Problems r/t Somatic & Dissociative Disorders

Question 1

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Also known as somatization disorder

Involves being distressed or having one’s life disrupted by concerns involving physical sx’s for which a physical cause cannot be found; causes significant distress in the person’s life

Answer 1

Somatic Symptom Disorder

Question 2

Somatic Symptom Disorder

• multiple somatic sx’s
• can’t be explained medically
• may be vague, dramatized, or exaggerated in their presentation & they have an excessive amt of time & energy devoted to worry & concern about their sx’s
• psychosocial distress
• are convinced that their sx’s are r/t organic pathology & irritated that others would attribute stress or psychological factors as playing a role in their condition
• freq visits to healthcare professionals

Answer 2

• chronic, < age 30
• comorbidities
• anxiety & depression are freq manifested; runs a fluctuating course w/periods of remission & exacerbation
• overmedicating
• suicide risk

Question 3

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Refers to having worry about serious illness

• Sx’s may be minimal or absent, but the individual is highly anxious about & suspicious of the presence of an undx’d serious medical illness
• “doctor shopping”
• Disabling fear; profound preoccupation w/their body; depression/OCD; sx’s may interfere w/social or occupational functioning

Answer 3

Illness Anxiety Disorder

Question 4

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Causes the client to suffer from neurological sx’s like numbness, blindness, paralysis, or seizures; is w/o a definable cause; it’s thought that these sx’s occur unconsciously & are in r/t a stressful situation affecting the client’s mental health

Answer 4

Conversion Disorder

Question 5

Conversion Disorder

• Functional Neurological Symptom Disorder
• Loss of or change in body function that cannot be explained by another medical disorder or pathophysiological mechanism

Answer 5

• A psychological component involved in the initiation, exacerbation, or perpetuation could be identifiable
• Individuals have a naïve or inappropriate lack of concern about the seriousness or implications of their physical health

Question 5

Conversion Disorder

• Functional Neurological Symptom Disorder
• Loss of or change in body function that cannot be explained by another medical disorder or pathophysiological mechanism

Answer 5

• A psychological component involved in the initiation, exacerbation, or perpetuation could be identifiable
• Individuals have a naïve or inappropriate lack of concern about the seriousness or implications of their physical health

Question 6

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In this disorder, a medical sx or a condition other than a mental disorder is present

Psychological or behavioral factors adversely affect the general medical condition in 1 of the following ways

Answer 6

Psychological Factors Affecting Other Medical Conditions (DSM-5 criteria)

Question 7

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Behaviors are conscious, deliberate, & intentional; may be assoc w/a compulsive element that diminishes personal control

Pretend to be ill; dx is very difficult as the individual becomes very intent in their quest to produce sx’s
> e.g., self-inflicted wounds, injection, insertion of contaminated substances, manipulating a thermometer to feign a fever, urinary tract manipulation or the use of rx’s in an inappropriate way

Answer 7

Factitious Disorder

Question 8

Predisposing Factors Associated with Somatic Symptom & Related Disorders

• Genetic
  > There’s a possible inheritable predisposition in these disorders
• Biochemical
  > Studies have indicated that tryptophan may be abn in clients w/somatic sx disorder
  > A dec lvl of serotonin & endorphins may play a role in the sensation of pain

Answer 8

• Neuroanatomical
  > Brain function has been proposed by some researchers as a factor in factitious disorder; this may be an impairment in information processing & assoc w/factitious disorder
• Psychodynamic
  > Psychodynamic theory of conversion disorder proposes that our emotions are assoc w/traumatic life events that an individual cannot express b/c of moral or ethical unacceptability, & they’re converted into physical sx’s

Question 9

• Family dynamics
  > Some families have difficulty expressing emotions openly in resolving conflicts verbally. When this occurs, the child may become ill, & a shift in the focus is made from the open conflicts to the child’s illness, leaving unresolved issues that the family cannot confront openly. Thus, somatization brings the child some stability to the family & harmony replaces discord
• Learning theory
  > This is the idea that a sick person learns that they may avoid stressful obligations; they may postpone unwelcome challenges & they’re excused from troublesome duties. This is called primary gain

Answer 9

• Transactional model of stress and adaptation
  > Explains that it’s most likely influenced by multiple factors

Question 10

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Inability to recall important personal information

• Information is usually traumatic or stressful in nature & it’s too extensive to be explained by ordinary forgetfulness
• Is not d/t any direct effects of substance use or neurological or medical condition

Answer 10

Dissociative Amnesia

Question 11

? amnesia

Cannot recall identity & total life history

Answer 11

Generalized

Question 12

? amnesia

Unable to recall all incidents associated with specific stressful event(s)

Answer 12

Localized

Question 13

? amnesia

Able to recall only certain incidents associated with a stressful event for a specific period after the event

Answer 13

Selective

Question 14

?

