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Nursing 1111
Somatoform and Dissociative Disorders Ch. 15
| Question | Answer |
|---|---|
| Somatization Disorder | Multiple somatic symptoms that cannot be explained medically; Vague, dramatized, or exaggerated symptoms; Pain in multiple sites; multiple physician; Anxiety & depression w/ suicide common; Symptoms present before age 30 |
| What does somatoform disorders different from? | Malingering; Factitous disorder; Psychosomatic illness |
| Malingering | Intentionally producing symptoms to achie e and environmental goal |
| Factitious disorder | Fabrication of symptoms or self-inflicted injury to assume the sick role |
| Psychosomatic illness | A general medical condidion affected by stress or psychological factors |
| These are behaviors not disorders | Malingering, Factitious disorder, Psychosomatic illness |
| Somatoform Disorders | Conversion; Hypochondriasis; Somatization disorder; Pain disorder; Body dysmorphic disorder |
| Dissociative Disorders | Amnesia; Fugue; Dissociative identity disorder; Depersonalization |
| Pain Disorder | Severe prolonged pain that impairs social or occupational functioning; Diagnostic testing rules out organic cause; Psychological issues causes the pain or affects the severity or maintenance; Usual sites of pain: head, face, lower back pelvis |
| Pain Disorder | Presence of pain provides primary, secondary and/or tertiary gain; Depression, suicide & substance abuse are common |
| Pain Disorder | Nursing Care: Assess physical status; Note pain episodes- duration, intensity, and factors influencing onset; Use distraction to manage pain, Reinforce non pain behaviors and interactions; Teach effective coping strategies; Explore meaning pain (client) |
| Hypochondriasis | Belief that one has a serious disease in spite of negative medical findings; Misinterpretation of physical sensations; Preoccupation causes impaired social and occupational functioning; Depression or anxiety disorders common; Repeat doctor shopping; 6 mon |
| Hypochandriasis | Something is there, could be be a mole & client believes it is cancerous |
| Hypochandriasis | Nursing Care: Thorough physical assessment; Limit focus on physical complaints; Encourage discussion of feelings; Convey acceptance, unconditional regard & non-judgemental attitude |
| Conversion Disorder | Loss or change in body function as result of psychological conflict or extreme stress; Symptoms affect voluntary motor or sensory function such as involuntary movements, abnormal gait, anesthesia, blindness, deafness, paralysis, or seizures |
| Conversion Disorder | La bell indiffererence; Primary gain; Secondary gain; symptoms resolve within a few weeks |
| Conversion Disorder | Common rape victim |
| Conversion Disorder | Comorbidities: Major depression, Dissociative disorder, Personality disorder |
| Somatization Disorder | Comorbidities: Major depression, Panic disorder, Personality disorder, Substance dependence |
| Hypochondriasis | Comorbidities: Depressive disorder, Anxiety disorder, Other somatoform disorders |
| Pain Disorder | Comorbidities: Anxiety disorder, Depressive disorder, Substance dependence |
| Body dysmorphic Disorder | Comorbidities: Major depression Obsessive-compulsive disorder, Social phobia |
| Primary gain | Avoid conflicts |
| Secondary gain | Avoids uncomfortable situation |
| Conversion Disorder | Nursing Care: Thorough physical; look for primary &secondary gains; Avoid judgement; Encourage verbalization of feelings; Teach adaptive coping |
| Body Dysmorphic Disorder | Preoccupation with an imagined defective body part; Exaggerated belief that body is deformed or defective; Delusional thinking (true) |
| Body Dysmorphic Disorder | Depression & Obsessive-compulsive behavior are common; Meay seek medical intervention to "fix" the perceived problem ( will actually have surgery to fix) |
| Body Dysmorphic Disorder | Nursing Care: Assess client's perception of body image; Help them see reality; Encourage expression of fears; Teach adaptive coping; Support groups may be helpful |
| Somatoform D/O | Treatment: May avoid psychiatric referrals or fail to persist with treatment; Pharmocological; Behavior and psychotherapy helpful if client will attend |
| Pharmocological for Somatoform D/O | Hard to get them into treatment because it makes them face their fear and feelings. |
| Pain Disorder | Suicide is a serious risk in clients with chronic pain: the rate is nine times higher than regular population |
