Somatic Symptom Disorder and Related Flashcards
somatization
expression of stress through physical symptoms
expressed in place of anxiety, depression or irritability in ways such as pain, paralysis, skin rash, etc.
somatization is the hallmark of psychiatric illness
specifiers of somatic symptom disorder
with pain predominant
persistent
mild, mod, severe
specifiers of illness anxiety disorder
care seeking
care avoiding
specifiers of conversion disorder
acute episodes
persistent
with or without psychological stressor
epidemiology of somatic symptom disorder
more frequent is females
lower education levels and socioeconomic status
past or recent stressful life event
underdiagnosed in older adults
how do children with somatic symptom disorder present?
recurrent abdominal pain
headache
fatigue
nausea
etiology of somatic symptom disorder
psychological
neurobiological
behavioral
*always rule out medical causation of presenting symptoms
psychological causes of somatic symptom disorder
personality factors: Histrionic personality traits
co-occurring psychiatric illness (anxiety/depression)
childhood physical/emotional abuse
repression of conflict- reaction of pain to traumatic event
exposure to trauma
anxiety transforms into physical symptoms
reaction to pain, medical illness, loss
neurobiological causes of somatic symptom disorder
more likely in first degree relatives of women with somatization disorder
no organic cause, no change in peripheral body system
functional brain imaging helps study correlation between brain and body
behavioral causes of somatic symptom disorder
familial influence (children mimic mother’s over concern about health, learned helplessness)
learn how to manipulate others to care for them
symptoms intensify with attention
helps avoid activities, obtain financial benefit or gain advantage in a relationship
reason is not evident
cultural considerations of somatic symptom disorder
African/southern Asian experience burning hands/feet, sensation of worms in head or ants under skin
Greek/ Puerto Rican symptoms occur more in men
immigrants/refugees fleeing death squads, violence against loved ones
Western Culture considerations of somatic symptom disorder
decrease value in family/group needs
decreases development of communities, socialization
decreased overall mental and physical health; increases somatization
somatic symptom DSM 5
one or more somatic symptoms that disrupt daily life
excessive thoughts, feelings, behaviors r/t somatic symptoms
for more than 6 months
*worry a lot about illness, think worst about health, think bodily symptoms are life threatening, harmful, and fear medical illness
feel medical care they receive is inadequate
possible assessment findings of somatic symptom disorder
a focus on somatic symptoms
interpret normal body sensations as a physical illness
repeatedly checks body for abnormalities
repeatedly seeking medical care and reassurance
avoidance of physical activity
medical consults from a variety of providers
non-acceptance of any suggestions of a mental health referral
comorbid anxiety and depression disorder
increased suicide risk
illness anxiety disorder DSM5
preoccupation with having or acquiring serious illness
hypochondriac
somatic symptoms are NOT present, or if present very mild, high risk of developing medical problem, preoccupation is clearly excessive or disproportionate
2 types
care seeking (excessive scans and appts) and care avoiding (does not go to any HCP)
symptoms present for at least 6 months
conversion disorder (functional neurological symptoms disorder)
person looses ability to see, hear, or speak or becomes paralyzed, but NO medical explanation can be found to explain symptoms
often begin after some stressful experience, expression of emotional conflict or need
symptoms include psychological and emotional pain may be converted to physical symptoms under conditions of extreme stress
Labelle’ indifference
Labelle’ indifference
a paradoxical absence of psychological distress despite having a serious medical illness of symptom related to health condition
“beautiful ignorance”
commonly associated with Conversion disorder, mere diagnosis of LaBelle’ does not confirm dx of conversion disorder however most commonly associated with conversion disorder.
