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Chapter 21
Somatic SymptomIllnesses
Chapter 21
Somatic SymptomIllnesses
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Somatic Symptom IllnessesSomatic Symptom Illnesses
• Psychosomatic: connection between mind (psyche) and body (soma)
• Hysteria: multiple physical complaints with no organic basis– Proposal by Freud that people can convert
unexpressed emotions into physical symptoms
• Somatization: transference of mental experiences, states into body symptoms
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Somatic Symptom Illnesses (cont.)Somatic Symptom Illnesses (cont.)
• Three central features
– Physical complaints suggest major medical illness but have no demonstrable organic basis
– Psychological factors and conflicts seem important in initiating, exacerbating, maintaining symptoms
– Symptoms or magnified health concerns are not under patient’s conscious control
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Types of Somatic Symptom IllnessesTypes of Somatic Symptom Illnesses
• Somatic symptom illness: multiple physical symptoms—combination of pain, GI, sexual, pseudoneurologic symptoms
• Conversion disorder: unexplained sensory or motor deficits associated with psychological factors; typically involves significant functional impairment; “la belle indifference”
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Types of Somatic Symptom Illnesses (cont.)Types of Somatic Symptom Illnesses (cont.)
• Pain disorder: pain unrelieved by analgesics; psychological factors influencing onset, severity, exacerbation, maintenance
• Illness anxiety disorder (hypochondriasis): disease conviction or disease phobia
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Onset and Clinical CourseOnset and Clinical Course
• Symptoms usually onset in adolescence or early adulthood
• All either chronic or recurrent
• Patients go from one physician or clinic to another, or see multiple providers at once, to obtain relief of symptoms
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QuestionQuestion
• Is the following statement true or false?
• A patient with a somatic symptom illness is able to voluntarily control the symptoms.
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AnswerAnswer
• False
• Rationale: The symptoms of somatic symptom illness are not under the patient’s voluntary control.
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Related Disorders Related Disorders
• Malingering: intentional false or grossly exaggerated symptoms; external incentives as motivation
• Factitious disorder: intentional symptoms to gain attention (Munchausen’s syndrome = imposed upon self)
– Munchausen’s syndrome by proxy = imposed upon others
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Related Disorders (cont.) Related Disorders (cont.)
• Malingering and factitious disorders: willful control of symptoms; somatic symptom illnesses—no voluntary control over symptoms
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EtiologyEtiology
• Psychosocial theories
– Internalization
– Primary gains: direct external benefits of being sick provide relief of anxiety, conflict, distress
– Secondary gains: person receives internal or personal benefits from others because one is sick.
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Etiology (cont.)Etiology (cont.)
• Biologic theories:
– Differences in regulation, interpretation of stimuli
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Cultural Considerations Cultural Considerations
• Variable in frequency, meaning across cultures (see Table 21.1)– Dhat (men in India)
– Koro (Southeast Asia)
– Falling-out episodes
– Hwa-byung (Korean folk syndrome)
– Shenjing shuariuo (China)
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TreatmentTreatment
• Symptom management, improvement in quality of life
• Antidepressants for accompanying depression: SSRIs (see Table 21.2)
• Pain clinic referral for disorder
• Involvement in therapy groups
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Somatic Symptom Illnesses and Nursing Process Application Somatic Symptom Illnesses and Nursing Process Application • Assessment
– Investigation of physical health status; screening (se Box 21.1)
– History: usually detailed medical history; distress about health status (except patient with conversion disorder who displays la belle indifference)
– General appearance, motor behavior
– Mood, affect: labile; exaggerated emotions
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QuestionQuestion
• Is the following statement true or false?
• A patient with a factitious disorder develops symptoms primarily for attention.
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AnswerAnswer
• True
• Rationale: Factitious disorder occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention.
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Somatic Symptom Illnesses and Nursing Process Application (cont.)Somatic Symptom Illnesses and Nursing Process Application (cont.)
• Assessment (cont.)– Thought process, content: focus on symptoms– Sensorium, intellectual processes– Judgment, insight – Self-concept: focus on physical self– Roles, relationships: problems– Physiologic, self-care concerns (Box 21.2)
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Somatic Symptom Illnesses and Nursing Process Application (cont.)Somatic Symptom Illnesses and Nursing Process Application (cont.)
• Data analysis/nursing diagnoses• Outcome identification
– Identify relationship between stress and physical symptoms
– Verbally express emotions/feelings– Establish and follow a daily routine– Demonstrate alternate ways to deal with stress,
anxiety, and other feelings– Demonstrate healthy behaviors regarding rest,
activity, and nutritional intake
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Somatic Symptom Illnesses and Nursing Process Application (cont.)Somatic Symptom Illnesses and Nursing Process Application (cont.)
• Intervention– Provide health teaching: improved health behaviors– Help express emotions: journaling; limiting time
spent on physical complaints– Teach coping strategies
• Emotion-focused coping strategies• Problem-focused coping strategies
• Evaluation
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Community-Based Care Community-Based Care
• Appropriate referrals, such as pain clinic for patients with pain disorder
• Information about community support groups
• Pleasurable activities or hobbies
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QuestionQuestion
• Which of the following would be an example of a problem-focused coping strategy?
– A. Progressive relaxation– B. Deep breathing– C. Interaction role-playing– D. Guided imagery
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AnswerAnswer
• C. Interaction role-playing
• Rationale: Interaction role-playing is an example of a problem-focused coping strategy.
– Progressive relaxation, deep breathing, and guided imagery are emotion-focused coping strategies.
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Mental Health Promotion Mental Health Promotion
• Assist patients to deal directly with emotional issues
• Assist patients to continue gaining knowledge about themselves, their emotional needs
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Self-Awareness IssuesSelf-Awareness Issues
• Deal with feelings of frustration.
• Be realistic about small successes.
• Validate patient’s feelings.
• Deal with feeling that patient “could do better if he tried.”
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