| Body Dysmorphic Disorder | There is no relief of symptoms; The disorder is chronic and the response to treatment is limited. |
| La belle indifference | Lack of emotional concern about the symptoms |
| Conversion Disorder | The course of this disorderis related to its acuity; in cases with acute onset during stressful events, remission rate is high; in cases with a more gradual onset, the disorder is not readily treated |
| Dissociative Disorders | Dissociative Amnesia; Dissociative Fugue; Dissociative Identity Disorder (DID); Depersonalization Disorder |
| Dissociative Disorders | DSM-IV-TR |
| Somatoform Disorders | DSM-II-TR |
| Dissociative Disorders | Disturbances in the normally well integrated continuum of consciousnes, memeory, identity, and perception |
| Dissociative Amnesia | Inability to recall important personal information; Begins abruptly; Usually related to a traumatic event; Client is aware of memory loss and is alert before and after incident; Not related to substances or medical condition |
| Dissociative Amnesia Types | Localized; Selective; Generalized |
| Localized | Unable to recall events from a certain period |
| Selective | Unable to recall portions of events from a certain period |
| Generalized | Unable to recall information about their entire life |
| Dissociative Amenesia | Nursing Care: Secure safe environment; Obtain as much information as possible; Dont pressure client to remember experiences allow them to process info at their own pace; Expose client to simuli that should remind the client of pleasant past experiences |
| Dissociative Amnesia | Encourage client to talk about recent stressors |
| Dissociative Fugue | Sudden unexpected travel from home; Inability to recall personal identity; May assume a new identity; Evidence of secondary gain is clear |
| Dissociative Fugue | Nursing Care: Safe environment; low stimuli; Redirect violence; Grive tranquilizing meds. (Valum, Zanax); Explore traumatice experiences (when calm); Teach effective coping; Refer to community support |
| Dissociative Fugue | Usually lives simple lives; Usually precipitated by a traumatic event; |
| Dissociative Identity Disorder | Multiple Personality Disorder |
| Dissociative Identity Disorder | (blank) |
| Dissociative Identity Disorder | 2 or more distinct personalitites are present and periodically take control of client's behavior; Unable to consistently recall personal information; May or may not be aware of alter ego; Not due to substances or a medical condition |
| Dissociative Identity Disorder | These alter-egos are created for protection |
| Dissociative Identity Disorder | Predisposing Factors: Biological capacity for dissociation; Threatening environment present as personality developed; History of severe trauma or abuse in childhood; Lack of nurturing or recovery from the abuse |
| Dissociative Identity Disorder | Nursing Care: Assure safety, assess suicidal intent and supervise closely; Provide structure and reassure client of safety; Establish a trusting relationship; Explore each personality and the role it plays. |
| Dissociative Identity Disorder | Nursing Care: Know that excessive switching between alters is result if trigger similar to past trauma |
| Dissociative Identity Disorder | Assist client to accept and integrate personalities into one; Teach grounding techniques to convey "not going away" -Safe place, -Ice in hands, -Wrapping self in blanket, -Counting |
| Dissociative Identity Disorder | Provide coping skills such as: -Relapse prevention, -Journaling |
| Depersonalization Disorder | Temporary sense of unreality; Parts of body feel unreal, sense of detachment from the environment; Derealizaiton may occur- altered perceptions w/ people automatic; Client is aware of perceptual distortions |
| Depersonalization Disorder | Accompanied by anxiety, depression, fear of going insane, obsessive thoughts, somatic complaints; Client is aware of perceptual distortions |
| Causes of Depersonalization Disorder | Neurophysicological: Brain, Tumors, Epilepsy, Drug Intoxication (LSD), Severe Sensory Deprivation; Conflicts within ego structure that protects one fromn trauma; multiple |
| Cause of Depersonaliztion Disorder | Multiple Causes: Stress increases & Person uses Repression to Deal with it |
| Common Treatments | Amobarital (Truth Serum) helps client recall memories; Psychotherapy; Hypnosis |
Created by:
keystudent
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