Somatoform Disorders

Somatoform disorders
Somatization: The transference of mental experiences and states into bodily

symptoms.
Somatoform disorders: Characterized as the presence of physical symptoms that

suggest a medical condition without demonstrable organic basis to account fully for
them. The three central features of somatoform disorders are as follows:
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 clients conscious
control.
The five specific somatoform disorders are as followed:

Somatization disorder: Characterized by multiple physical symptoms. It
begins by 30 years of age, extends over several years, and includes a
combination of pain and GI, sexual, and pseudoneurologic symptoms.
o Clients jump from one physician to the next, or may see several
providers at once in an effort to obtain relief of symptoms.
o They tend to be pessimistic about the medical establishment and often
believe their disease could be diagnosed of the providers were more
competent.
Conversion disorder: Involves unexplained, usually sudden deficits in sensory
or motor function (blindness, paralysis). These deficits suggest a neurological
disorder but are associated with psychological factors. An attitude of la belle
indifference, a seemingly lack of concern or distress, is the key feature.
Pain disorder: Pain is the primary physical symptom which is generally

unrelieved by analgesics and greatly affected by psychological factors in
terms of onset, severity, exacerbation, and maintenance.
Hypochondriasis: 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.
Body dysmorphic disorder: Preoccupation with an imagined or exaggerated
defect in personal appearance such as thinking ones nose is too large or
teeth are crooked and unattractive.
Symptoms of a 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 (other than pregnancy), diarrhea, or
intolerance of several foods.
Sexual symptoms: Sexual indifference (dont care to do the dirty), erectile or
ejaculatory dysfunction, irregular menses, excessive menstrual bleeding.
Pseudoneurologic symptoms: Impaired coordination or balance, paralysis or
localized weakness, difficulty swallowing or lump in throat, aphonia (loss of
speech sounds), urinary retention, swollen tongue, hallucinations, double
vision, blindness, deafness, seizures; disassociative symptoms such as
amnesia; or loss of consciousness other than fainting.
Related disorders:
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. Their purpose is some external incentive or

outcome that they view as important and results directly from their illness.
People who malinger can stop the physical symptoms as soon as they have
gained what they wanted.
Factitious disorder: This is also known as Munchausen syndrome. Occurs
when a person intentionally produces or feigns physical or psychological
symptoms solely to gain attention.
o Munchausen syndrome by proxy occurs when a person inflicts illness
or injury to someone else to gain the attention of emergency medical
personnel or to be a hero for saving the victim. This occurs most
often in people who are in or familiar with medical professions, such as
nurses, physicians, medical technicians, or hospital volunteers.
Primary gain: Direct external benefits that being sick provides, such as relief
of anxiety, conflict, or distress.
Secondary gains: Internal or personal benefits received from others because
one is sick, such as attention from family members and comfort measures
(being brought tea, receiving a back rub).
Treatment:
Treatment focuses on managing symptoms and improving quality of life.
A trusting relationship helps to ensure that clients stay with and receive care
from one provider instead of doctor shopping.
SSRIs are commonly used for depression that may accompany somatoform
disorders.
Assessment
The nurse must investigate physical health status thoroughly to ensure there
is no underlying pathology requiring treatment. It is important not to dismiss
all future complaints because at any time the client could develop a physical
condition that would require medical attention.
In many cases, the clients appearance brightens and they look much better
as the assessment interview begins because they have the nurses undivided
attention.
Clients often have sleep pattern disturbances, lack basic nutrition, and get no
exercise.
Nursing diagnoses
Ineffective coping
o The client will identify the relationship between stress and physical
symptoms.
Emotion-focused coping strategies help the clients relax and
reduce feelings of stress. This includes progressive relaxation,
deep breathing, guided imagery, and distractions such as
music.
Problem-focused coping strategies help to resolve or change a
clients behavior or situation or to manage life stressors. This
includes learning problem solving methods.
The nurse should help the client role play the above situations.
Ineffective denial
o The client will verbally express emotional feelings
The nurse should not attempt to confront clients about somatic
symptoms or attempt to tell them that these symptoms are not
real.
Encourage the client to write in a daily journal
Limiting the time that clients can focus on physical complaints

alone may be necessary.
The nurse may have to explain to the family about primary and
secondary gains; this will encourage relatives to stop
reinforcing the sick role.
Impaired social interactions
o The client will follow an established daily routine
The nurse must help the client to establish this that includes
improved health behaviors.
The challenge for the nurse is to validate the clients feelings
while encouraging him to participate in activities.
The nurse should help the client plan social contact with others,
what to talk about (other than the clients complaints), and can
improve the clients confidence in making relationships.
Anxiety
o The client will demonstrate alternative ways to deal with stress,
anxiety, and other feelings
Disturbed sleep pattern
o The client will demonstrate healthier behaviors regarding rest, activity,
and nutritional intake.
The nurse explains that inactivity and poor eating habits
perpetuate discomfort and that often it is necessary to engage
in behaviors even though one doesnt feel like it.
Fatigue
Pain

Somatoform Disorders

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Somatoform disorders

Somatization: The transference of mental experiences and states into bodily

Somatoform disorders: Characterized as the presence of physical symptoms that

The five specific somatoform disorders are as followed:

Pain disorder: Pain is the primary physical symptom which is generally

Symptoms of a somatization disorder

compensation, or obtaining drugs. Their purpose is some external incentive or

Limiting the time that clients can focus on physical complaints

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