Somatoform disorders

SOMATOFORM DISORDERS FOR NURSING STUDENTS

1. SOMATOFORM
DISORDERS

2. SOMATOFORM DISORDERS
These disorders are characterized by
repeated presentation with physical
symptoms which do not have any physical
basis, and a persistent request for
investigations and treatment despite
repeated assurance by the treating doctors.

3. DEFINITION
Somatoform disorder is characterized by a
pattern of recurring, multiple physical complaints
that results in seeking medical treatment, such
as taking medication, or significant impairment
in social, occupational or other important areas
of functioning.- APA-2000.

4. ICD- 10 CLASSIFICATION
F 45- somatoform disorders
F 45.0- somatization disorder.
F 45.1- undifferentiated somatoform disorder.
F 45.2- hypochondriacal disorder.
F 45.3- somatoform autonomic dysfunction.
F 45.4- persistent somatoform pain disorder.
F 45.8 – other somatoform disorders
F 45.9- somatoform disorders, unspecified.

5. These disorders are divided into the following
categories
Somatization disorders
Hypochondriasis
Somatoform autonomic dysfunction
Persistent somatoform pain disorder
Undifferentiated somatoform disorders

6. ETIOLOGY
Psychodynamics:
As an ego defense mechanism
Physical complaints are the expression of
low self esteem and worthlessness.
Easier to feel something is wrong with body
than to feel something is wrong with self.

7. ETIOLOGY
Learning theory:
Somatic complaints are reinforced when
the sick role relieves the individual from the
need to deal with a stressful situation
They learn to avoid stressful obligations and
excused from troublesome duties
Become the prominent focus of attention

8. ETIOLOGY
Family dynamic theory:
Some families have difficulty in expressing
emotions openly and resolving conflicts
verbally.
When this occurs the child may become ill, a
shift in focus from open conflict to child's illness.
Somatization of child may bring some stability to
the family.

9. ETIOLOGY
Genetics
More in first degree relatives
Biochemical
decreased level of serotonin

10. SOMATIZATION DISORDER
( BRIQUET’S SYNDROME)
Somatization disorders are characterized by
chronic multiple somatic symptoms in the
absence of physical disorders. The symptoms
are vague, presented in a dramatic manner and
involve multiple organ system.

11. EPIDEMIOLOGY
Symptoms usually begin in the teen years
affect about 0.2- 2% of females and rarely in
males.

12. SIGNS AND SYMPTOMS
Multiple somatic complaints, unexplained by
medical findings.
Complaints of pain in at least four different
location.
Two gastrointestinal, one sexual or reproductive
and one neurologic symptom.
Moderate to severe anxiety.

13. SIGNS AND SYMPTOMS
Inability to voluntarily control the symptoms.
Dependency with demanding, attention
getting behaviours.
Secondary gain.
Significant distress or impairment in social or
occupational areas.

14. SIGNS AND SYMPTOMS
In gastro intestinal system: Vomiting other than
in pregnancy, nausea, diarrhea, abdominal
pain other than when menstruating, intolerance
of several different foods.
Pain symptoms: pain in extremities and joints,
pain during urination, back pain head ache etc.

15. SIGNS AND SYMPTOMS
Sexual symptoms: burning sensation in
sexual organs or rectum other than during
intercourse, pain during intercourse,
impotence.

16. SIGNS AND SYMPTOMS
Female reproductive symptoms: painful menstruation,
excessive menstrual bleeding, irregular menstrual
periods, vomiting through out pregnancy.
Other symptoms: Amnesia, loss of voice, double vision,
seizure or convulsion, paralysis or muscle weakness,
difficulty in swallowing, deafness, blurred vision, fainting
or loss of consciousness, trouble walking, urinary
retention or difficulty in urination.

17. HYPOCHONDRIASIS
Hypochondriasis is defined as a
persistent pre- occupation with a
fear or belief of having a serious
disease despite repeated medical
reassurance.

18. SIGNS AND SYMPTOMS
Fear or preoccupation with bodily functioning misperceived
as a major illness.
Repeated health care visits seeking verification of fear.
Symptoms reported in specific detail.
Involvement of one or more body system.
Unconvinced by repeated examinations, investigations and
reassurance that disease does not exist.
Impaired social and family relationship

19. SOMATOFORM AUTONOMIC
DYSFUNCTION
In this disorder, the symptoms are predominantly
under autonomic control
some of them include palpitations, hiccups,
hyperventilation, irritable bowel, dysurea etc.

20. PERSISTENT SOMATOFORM PAIN
DISORDER
main feature of this disorder is severe persistent
pain without any physical basis.
It may be of sufficient severity so as to cause
social or occupational impairment.
Pre – occupation with pain is common.

21. UNDIFFERENTIATED SOMATOFORM
DISORDER
When physical complaints are multiple, varying
and persistent, but the complete and typical
clinical picture of somatization disorder is not
fulfilled, this category is considered.

26. DIAGNOSIS
Physical workup to rule out medical and
neurological conditions.
Complete patient history with current
psychologic stressors.
Test to rule out underlying organic diseases.

27. TREATMENT
Drug therapy
Antidepressants and Benzodiazepines
Psychological treatment
Supportive psychotherapy
 relaxation therapy.
Alternative treatment
Acupuncture,,
therapeutic massage,
yoga, meditation,
botanical medicine, and homeopathic
treatment

28. NURSING MANAGEMENT
Assessment:

29. NURSING MANAGEMENT
NURSING DIAGNOSIS
Ineffective coping related to appraisal of
the stressors as evidenced by inability to
problem solve
Ineffective denial related to anxiety or fear
as evidenced by inadequate copying skills