain
• Joint/bone pain
• Chest pain
• Eye/ear/throat pain
• Pelvic pain
 HYPOCHONDRIASIS

• Unrealistic or inaccurate interpretation

of physical symptoms or sensations,
leading to preoccupation and fear of
having a serious disease
HYPOCHONDRIASIS (CONT.)

• Even in the presence of medical disease, the

symptoms grossly exceed extent of
pathological condition.
• Anxiety and depression are common
findings, and obsessive-compulsive
traits frequently accompany
the disorder.
 CONVERSION DISORDER
• A loss of or change in body function resulting
from a psychological conflict, the physical
symptoms of which cannot be explained by
any known medical disorder or
pathophysiological mechanism
 CONVERSION DISORDER (CONT.)

Predominant feature:
• la belle indifference
• a relative lack of concern about the severity
of the impairment.
• may be a clue to the physician that the
problem is psychological rather than
physical.
 CONVERSION DISORDER
CHARACTERISTICS

• Symptoms often suggest a neurological

disorder
• Examples: paralysis, localized weakness,
impairment in balance, urinary retention,
difficulty swallowing, seizures, blindness,
deafness
• Unconscious mechanism
• Onset of symptoms follows an event or
experience perceived as a major stressor
 BODY DYSMORPHIC
DISORDER

• Defined as the fear of some physical defect

thought to be noticeable to others although the
client appears normal.
• Characterized by the exaggerated belief that the
body is deformed or defective in some specific way
• Common complaints involve imagined or slight
flaws of face or head
 BODY DYSMORPHIC
DISORDER (CONT.)

• Symptoms of depression and

characteristics associated with
OCD common in people with
body dysmorphic disorder
• Etiology unknown
• Often leads to social isolation
• Individuals usually remain single
 SOMATOFORM DISORDER, NOS

• Used for disorders that do not meet criteria for

other somatoform disorders
• Physical symptoms present for less than 6
months
• Includes:
– Pseudocyesis
• False belief that one is pregnant
– Unexplained physical symptoms of fatigue or
body weakness
TREATMENT MODALITIES

• Somatoform disorders
– Individual psychotherapy
– Group psychotherapy
– Behavior therapy
– Psychopharmacology
NURSING DIAGNOSIS

• Ineffective coping related to repressed

anxiety and unmet dependency needs
• Deficient knowledge (psychological causes
for physical symptoms) related to strong
denial defense system
 NURSING DIAGNOSIS

• Chronic pain related to repressed anxiety

and learned maladaptive coping skills
• Social isolation related to preoccupation
with self and pain
 NURSING DIAGNOSIS

• Fear (of having serious disease) related to

past experience with life-threatening illness
• Chronic low self-esteem related to
unfulfilled childhood needs for nurturing
and caring
 NURSING DIAGNOSIS

• Self-care deficit related to loss or alteration

in physical functioning
• Disturbed sensory perception related to
repressed severe anxiety
NURSING DIAGNOSIS

• Disturbed body image related to

repressed severe anxiety
NURSING INTERVENTIONS

• Avoid “in the patients head”

• Accept the reality of the symptoms as the
pt.. presents them, avoiding dispute
• Encourage verbalization of thoughts and
feelings, life events, stressors
• Assist in problem-solving
NURSING INTERVENTIONS

• Emphasize the relationship between stress

and physical symptoms
• Focusing attention to relaxation task
• Challenge irrational beliefs and self
statements regarding illness
• Convey empathy “This must be very trying
for you”
NURSING INTERVENTIONS

• Keep discussion of symptoms brief and

matter-of-fact, but without dismissal
• Treat physical symptoms conservatively,
matter-of-factly
• Focus on coping techniques
• Work on Social activities and relationships
 PRACTICE

• A pt.. treated for pain d/o has an upsetting

phone conversation with her husband and
requests an analgesic. The pt.. states, “my
neck is killing me, I just need my pain pill so
I can feel better.” The nurse’s best
response is?
 PRACTICE

• A. “your neck is fine, your just angry with you

husband”
• B. “you must try not to rely on the pain pills so
much since they are addictive”
• C. “Go lay down for awhile and I’ll come check
on you”
• D. “I’ll get your medication and then lets talk
about what just happened.”
 PRACTICE

• A pt. with a somatization d/o has been

attending group therapy. Which pt..
statement suggest to the nurse that the
therapy has been effective?
 PRACTICE

• A. “I think I’d better get some pain pills. My

back hurt form sitting in group”
• B. “the other people in group have mental
problems”
• C. “I haven’t said much, but I get a lot out of
listening”
• D. “I feel better physically just from getting a
chance to talk”
 PRACTICE

• A patient who is being counseled for somatoform pain disorder

states he believes his pain is the result of an undiagnosed injury. He
adds that he cannot adhere to his plan for care involving performing
his own activities of daily living, walking 20 minutes daily, and using
pain medication only at bedtime. He states he feels “like a baby”
because his wife and children must provide so much care for him.
The nurse understands that it is most important to assess:
• a. mood.
• b. cognitive style.
• c. secondary gains.
• d. identity and memory.