• 2 or more personality states
• only one is evident @ a time; one is more dominant
• each is unique; transition varies
• formerly known as multiple personality disorder
  ! most have been victims of childhood physical & sexual abuse; it’s not uncommon for clients w/this to also manifest other sx’s like amnesia, depersonalization, or derealization
• is not always incapacitating

Answer 14

Dissociative Identity Disorder (DID)

Question 15

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Is characterized by a temporary change in the quality of self-awareness, which often takes the form of feeling of unreality, changes in body image, feelings of detachment from the environment, or a sense of observing oneself from outside the body

Answer 15

Depersonalization-Derealization Disorder

Question 16

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Is the alteration of the perception of the external environment

There’s distorted perceptions that are disturbing

Perceptions often accompany anxiety, depression, fear of going insane, obsessive thoughts, & somatic complaints in an alteration in the subjective sense of time

Answer 16

Derealization

Question 17

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Is the disturbance in the perception of oneself; the client experiences a dream-like state

Answer 17

Depersonalization

Question 18

Predisposing Factors Associated with Dissociative Disorders

• Genetics
  > 85-97% of clients w/DID have a h/o physical or sexual abuse
• Neurobiological
  > In dissociative amnesia, it may be r/t neurophysiological dysfunction & possibly linked to DID in certain neurological conditions like temporal lobe epilepsy & severe migraine ha’s

Answer 18

• Psychodynamic theory
  > This is the idea that the repression of mental contents, like memories, are believed to protect the client from extreme emotional pain
• Psychological trauma
  > This ideology of dissociative disorders says it’s a response to a traumatic experience that overwhelms that individual’s ability to cope; it’s a survival strategy to help children cope w/horrifying physical, sexual, or psychological abuse
• Transactional model of stress and adaptation
  > Is the ideology of dissociative disorders that are likely influenced by multiple factors

Question 19

Nursing Diagnoses

Answer 19

Outcome Criteria

Question 20

Interventions - Ineffective Coping

→ medical eval to r/o organic pathology
→ recognize & accept that physical complaint is real to the client
→ provide pain medication as prescribed
→ identify gains that physical sx’s are improving

Answer 20

→ initially, fulfill the most urgent dependency needs, but gradually withdraw attention to physical sx’s
→ encourage journeling
→ discuss how interpersonal relationships are affected
→ teach relaxation techniques & assertiveness skills

Question 21

Fear

→ identify times when the preoccupation w/physical sx’s worsens

→ convey empathy

Answer 21

→ encourage client to discuss feelings assoc w/fear of serious illness

→ role-play client’s plan for dealing w/the fear

Question 22

Disturbed sensory perception (depersonalization)

→ provide support & encouragement

→ explain the depersonalization behaviors

Answer 22

Deficient Knowledge

→ explore the client’s feelings & fears

→ help the client identify needs that are being met through the sick role

Question 23

Disturbed Personal Identity

→ develop a trusting relationship w/the client

→ help the client identify stressful situations that precipitate transition from one personality

→ use nursing interventions necessary to deal w/maladaptive behaviors assoc w/individual subpersonalities

Answer 23

Impaired Memory

→ obtain info as possible about client from family/significant others

→ avoid disputing info

→ expose the client to stimuli that represent pleasant experiences from the past

→ listen empathically & provide positive feedback

Question 24

Treatment Modalities for Somatic Symptom Disorder

• Individual psychotherapy
• Group psychotherapy
• CBT & Psychoeducation
• Psychopharmacology

Question 25

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Is the mental re-experience of abuse that’s caused from the illness

Answer 25

Abreaction

Question 26

?

Is the blending of personalities into one

Is a goal that’s considered to be desirable, but some clients choose not to pursue this lengthy therapeutic regimen

Answer 26

Integration

Question 27

Treatment Modalities

Dissociative Amnesia

• amobarbital, supportive psychotherapy

Answer 27

Dissociative Identity Disorder

• integration, psychotherapy, abreaction

Question 28

Depersonalization-Derealization Disorder

• psychotherapy, hypnotherapy or CBT