Somatic Symptom Disorder Chapter 17

Chapter 17 Somatic Symptom Disorders 2 Clinical Picture Somatic symptom disorder (SSD) Illness anxiety disorder (previously hypochondriasis) Conversion disorder Psychological factors affecting medical condition Factitious disorder Munchausen Syndrome Malingering 3 Somatic Symptom Disorder Distressing symptoms Maladaptive response Without significant physical findings and medical diagnosis Suffering is authentic High level of functional impairment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4 Illness Anxiety Disorder Misinterpretation of physical sensations Overconcerned for health and preoccupied with symptoms Extreme worry and fear Course of illness chronic and relapsing Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5 Conversion Disorder Neurological symptoms in the absence of a neurological diagnosis Presence of deficits in voluntary motor or sensory functions Common symptoms—paralysis, blindness, movement and gait disorders, numbness, paresthesias, loss of vision or hearing, or episodes resembling epilepsy “La belle indifférence” versus distress 6 Psychological Factors Affecting Medical Condition Psychological factors present risk for medical diseases Depression Cardiovascular diseases and cancer 7 Etiology Biological factors Genetic Psychological factors Psychodynamic theories Behavioral theories Cognitive theories Environmental factors Cultural considerations 8 Application of the Nursing Process Assessment Psychosocial factors Coping skills Spirituality and religion Secondary gains Cognitive style 9 Application of the Nursing Process (Cont.) Assessment (cont.) Ability to communicate feelings and emotional needs Dependence on medication Self-assessment 10 Application of the Nursing Process (Cont.) Nursing diagnosis Ineffective coping Anxiety Risk for loneliness Outcomes identification Interventions Psychosocial interventions Promotion of self-care activities Assertiveness training 11 Application of the Nursing Process (Cont.) Interventions (cont.) Psychobiological interventions Pharmacological interventions Health teaching and health promotion Case management Advanced nursing practice interventions 12 Factitious Disorders Artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury Goal of assuming a sick role 13 Examples of Factitious Disorders Self-directed Other-directed Malingering 14 Somatic Disorders Somatic symptom D/O- High incidence in Women. Distressing symptoms and excessive response without significant physical finding and medical dx. Example: Patient has pain and lethargy and complains about it often, but no medical reason can be established Factitious D/O-People consciously pretend to be ill to get needs met, and remain a ‘patient.’ Example: Patient doesn’t want to discharge home because he will need to go to court for his DUI, so he says his stomach pain is a 10/10. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15 Somatic Disorders Illness Anxiety D/O- (Hypochondriac) misinterpretation of physical symptoms as evidence of illness. Example: “My stomach is cramping and they ran tests that were negative, but I’m sure it is cancer.” Conversion D/O- (Functional neurological d/o) Neurological symptoms in the absence of a neurological dx. Channeling emotions into phys. symptoms..blindness, paralysis, gait issues w/o medical rationale. Example: Girl gets physically assaulted and 3 days later cannot walk. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16 Audience Response Questions 1. Which diagnosis is a Factitious Disorder? (select all that apply) A. Conversion disorder (functional neurological disorder) B. Illness anxiety disorder (hypochondriasis) C. Munchausen syndrome by proxy D. Somatic symptom disorder E. Malingering