Somatoform and Dissociative Disorders Ch. 15
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| 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
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| What does somatoform disorders different from? | Malingering; Factitous disorder; Psychosomatic illness
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| Malingering | Intentionally producing symptoms to achie e and environmental goal
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| Factitious disorder | Fabrication of symptoms or self-inflicted injury to assume the sick role
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| Psychosomatic illness | A general medical condidion affected by stress or psychological factors
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| These are behaviors not disorders | Malingering, Factitious disorder, Psychosomatic illness
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| Somatoform Disorders | Conversion; Hypochondriasis; Somatization disorder; Pain disorder; Body dysmorphic disorder
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| Dissociative Disorders | Amnesia; Fugue; Dissociative identity disorder; Depersonalization
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| 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
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| Pain Disorder | Presence of pain provides primary, secondary and/or tertiary gain; Depression, suicide & substance abuse are common
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| 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)
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| 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
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| Hypochandriasis | Something is there, could be be a mole & client believes it is cancerous
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| Hypochandriasis | Nursing Care: Thorough physical assessment; Limit focus on physical complaints; Encourage discussion of feelings; Convey acceptance, unconditional regard & non-judgemental attitude
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| 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
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| Conversion Disorder | La bell indiffererence; Primary gain; Secondary gain; symptoms resolve within a few weeks
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| Conversion Disorder | Common rape victim
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| Conversion Disorder | Comorbidities: Major depression, Dissociative disorder, Personality disorder
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| Somatization Disorder | Comorbidities: Major depression, Panic disorder, Personality disorder, Substance dependence
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| Hypochondriasis | Comorbidities: Depressive disorder, Anxiety disorder, Other somatoform disorders
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| Pain Disorder | Comorbidities: Anxiety disorder, Depressive disorder, Substance dependence
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| Body dysmorphic Disorder | Comorbidities: Major depression Obsessive-compulsive disorder, Social phobia
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| Primary gain | Avoid conflicts
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| Secondary gain | Avoids uncomfortable situation
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| Conversion Disorder | Nursing Care: Thorough physical; look for primary &secondary gains; Avoid judgement; Encourage verbalization of feelings; Teach adaptive coping
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| Body Dysmorphic Disorder | Preoccupation with an imagined defective body part; Exaggerated belief that body is deformed or defective; Delusional thinking (true)
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| Body Dysmorphic Disorder | Depression & Obsessive-compulsive behavior are common; Meay seek medical intervention to "fix" the perceived problem ( will actually have surgery to fix)
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| 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
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| Somatoform D/O | Treatment: May avoid psychiatric referrals or fail to persist with treatment; Pharmocological; Behavior and psychotherapy helpful if client will attend
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| Pharmocological for Somatoform D/O | Hard to get them into treatment because it makes them face their fear and feelings.
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| Pain Disorder | Suicide is a serious risk in clients with chronic pain: the rate is nine times higher than regular population
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| Body Dysmorphic Disorder | There is no relief of symptoms; The disorder is chronic and the response to treatment is limited.
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| La belle indifference | Lack of emotional concern about the symptoms
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| 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
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| Dissociative Disorders | Dissociative Amnesia; Dissociative Fugue; Dissociative Identity Disorder (DID); Depersonalization Disorder
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| Dissociative Disorders | DSM-IV-TR
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| Somatoform Disorders | DSM-II-TR
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| Dissociative Disorders | Disturbances in the normally well integrated continuum of consciousnes, memeory, identity, and perception
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| 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
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| Dissociative Amnesia Types | Localized; Selective; Generalized
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| Localized | Unable to recall events from a certain period
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| Selective | Unable to recall portions of events from a certain period
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| Generalized | Unable to recall information about their entire life
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| 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
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| Dissociative Amnesia | Encourage client to talk about recent stressors
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| Dissociative Fugue | Sudden unexpected travel from home; Inability to recall personal identity; May assume a new identity; Evidence of secondary gain is clear
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| 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
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| Dissociative Fugue | Usually lives simple lives; Usually precipitated by a traumatic event;
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| Dissociative Identity Disorder | Multiple Personality Disorder
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| Dissociative Identity Disorder | (blank)
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| 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
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| Dissociative Identity Disorder | These alter-egos are created for protection
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| 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
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| 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.
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| Dissociative Identity Disorder | Nursing Care: Know that excessive switching between alters is result if trigger similar to past trauma
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| 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
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| Dissociative Identity Disorder | Provide coping skills such as: -Relapse prevention, -Journaling
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| 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
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| Depersonalization Disorder | Accompanied by anxiety, depression, fear of going insane, obsessive thoughts, somatic complaints; Client is aware of perceptual distortions
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| Causes of Depersonalization Disorder | Neurophysicological: Brain, Tumors, Epilepsy, Drug Intoxication (LSD), Severe Sensory Deprivation; Conflicts within ego structure that protects one fromn trauma; multiple
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| Cause of Depersonaliztion Disorder | Multiple Causes: Stress increases & Person uses Repression to Deal with it
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| Common Treatments | Amobarital (Truth Serum) helps client recall memories; Psychotherapy; Hypnosis
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