Somatoform Disorders and Dissociative Diseases

Somatoform Disorders and Dissociative Diseases

1. Somatoform Disorders and Dissociative
Diseases
Chapter 9

2. Somatoform disorders
Definition
Physical symptoms in the absence of pathology
Symptoms are not intentional or under conscious control as in
malingering or factitious disorder
Malingering: conscious intent to produce symptoms for benefit
Factitious Disorder: deliberate fabrication of symptoms or self –
inflicted injury (Munchausen's Syndrome-most severe) &
Munchausen's by proxy-caregiver injuring child for sympathy
Prevalence
Estimated 38% present with symptoms: no medical basis
Co-morbidity
Depressive Disorders, Anxiety Disorders, Substance Abuse
and Personality Disorders

3. Genetic and Familial Factors
-Tends to run in families
-Genetic and environmental origins
Learning and socio-cultural factors
-Early experiences & learning are primary factors of
somatic sensitivity and body preoccupation
Psychodynamic Theory
-Development of narcissism is turned into bodily
preoccupation during separation & individual phase of
development
Interpersonal Model
-Childhood adversity linked to hypochondriasis
Theory

4. Cultural considerations
Cultural factors influence somatization
May be 1
st
symptoms that indicate anxiety
or depressive disorder
Types and frequency vary among culture
In some cultures, physical symptoms are
believed to result from casting of spells

5. Types of somatization disorders
Somatization Disorder
Physical symptoms accompanied by functional impairment
Hypochondriasis
Misinterpretation of innocent physical sensations as serious
illness
Pain Disorder
When testing rules out organic cause for pain & discomfort leads
to significant impairment
Body Dysmorphic Disorder
Preoccupation with defective body part
Conversion Disorder
Symptoms that affect voluntary motor or sensory functions which
suggest medical condition

6. Assessment
-Symptoms & unmet needs, voluntary control of symptoms, secondary
gains, cognitive style, ability to communicate feelings and emotional
needs, dependence on meds & assessment guide
Diagnosis
-Ineffective coping frequently diagnosed
Outcomes Identification
Planning
Implementation
-Communication guidelines, health teaching & promotion, case
management, psychotherapy
-Pharmacology: use of SSRIs show greatest promise
Evaluation
-Simple process, measurable behavior outcomes
Applications of nursing process

7. Definition
-Disturbances in normally well-integrated continuum of-
consciousness, memory, identity & perception
-Characterized by altered mind body connections
-Related to stress or anxiety
Prevalence
-Inpatients-5%-20%, Outpatient: 12%-29%
Comorbidity
-Often exist with patients present psych ER: suicide,
self-mutilation, addiction, rapid cycling, etc
Theory
Dissociative disorders

8. Culturally bound disorders exist in which
there is a high level of anxiety, trancelike
state, running or fleeing followed by
exhaustion, sleep & amnesia
These syndromes include piblokto, seen in
native people of Arctic, Navajo frenzy
witchcraft & amok among western Pacific
natives
These syndromes must be differentiated from
dissociative disorders
Cultural considerations

9. Depersonalization Disorder
Persistent alteration in perception of self while reality testing
remains intact
Dissociative Amnesia
Marked by inability to recall important personal info often of
traumatic or stressful nature
Dissociative Fugue
Sudden unexpected travel away from customary locale and
inability to recall ones identity and info about the past
Dissociative Identity Disorder
Multiple personality disorder
Presence of 2 or more distinct personality states that take
control of behavior
Types of dissociative disorders

10. Assessment
-Medical workup, identity and memory, pt history, mood, use of
alcohol or drugs, effect on patient and family, suicide risks and
assessment guidelines
Diagnosis
Outcomes Identification
-Develop trust, correct faulty perceptions, & encourage pt to live in
present
Planning
Implementation
-Communication guidelines, health teaching & promotion, milieu
therapy, psychotherapy & pharmacological, biological &
integrative therapies
Evaluation
-Treatment is considered successful when outcomes met
Applications of nursing process