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SOMATOFORM DISORDERS
Disorders that are associated with ANXIETY at a severe level. The anxiety is REPRESSED and results in the presence of real physical symptoms for which there is no evidence of medical illness.
Somatoform Disorders Include
Somatization Disorder. Conversion Disorder. Hypochondriasis. Pain Disorder. Body Dysmorohic Disorder(BDD).
Somatoform Disorders and Associated Defense/Adaptive Mechanisms
Somatization-Somatization Conversion Disorder Conversion Disorder-Conversion. Hypochondrias-Denial and somatization. Pain Disorder-Displacement. Body Dysmorphic Disorder-Symbolism and Projection.
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Somatization-process of expressing a mental condition (anxiety)as a disturbed bodily function. Conversion express emotional conflict Conversionexpress through the development of physical symptoms (sensorimotor). Symbolism-everything that occurs is a symbol of the clients own thoughts.
Somatization Disorder Assessment
Chronic with multiple somatic symptoms, cannot be explained medically. A i t d Anxiety, depression, suicidal id ti i i id l ideation, d drug abuse and dependence are common. Heightened emotionality, strong dependence, preoccupation with symptoms.
Pain Disorder Assessment
Severe and prolonged pain causing significant distress or impairment. Pain systems correlate with stressful situation. Symptoms of depression and substance abuse are common. Pain disorder may be maintained by Primary,Secondary,Tertiary gain.
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Definition
Primary Gain-positive reinforcement for somaticizing through added attention, sympathy and nurturing.(eg. Pain disordersymptoms enable client to avoid unpleasant activity.) l t ti it ) Secondary Gain-positive reinforcement by avoiding difficult situation because of physical complaint.(eg Pain promotes emotional support and attention.)
Definitions Cont.
Tertiary gain-focus of family switch to him/her and away from conflict in the family. (eg Pain the family (eg.Pain-the physical symptoms take such a position that the real issue is disregarded and remains unresolved.)
Hypochondriasis Disorder Assessment
Preoccupied with fear of contracting or having a disease. Fear becomes disabling with no organic pathology or symptoms become excessive in relation to the pathology. Anxiety and depression are common, OCD traits are often seen.
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Conversion Disorder Assessment
Loss or change in body function resulting from psychological conflict unexplained by medical disorder or pathophysicalogy. y p Classic conversion symptoms are NEUROLOGICAL symptoms that occur after extreme stress. Client expresses lack of concern, la belle indifference with severe impairment, a clue that the problem is psychological.
Body Dysmorphic Disorder Assessment
Exaggerated belief that the body is deformed or defective. D Depression and symptoms of OCD are i d t f common.
Predisposing Factors Somatoform Disorder
Genetic: hereditary factors possible in somatization,conversion and hypochandriasis disorders. Psychodynamic Theory: a.hypochondriasis may b EGO defense h h di i be d f mechanism. Physical complaints=low self esteem. b.Conversion disorder results from unacceptable emotions converted to physical symptoms.
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Predisposing Factors Cont.
Learning Theory: a.Somatic complaints reinforced when sick person is excused from unwanted duties (primary gain) gain). b.Sick person becomes prominent focus of attention (secondary gain). c.Conflict shifts to ill person away from issues (tertiary gain).
Predisposing Factors Cont.
Learning Theory Cont. d.hypochondriasis- past experience with illness predispose a person (learned). Family Dynamics: Somatization brings stability to the family and positive reinforcement to child. Biochemical: <levels serotonin/endorphins=pain disorder. Transactional Model Stress/Adaptation: multiple causes
Dissociative Disorders
Dissociative Disorders involve a disruption in consciousness with a significant impairment in memory, identity or memory identity, perception of self.
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Dissociative Disorders
Dissociative Amnesia-inability to recall important information. Dissociative Fugue-Sudden, unexpected travel away from home with the inability to recall ones y y past. Dissociative Identity Disorder-Existence of 2 or more personalities in one person. Depersonalization-characterized by feeling of detachment or estrangement from oneself.
Dissociation Disorders Assessment
Splitting of clusters of mental contents from conscious awareness, a mechanism central to hysterical conversion and dissociation. dissociation Dissociative symptoms of emotional numbing (detachment) amnesia, depersonalization often accompanied by symptoms of anxiety.
Dissociative Amnesia Assessment
Inability to recall important information usually associated with stress/trauma. a.local-ALL incidents for specific period. b.selective-CERTAIN incidents for specific period. period c.continious-event after a specific time to present. d.General-everything including ID. e.Systematized-Specific catecory of info. (eg.event)
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Dissociative Fugue Assessment
Sudden unexpected travel from home or customary place. U bl t recall personal ID often Unable to ll l ID, ft assumes new ID. Occurance of severe psychological stress or excessive alcohol use often precipitates the fugue behavior.
Dissociative Identity Disorder (DID) Assessment
Existence of 2> distinct personalities within a single person. At least 2 personalities states recurrently take control of clients behavior. Transition usually sudden, dramatic and precipated by stress. Psychological trauma-traumatic events overwhelm the individual .DID used as a survival strategy.
Depersonalization Disorder Assessment
Depersonalization in perception of self. Feeling of detachment/estrangement from oneself. Derealization alteration in the perception Derealization-alteration of external environment. Anxiety, depression, fear of going insane, somatic complaints, disturbance in subjective sense of time.
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Predisposing Factors Dissociation Disorders
Genetics: possible in DID. Neurobiological: dissociative amnesia and fugue maybe related to neurophysiological dysfunction. EEG abnormal in DID. y Psychodynamic: Freud (repression) dissociation behaviors are a defense against unresolved painful issues. Psychological trauma: DID-many personalities to cope (survival strategy).
Nursing Diagnosis Somatoform
Ineffective coping-physical complaint (somatization) Chronic pain-(pain disorder) Di t b d S Disturbed Sensory P Perceptionti (conversion). Disturbed body image-(dysmorphic). Fear-(hypochondrasis). Social Isolation-(somatoform disorders).
Nursing Diagnosis Dissociative Disorders
Disturbed thought process-(amnesia). Risk for suicide-(DID). ( ) Disturbed sensory perception(depersonalization). Ineffective coping-(dissociative fugue).
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Nursing Interventions Somatoform/Dissociative Disorders
Coping Strategies: a. Emotion-focused coping strategies such as relaxation techniques, deep breathing, guided imagery and distraction. b.Problem focused coping strategies such as focused problem-solving strategies and role-playing. Expressing of emotional feelings: recognize relationship between stress/coping and physical symptoms. (physical complaints,primary/secondary gains) *Keep patient safe.
Treatment Modalities Somatoform Disorders
Individual psychotherapy. Group psychotherapy. Behavior therapy. Psychopharmacology
Treatment Modalities Dissociative Disorders
Individual psychotherapy. Hypnosis. Supportive care. Integration therapy (DID). Cognitive therapy. Group/Family therapy Psychopharmacology
