Chapter 12: Somatoform Disorders and Dissociative Disorders Flashcards
- A medical-surgical nurse works with a patient diagnosed with a somatic system disorder. Care planning is facilitated by understanding that the patient will probably:
a. readily seek psychiatric counseling.
b. be resistant to accepting psychiatric help.
c. attend psychotherapy sessions without encouragement.
d. be eager to discover the true reasons for physical symptoms.
ANS: B
Patients with somatic system disorders go from physician to physician trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling is offered, these patients reject both.
- A patient has blindness related to a functional neurological (conversion) disorder but is unconcerned about this problem. Which understanding should guide the nurses planning for this patient? The patient is:
a. suppressing accurate feelings regarding the problem.
b. relieving anxiety through the physical symptom.
c. meeting needs through hospitalization.
d. refusing to disclose genuine fears.
ANS: B
Psychoanalytic theory suggests conversion reduces anxiety through the production of a physical symptom that is symbolically linked to an underlying conflict. Conversion, not suppression, is the operative defense mechanism in this disorder. The other distractors oversimplify the dynamics, suggesting that only dependency needs are of concern, or suggest conscious motivation (conversion operates unconsciously).
- A patient has blindness related to a functional neurological (conversion) disorder. To help the patient eat, the nurse should:
a. establish a buddy system with other patients who can feed the patient at each meal.
b. expect the patient to feed himself or herself after explaining the arrangement of the food on the tray.
c. direct the patient to locate items on the tray independently and feed himself or herself unassisted.
d. address the needs of other patients in the dining room, and then feed this patient.
ANS: B
The patient is expected to maintain some level of independence by feeding himself or herself, whereas the nurse is supportive in a matter-of-fact way. The distractors support dependency or offer little support.
- A patient with blindness related to a functional neurological (conversion) disorder says, All the doctors and nurses in this hospital stop by often to check on me. Too bad people outside the hospital dont find me interesting. Which nursing diagnosis is most relevant?
a. Social isolation
b. Chronic low self-esteem
c. Interrupted family processes
d. Ineffective health maintenance
ANS: B
The patient mentions that the symptoms make people more interested, which indicates that the patient believes he or she is uninteresting and unpopular without the symptoms, thus supporting the nursing diagnosis of Chronic low self-esteem. Defining characteristics for the other nursing diagnoses are not present in this scenario.
- To assist a patient diagnosed with a somatic system disorder, a nursing intervention of high priority is to:
a. imply that somatic symptoms are not real.
b. help the patient suppress feelings of anger.
c. shift the focus from somatic symptoms to feelings.
d. investigate each physical symptom as soon as it is reported.
ANS: C
Shifting the focus from somatic symptoms to feelings or to neutral topics conveys an interest in the patient as a person rather than as a condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome is that the patient expresses feelings, including anger, if it is present. Once physical symptoms have been investigated, they do not need to be reinvestigated each time the patient reports them.
- A patient who fears serious heart disease was referred to the mental health center by a cardiologist after diagnostic evaluation showed no physical illness. The patient says, My heart misses beats. Im frequently absent from work. I dont go out much because I need to rest. Which health problem is most likely?
a. Body dysmorphic disorder
b. Antisocial personality disorder
c. Illness anxiety disorder (hypochondriasis)
d. Persistent depressive disorder (dysthymia)
ANS: C
Illness anxiety disorder (hypochondriasis) involves a preoccupation with fears of having a serious disease, even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Body dysmorphic disorder involves a preoccupation with ones perceived defective body parts or appearance. Persistent depressive disorder (dysthymia) is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others.
- A nurse assessing a patient diagnosed with a somatic system disorder is most likely to note that the patient:
a. readily sees a relationship between symptoms and interpersonal conflicts.
b. rarely derives personal benefit from the symptoms.
c. has little difficulty communicating emotional needs.
d. has unmet needs related to comfort and activity.
ANS: D
The patient diagnosed with a somatic system disorder frequently has altered comfort and activity needs. In addition, hygiene, safety, and security needs may also be compromised. The patient is rarely able to see a relation between symptoms and events in his or her life, which is readily discernible to health professionals. Patients with somatic system disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others.
- To plan effective care for patients diagnosed with somatic system disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms:
a. are generally chronic in nature.
b. have a physiological basis.
c. can be voluntarily controlled.
d. provide relief from health anxiety.
