Somatic Disorders

Question 1

Clients report distressing physical symptoms that disrupt daily life

Answer 1

Somatic disorders

Question 2

occurs when psychological distress is experienced as physical symptoms (e.g., headaches, backaches, GI issues, chest discomfort)

Answer 2

somatization

Question 3

internal rewards that an illness can provide (ex: somatic symptoms can protect some clients from consciously experiencing stress & anxiety)

Answer 3

primary gains

Question 4

external rewards an illness can provide (excused from work, relieved of responsibility, financial benefit, care & attention)

Answer 4

secondary gains

Question 5

intentional act of exaggerating of faking an illness for personal gain

Answer 5

malingering

Question 6

Clients have physical symptoms that are distressing and disruptive to their life. Despite extensive medical testing and evaluation by multiple providers, no satisfying answer or diagnosis has been found. Clients are preoccupied with these physical problems.

Answer 6

somatic symptom disorder

Question 7

prevalence of somatic symptom disorder in the US

Answer 7

4%
rates higher in women
most cases start to develop in adolescence

Question 8

etiology of somatic symptom disorder - childhood factors

Answer 8

Clients with somatic symptom disorder may have been raised in homes were negative emotions were not freely expressed. In addition, some clients experienced abuse and neglect. Medical treatment sometimes provides the care and attention these clients did not receive in childhood.

Question 9

etiology of somatic symptom disorder - psychological factors

Answer 9

• express negative unconscious emotions
• recognizes the positive reinforcements somatic complaints often receive
• CBT highlights incorrect assumptions about health and illness; clients can misinterpret normal bodily sensations as signs of catastrophic problem

Question 10

etiology of somatic symptom disorder - biological factors

Answer 10

There is some evidence of a genetic influence in developing somatic symptom disorder. The influence, however, is not strong.

Question 11

somatic symptom disorder - effective treatments

Answer 11

• focus upon caring rather than curing
• psychoeducation & relaxation training
• antidepressants

Question 12

somatic symptom disorder - nursing interventions

Answer 12

• create a therapeutic alliance
• take client’s concerns seriously
• perform careful assessments and review test results
• gradually decrease attention to clients’ physical symptoms
• treat new somatic symptoms matter-of-factly & w/o further reinforcement
• encourage clients to verbalize negative emotions
• provide psychoeducation to receptive clients

Question 13

clients have neurological symptoms (e.g., seizures, paralysis, speech difficulty, blindness) that can’t be explained medically and that cause significant distress or impairment

Answer 13

conversion disorder

Question 14

conversion disorder - epidemiology

Answer 14

• 0.004-0.012% of population
• more likely in females
• average onset 27-39 years

Question 15

conversion disorder - etiology

Answer 15

often preceded by traumatic life events; stressors are too overwhelming and clients convert these stressors into physical disabilities, allowing the conflict to remain unconscious

Question 16

conversion disorder - effective treatments

Answer 16

• present diagnosis delicately (describe as software problem rather than hardware problem)
• psychoeducation, CBT techniques, hypnosis
• antidepressants

Question 17

conversion disorder - nursing interventions

Answer 17

• create therapeutic alliance
• take client’s concerns seriously
• perform careful assessments & review test results
• gradually decrease attention to clients’ physical symptoms
• encourage clients’ to verbalize negative emotions
• provide psychoeducation to receptive clients

Question 18

clients consciously pretend to have a physical or psychological illness–some may actually physically injure themselves– because they enjoy the sick role & being cared for

Answer 18

factitious disorder imposed on self

Question 19

deceiving others about the health of someone under their care (e.g., a child)

Answer 19

factitious disorder imposed on others

Question 20

factitious disorder imposed on self - epidemiology

Answer 20

• lifetime prevalence to be 0.1%
• in clinical settings, incidence rate is appx 1%
• rates highest in women
• avg age of onset is 30-50 years

Question 21

factitious disorder imposed on others - epidemiology

Answer 21

• 0.53% of hospitalized children

* 95% of perpetrators are mothers

Question 22

factitious disorder - etiology

Answer 22

• unknown
• often a hx of abandonment or abuse
• clients use sickness as a way to receive affection

Question 23

factitious disorder - effective treatments

Answer 23

• prognosis is poor
• tests and treatments should be based on objective clinical findings
• psychotherapy & CBT, but clients often resistant
• antidepressants or antipsychotics may be tried

Question 24

factitious disorder - nursing interventions

Answer 24

• create a therapeutic alliance; monitor your own feelings
• avoid ignoring genuine problems
• monitor client to prevent self-injury
• encourage communication & coping skills and social support