8.5 Somatic Symptom and Dissociative Disorder Nursing Process

Question 1

Somatic Symptom Disorder

Answer 1

• People are so convinced that their symptoms are related to organic pathology that they reject it is caused by stress or psychosocial factors

Question 2

Illness Anxiety Disorder

Answer 2

• Symptoms may be minimal but due to extreme anxiety, they are suspicious of undiagnosed illness.
• Very conscious of bodily sensation and changes.

Question 3

Conversion Disorder

Answer 3

• Symptoms affect voluntary motor or sensory function.

Question 4

Factitious Disorder

Answer 4

• Individuals make up illness for emotional support.

Question 5

Predisposing Factors of Somatic Disorders

Answer 5

• Genetics
• Decreased serotonin and endorphins (serotonin is a major neurotransmitter inhibiting afferent pain fibers)
• Conversion disorders may come from traumatic events converted into physical symptoms

Primary Gain
- May pretend to be sick to avoid stressful obligations

Secondary Gain
- Pretend to be sick to become the focus of attention

Tertiary Gain
- May relieve conflict in the family by shifting focus towards themselves

Question 6

Somatic Symptom Disorder Diagnosis

Answer 6

• Ineffective coping evidenced by physical complaints
• Deficient Knowledge on psychological causes of physical symptoms
• Chronic Pain (somatic symptom disorder)
• Fear (illness anxiety disorder)
• Disturbed sensory perception (conversion disorder)
• Self-care Deficit (Conversion disorder)

Question 7

Dissociative Disorder Diagnosis

Answer 7

• Impaired memory (dissociative amnesia)
• Powerlessness (Dissociative Amnesia)
• Risk for suicide (DID - Identity Disorder)
• Disturbed personal identity (DID)

Question 8

Outcomes for Somatic Syndrome

Answer 8

• Uses coping strategies during stressful events to restore physical symptoms
• Interprets bodily sensations rationally
• Free of physical disability to verbalize understanding of possible correlation between loss of alteration in functioning and extreme emotional stress.

Question 9

Outcomes for Dissociative Syndrome

Answer 9

• Recall events of traumatic or stressful events
• Verbalize the extreme events that happened before their dissociation
• Demonstrate adaptive coping in the face of severe anxiety
• Verbalize understanding of multiple personalities and the purpose they serve
• Maintain sense of reality during stressful situations (depersonalization/derealization)

Question 10

Planning for Somatic Syndrome

Answer 10

• Relief of physical symptoms
• Cope with stress
• Interpret bodily sensations accurately
• Recover lost or altered function

Question 11

Planning for Dissociative Disorders

Answer 11

• Restore normal thought process
• Verbalize reasons for fragmented reality
• Recover deficits in memory
• Verbalize psychological factors for their condition

Question 12

Somatic Syndrome Interventions

Answer 12

Psychotherapy
- Develop healthy adaptive behaviors and manage their life more effectively
- Stress management

• GRADUALLY MINIMIZE TIME FOCUSING ON PHYSICAL SYMPTOMS

Question 13

Dissociative Disorder Interventions

Answer 13

• Adaptive methods of stress management
• Expose client to pleasant experiences of their past
• Identify causes of transitioning from 1 personality to another
• Dissociative amnesia usually resolves itself when removed from stressful situation.
• IV AMOBARBITAL can help retrieve lost memories
• PSYCHOTHERAPY IS PRIMARY TREATMENT
• Hypnosis can also be used to mobilize memories.

DID GOALS
- Optimize function and potential
- Integration (Combining all personalities) is desirable.

ABREACTION
- Mentally re-experience the abuse that caused their illness.