ANS: D
the unconscious level, the patients primary gain from the symptoms is anxiety relief. Considering that the symptoms actually make the patient more psychologically comfortable and may also provide a secondary gain, patients frequently and fiercely cling to the symptoms. The symptoms tend to be chronic; however, this does not explain why they are difficult to give up. The symptoms are not under voluntary control or physiologically based.
- A patient diagnosed with a somatic symptom disorder has the nursing diagnosis: Interrupted family processes, related to patients disabling symptoms as evidenced by the spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will:
a. assume roles and functions of the other family members.
b. demonstrate a resumption of former roles and tasks.
c. focus energy on problems occurring in the family.
d. rely on family members to meet his or her personal needs.
ANS: B
The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and the resumption of former roles are necessary to change this pattern. The distractors are inappropriate outcomes.
- A woman wears a size 7 shoe. She says, My feet are huge. Ive asked three orthopedists to surgically reduce my feet. The patient tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely?
a. Dissociative amnesia with fugue
b. Illness anxiety disorder
c. Body dysmorphic disorder
d. Dissociative identity disorder
ANS: C
Body dysmorphic disorder refers to a preoccupation with an imagined defect in appearance in a normal-appearing person. The patients feet are proportional to the rest of her body. Dissociative amnesia with fugue is characterized by sudden, unexpected travel away from the customary locale and the inability to recall ones identity and information about some or all of the past. Illness anxiety disorder involves a belief that one has a serious, life-threatening illness when none exists. Dissociative identity disorder involves the existence of two or more personality states that take control of ones behavior.
- Which assessment finding best supports the diagnosis of dissociative amnesia with fugue? The patient states:
a. I cannot recall why Im living in this town.
b. I feel as if Im living in a fuzzy dream state.
c. I feel like different parts of my body are at war.
d. I feel very anxious and worried about my problems.
ANS: A
The patient in a fugue state frequently relocates and assumes a new identity while not recalling his or her previous identity or places previously inhabited. The distractors are more consistent with depersonalization, generalized anxiety disorder, or dissociative identity disorder.
- A college student observes a roommate going out wearing uncharacteristically seductive clothing, returning 12 to 24 hours later, and then sleeping for 8 to 12 hours. At other times, the roommate sits on the floor speaking like a young child. Which health problem should be considered?
a. Functional neurological (conversion) disorder
b. Dissociative identity disorder
c. Dissociative amnesia
d. Body dysmorphic disorder
ANS: B
Dissociative identity disorder involves the existence of two or more distinct subpersonalities, each with its own patterns of relating, perceiving, and thinking. At least two of the subpersonalities take control of the persons behavior but leave the individual unable to remember the periods of time in which the subpersonality is in control.
- A nurse assesses a patient diagnosed with functional neurological (conversion) disorder. Which comment is most likely from this patient?
a. Since my father died, Ive been short of breath and had sharp pains that go down my left arm, but I think its just indigestion.
b. I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry and I think Im getting seriously dehydrated.
c. Sexual intercourse is painful. I pretend as if Im asleep so I can avoid it. I think its starting to cause problems with my marriage.
d. I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus.
ANS: A
Patients with functional neurologic (conversion) disorder often demonstrate a lack of concern regarding the seriousness of symptoms. This lack of concern is termed la belle indiffrence. In addition, a specific cause for the development of the symptoms is identifiable; in this instance, the death of a parent precipitates the stress. The incorrect options suggest other types of somatic symptom disorders.
- A nurse counsels a patient diagnosed with body dysmorphic disorder. Which nursing diagnosis would be a priority for the plan of care?
a. Anxiety
b. Risk for suicide
c. Disturbed body image
d. Ineffective role performance
ANS: B
A high risk of completed suicide exists in patients with body dysmorphic disorder. Safety is always a high priority for the nurse; in this instance, the plan of care should include an awareness of the risk for self-inflicted harm.
- Select the correct etiology to complete this nursing diagnosis for a patient diagnosed with dissociative identity disorder: Disturbed personal identity, related to:
a. obsessive fears of harming self or others.
b. poor impulse control and lack of self-confidence.
c. depressed mood secondary to nightmares and intrusive thoughts.
d. cognitive distortions associated with unresolved childhood abuse issues.
ANS: D
Nearly all patients with dissociative identity disorder have a history of childhood abuse or trauma. None of the other etiology statements is relevant.
