Ch 20 Flashcards
An individual who is diagnosed with Adjustment Disorder with Disturbance of Conduct most likely:
violates the rights of others to feel better
are characterized by physical symptoms suggesting medical disease but without demonstrable organic pathology or a known pathophysiological mechanism to account for them
somatic symptom disorders
defined by a disruption in the usually integrated functions of consciousness, memory, and identity
very RARE
dissociative disorders
somatic symptom disorders are more commonly found in
Women than in men
Less educated persons
Rural areas
Brief episodes of _____ _____ appear to be common in young adults, particularly in times of severe stress.
depersonalization symptoms
A syndrome of multiple somatic symptoms that cannot be explained medically and is associated with psychosocial distress and long-term seeking of assistance from health-care professionals
“doctor shopping”
somatic symptom disorder
what is frequently manifested in somatic symptom disorder
is chronic, and anxiety, depression, and suicidal ideation
common complications of somatic symptom disorder
Drug abuse and dependence
personality characteristics of somatic symptom disorder
Heightened emotionality, strong dependency needs, and a preoccupation with symptoms and oneself
describe somatic symptom disorder
symptoms cannot be explained medically
associated with psychosocial distress
similar to hypochondriac
Unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease
illness anxiety disorder
describe illness anxiety disorder
The behavioral response to even the slightest changes in feeling or sensation is unrealistic and exaggerated.
Anxiety and depression are common, and obsessive-compulsive traits frequently accompany the disorder.
does not go “doctor shopping”
A loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism.
conversion disorder
The most obvious and “classic” conversion symptoms are those that
suggest neurological disease
Some instances of conversion disorder may be precipitated by
psychological stress.
when dealing with somatic disorders what should always be considered first
physical concerns before mental concerns
Conscious, intentional feigning of physical and/or psychological symptoms
Individual pretends to be ill to receive emotional care and support commonly associated with the role of “patient.”
Factitious disorder
what can factitious disorder also be identified as
Munchausen syndrome.
The disorder may be imposed on another person under the care of the perpetrator
ie/ make child ill for attention
factious disorder by proxy
A client, experiencing lower extremity paralysis, is admitted to a medical unit. Extensive tests confirm disability but rule out any underlying organic pathology. The nurse concludes that this is most suggestive of which disorder?
conversion disorder
biochemical factors associated with somatic disorders
Decreased levels of serotonin and endorphins
This theory suggests that illness associated with anxiety disorder is an ego defense mechanism. Physical complaints are the expression of low self-esteem and feelings of worthlessness.
psychodynamic theory
what are the steps of learning theory r/t somatic disorders
primary, secondary, and tertiary gain
May avoid stressful obligations or be excused from unwanted duties
ie/ call in sick to work
primary gain
May become the prominent focus of attention because of the illness
secondary gain
May relieve conflict within the family as concern is shifted to the ill person and away from the real issue
tertiary gain
Past experience with serious or life-threatening physical illness, either personal or that of close relatives, can predispose the person to
illness anxiety disorder (learning theory)
an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness, and which is not due to the direct effects of substance use or a neurological or other medical condition
dissociative amnesia
onset of dissociative amnesia usually follows what
severe psychosocial stress
The inability to recall ALL incidents associated with the traumatic event for a specific period following the event
localized amnesia
The inability to recall only CERTAIN incidents associated with a traumatic event for a specific period following the event
selective amnesia
The inability to recall anything that has happened during the individual’s ENTIRE LIFETIME, including personal identity
generalized amnesia
subtype of amnesia
there is a sudden, unexpected travel away from home with the inability to recall some or all of one’s past
dissociative fuge
Characterized by the existence of two or more personalities within a single individual
Transition from one personality to another usually sudden, often dramatic, and usually precipitated by stress
dissociative identity disorder
Characterized by a temporary change in the quality of self-awareness, which often takes the form of
Feelings of unreality
Changes in body image
Feelings of detachment from the environment
A sense of observing oneself from outside the body
Depersonalization-derealization disorder
defined as a disturbance in the perception of oneself.
depersonalization
described as an alteration in the perception of the external environment
derealization
Symptoms of this depersonalization derealization are often accompanied by
Anxiety and depression Fear of going insane Obsessive thoughts Somatic complaints Disturbance in the subjective sense of time
Freud described dissociation as repression of distressing mental contents from conscious awareness.
Current psychodynamic explanations reflect Freud’s concepts that dissociative behaviors are a defense against unresolved painful issues.
psychodynamic theory
DID is thought to serve as
a survival strategy for the child in this traumatic environment. (protective mechanism)
According to psychodynamic theory, which primary defense mechanism would the nurse expect to find in a client with dissociative amnesia?
supression
nursing diagnoses for somatic syndrome disorder
Ineffective coping evidenced by numerous physical complaints
Deficient knowledge [psychological causes for physical symptoms]
Chronic pain
nursing diagnosis for illness anxiety disorder
Fear [of having a serious disease]
nursing diagnoses for conversion disorder
Disturbed sensory perception (conversion disorder)
Self-care deficit
nursing diagnoses for DID
Risk for suicide
Disturbed personal identity
nursing diagnoses for dissociative amnesia
Impaired memory
Powerlessness
client outcomes for somatic syndrome disorder
Copes effectively without resorting to physical symptoms
Verbalizes relief from pain
Has decreased frequency of physical complaints and interprets bodily sensations rationally
Is free of physical disability
client outcomes for dissociative disorders
Can recall events associated with stressful situation
Can recall all events of past life
Can verbalize anxiety that precipitated the dissociation
Can demonstrate coping methods to avert dissociative behaviors
Verbalizes existence of multiple personalities
implementation for somatic syndrome disorder
aimed at relief of discomfort from the physical symptoms.
Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than preoccupation with physical symptoms.
implementation for dissociative disorders
aimed at restoring normal thought processes.
Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than dissociation from the environment
When working with a client diagnosed with a somatic symptom disorder, which is the most appropriate nursing action?
Gradually minimize time focusing on physical symptoms.
medical treatment modalities for dissociative disorders
Individual psychotherapy Hypnosis Supportive care Cognitive therapy Group therapy Integration therapy (DID) Psychopharmacology
what is the goal of pt with DID
merge personalities
what is integration therapy used for
DID
it is the blending of all the personalities into one
what medication is used for somatization disorders
none, is not usually effective