sensory symptoms of conversion disorder
anesthesia, hyper anesthesia, analgesia, tingling or crawling sensations
motor symptoms of conversion disrorder
any muscle group may be involved: arms, legs, vocal chords, resulting in tremors, tics, disorganized mobility or paralysis
visceral symptoms of conversion disorder
dysphagia, frequent belching, spells of coughing or vomiting: all carried to an uncommon extreme
other symptoms of conversion disorder
pseudo seizures
pseudo coma
pseudo blindness
pseudo paralysis
pseudo sensory syndromes ( complaints of numbness or lack of sensation to body parts)
hysteria (historical)
Greece believed hysteria only occurred in females and was caused by the uterus wondering the body
regarded to as fakers
were thought to be involved with witchcraft and were burned at the stake
factitious disorder imposed on self
falsification of physical or psychological signs or symptoms or induction of injury associated with identified deception
presents themselves to others as ill, impaired, or injured
deceptive behavior
behavior is not better explained by another mental disorder
factitious disorder imposed by another
Munchausen by proxy
perpetrator receives the diagnosis not the victim
psychological factors affecting other medical conditions
a medical symptom or condition is present
psychological or behavioral factors adversely affects the medical
factors have influenced the course of the medical condition
factors interfere with the treatment
examples of psychological/behavioral: anxiety/depression, stressful life event
common clinical examples: anxiety-exacerbating asthma, manipulation of insulin by patient with diabetes to loose weight
acute: takotsubo (octopus pot) cardiomyopathy, broken heart syndrome
chronic: occupational stress increasing risk for HTN
malingering
conscious fabrication of illness exaggerating symptoms for secondary gain
for personal gain, where as fictitious is not for personal gain
body dysmorphic disorder
imagined defect in appearance
mild to severe symptoms
may have several plastic surgeries, compulsive skin picking, or body mutilation
increased risk of suicide
in which of the following disorders is he primary feature loss of voluntary motor or sensory functioning that appears to represent physiologic pathology but, instead, relates to psychological conflict or need?
a- somatic symptom disorder
b- body dysmorphic disorder
c- conversion disorder
d- hypochondriasis
C
primary gain
primarily relief from emotional conflict and freedom from anxiety; attained through the use of a defense mechanism or other psychological process such as conversion disorder
symptoms block psychological conflict or anxiety from conscious awareness, as in conversion disorder.
secondary gain
indirect benefit obtained through illness or disability such as gains may include monetary and disability benefits personal attention to escape from unpleasant situations and responsibilities
patients are not consciously aware of gains
you DO NOT want to focus on the symptom or complaint, but rather on the feeling
assessment of patient with somatic disorders
mental/emotional status- traumatic life event
psychological distress- comorbid symptoms of anxiety/depression, identify if secondary gain
physical exam- assess location, onset, characteristics of symptoms
social/lifestyle/relationships- pt.’s ability to communicate needs, quality of life, social support, coping skills, spirituality
potential nursing diagnosis for somatic disorders
risk for suicide
ineffective coping
anxiety
risk for loneliness
anxiety
powerlessness, hopelessness
social isolation
disturbed sleep pattern
pain
altered family process
planning and implementing nursing interventions for somatic disorders
monitor for safety
build trusting/ therapeutic relationship
educate regarding treatment
encourage increased and appropriate expression of feelings and emotions
focus on strengths, use positive reinforcement and limit setting to focus patient away from discussion of physical complaints
teach coping strategies
enhance patients self-knowledge and self awareness
agree on how to name illness
regular but brief office visits/ control access to healthcare
frequent supportive contacts
regular check ups
normalize and empathize
explore predisposing factors
use of chronic disease
offer support; partner with patient
treatment of somatic disorders
focus is care not cure, care is the cure
coordinated physical and psychiatric care
provide frequent, brief, and regular visits
avoid despairing comments
set reasonable therapeutic goals
individual and group psychotherapy
CBT
psychopharmacologic agents (SSRI)
evaluation of somatic disorders
fewer visits to physicians as a result of physical complaints
use less medications and more positive coping strategies
an increase in functional abilities
improved family and social relationships
when working with clients with somatic symptom disorders, nurses should extensively explore symptoms form other doctor visits during each visit
true or false
false
