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Somatoform Disorder.doc

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University of Waterloo

Somatoform Disorder • Description o Characterized by persistent worry or complaints regarding physical illness without supportive physical findings o Client focuses on the physical signs and symptoms and is unable to control the signs and symptoms o The physical sign and symptoms increase with psychosocial stressors o The anxiety is redirected into a somatic concern o The client may unconsciously use somatization for secondary gains, such as increased attention and responsibilities o Strong presumption linked to psychological factors (DSM IV- TR) o Must carefully rule-out medical etiology before presuming psychological assumptions o Not under the patients’ conscious control • Types o Somatization disorder o Undifferentiated somatoform disorder o Conversion disorder o Pain disorder o Hypochondriasis o Body dysmorphic disorder o Somatoform disorder NOS • Somatization disorder: most common o Description  Client has multiple physical complaints involving numerous body systems  The cause of these complaints is presumed to be psychological o Assessment  Physical complaints of pain • GI symptoms • Sexual symptoms  Signs of anxiety, fear, and low self-esteem may be present • Denial of emotional problems  Suicide threats and gestures are common  History of physical and sexual abuse o NOTES:  For a client with a somatoform disorder, allow specific time for period for the client to discuss physical complaints because the client may feel less threatened if this behavior is limited rather than stopped completely. Avoid responding with positive reinforcement about physical complaints. • Hypochondriasis o Description  Misinterpret physical sensations as serious illness  Preoccupation with fears of having a serious disease  No evidence of physical illness exists  Hypochondriasis significantly impair social and occupational functioning • Pain Disorder o Most frequent cause of medical assistance o Depression is common o Difficult to measure objectively • Body Dysmorphic Disorder o Normal appearance o Preoccupation with imagined defective body part  Mirror checking  Camouflaging  Overwhelming emotions of disgust, shame and depression o May lead to frequent plastic surgery o Men – compulsive body building o Woman – skin, weight, body parts • Conversion Disorder o Description  Conversion disorder is a mental health condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.  Aphysical symptom or a deficit suggesting loss or altered body function related to psychological conflict of a neurobiological disorder  Most common symptoms: • Blindness • Deafness • Paralysis • Inability to talk • Pseudo-epilepsy  No organic cause  Symptoms are beyond the clients conscious control • Childhood physical or sexual abuse is common • May have origin in medical disorder that gets exaggerated o Assessment  La belle indifference: • Unconcerned for symptoms • Lack of emotional concern for symptoms • Common Medical Causes to Rule Out o Multiple Sclerosis o Brain tumor o Hyperthyroidism o Hyperparathyroidism o Lupus o Myasthenia gravis o Evaluate cultural issues • Nursing Interventions for Somatoform Disorders o Obtain a nursing history and assess for physical problems o Explore the needs being met by physical symptoms with the client o Assist the client to relate feelings and conflicts to the physical symptoms  Convey understanding that the physical symptoms are real to the client  Assure that physical illness has been ruled out • Treatment o Antidepressants for pain and anxiety o Short term benzos for anxiety Factitious Disorder • Description o Person acts as if he or she has a physical or mental illness when he or she is not really sick o Under conscious control  Deliberately creating or exaggerating symptoms of an illness in several ways • They may lie or fake symptoms • Hurt themselves to bring on symptoms • Alter tests (such as contaminating urine sample) to make it lo
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