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Mental Health Ch.

22 Somatoform and Dissociative Disorders

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mental or emotiona distress with some somatic sxs

what is the cheif complaint with anxiety disorders somatization charatcerists of somatoform physical sx malingering



the expression of psychological stress through physical symptoms they are symptoms with out orgainic disease, will see general practitioners and even when MD has told them nothing wrong they still think something is worng counscious process of intentionally producing symptoms of an obvious benefit an employee complains of nonexistent back pain to get disability income is an example of what? the disorder that refer to deliberate fabrication of symptoms or self infleicted injury for the purpose of assuming the sick and receiving nurturance, comfort and attention a patient has come in the clinic who has been injecting self with ecoli into abd. that has cause abscess is an example of what disorder? the most severe and chronic form of factitious disorder, and results in self harm severe enough for hospitalization. this disorder the patient will doctor shop and seek invasive diagonstic tests this is the disorder that manifested in a caregiver , kunjurig a child to get attention or sympathy somatoform disorder taht one or more sx of deficits suggesting a neurological disorder of general medical condition, exacerbated by stessors, not due to malingering or factitious disord , cannot be explained, impairmentof soical or occupational functioning, marked disstress or requires medical attention beginning before age 30, four sites of pain, two GI sx or than pain, one sexual or reproduction sx one defined as or suggesting a neruologic disorder

for at least 6 MONTHS; preoccupation with fears of having a serious disease, despite appropiate med tx and reassurance, causing significant impairment in social or occupational fucntioning or causes marked distress somatoform disorder that pain is a major part of the clinical picture, significant impairment, psychological factor thought to cause onset severity or exacerbation, Pain associated with psychological or medical factors (onset severity or excerbated by) medical condition may be present but plays minor role. peroccupied with imagine defect in appearance, causing significant impairment somatizaiotn disorder, hypochondriasis, pain disorder, body sysmorphic disorder, conversion disorder disorder that requries the presence of a certain number of symptoms accompainted by significant functional impairment, most frequent are pain sx.( head, chest, back, joint pelvis) dysphaigia, nausea, bloating, constipation, palptiation, dizziness, SOB 28 yr old former secretary, awakens on morning to find taht she has a tingling in both hands and connot mover her fingers. Two days earlier her husband had told her that he wanted a separation nd that she would have to go back toe work to support herself. what defense mechanism is she showing.

criteria for hypchorndriasis



criteria for pain disorder





factitious disorder

criteria for body dysmorphic disorder somatoform disorder



factitious disorder


somatization disorder


munchausen syndrome muchausen syndrome muchausen syndrome by proxy conversion disorder





CONVERSION conversion disorder (coversion of anxiety relates to the separation and increased in dependency needs to paralysis of her finger so that she s unable to work


criteria for somatization disorder


Henry 47 laborer, pulled a muscle in his back a year ago. Two weeks before this his wife a waitress told him that she wanted to go back to school to get her bacherlor degree. He suffers severe, constant pain, despite negative results from testing. Which defense mechanism

DENIAL (pain) (henry displaces his anxiety over the threat to his own self esteem by his wife potential change of status onto pian in his back foucusin on bac kand not on his threatened self esteem Symbolism and projection (BDD)


highly distressing and impairing disorder, patient with normal appearance with minor defects, preoccupied wit image, resulting in obsessive thinking and compulsive behavior such as mirror checkin and camouflaging. the feel great shame and hide or withdraw from others seek cosmetic surgery MDD, OCD, social phobia

body dysmorphic disorder



Attractive woman is preoccupied with her nose, thinking it is too long. she is constantly concerned by and distressed over her perception. Two plastic surgeons she consulted are hesitant to reshape her nose but this has not altered her thinking, which defense mechanism man lost his wife to colon ca 5 mth earlier, which he took well. recently he saw a sixth phsician with the same complaint. He believes that he has liver CA. despite negative tests. which defense mechanism female presents at the MD office with heavy menstration, telling the nurse that recently she experienced pain in her back radiating to every part of her body. Also constipation, vomiting when eating wrong food. States she is unwell and suffers from seziures. The nurse is confused not know what symptom to address. which defense mechanism requires the presence of a certain number of symptoms accompained by significant functional impairment can not be assured by negative findings, they seek extensive medical care with furstrating results most frequent reason people seek medical attention. When testing rlues out any organic cause for the pain, and the discomfort that leads to significant impairment

what are some comorbid diagnosis that are commone with BDD Can BDD be sucessfully treated conversion disorder


response to treatment is limited



Denial and somatization hypochondriasis


deficits that affect vountary motor or sensory functions, which suggest another medical condition. Common sx, involuntary movements seizure, paralysis abnormal gait, anesthesia, blindness and deafness conversion disorder


somatizaion , somatization disorder


what is one of the most common somatoform disorder what may be associated with conversion disorder what are some common comorbid conditions with conversion disorder psychosomatic illness what are some cormorbid conditions with hypochondriasis what is a serious risk factor with pain disorder what are some comorbid conditions with pain disorder

childhood physical or sexual abuse


depression anxiety, other somatoform disorders and personality disorders


somatization disorder



a medical condition affected by stressor psychological factors depression, ADs, PDs substance abuse


pain disorder



depression, sub. abuse, PDs



does location of symptoms change with pain disorder does locaton of symptoms change with somatizaiton disorder what are the assesment areas with somatic disorders


A. offer explanation and suppor during diagnositic testing




sx and unmet needs voluntary control of sx secondary gains congnitive style ability to communicate feelings or emotions dependence on medication this is when the patient wants to decrease actual symptoms and want relief from symptoms when the patient will benefit from the symptoms alone what can't you do that you used to be able to do? or How has this problem affected your life?


primary gains

when working with a patient with somatoform disorder the nurse should do which of the following: A. offer explanation and suppor during diagnositic testing B. imply that syptoms are not real C. assess the patient each time they complain about symptoms D. stay with patient when they are complaining about symptoms Choose all that apply: As nursing intervention for somatoform disorders, what should be done? A. teach assertive communication B. teach patient stress reduction techniques, such as meditation, relaxation, and mild physical exercise C. help patient in fostering dependency needs D.Have patient direct all reqeusts to case manager how is case management helpful with somatoform disorders what kind of therapy is used for somatoform disorders how is behavioral therapy helpful for somatoform disorders what therapeutic approach is used with conversion what therapeutic approach is used with somatization


secondary gains what are some questions you may ask when trying to identify the presence of secondary gain what is an appropiate Nur DX for patient with somatoform disorder


A,B,D d because it helps avoid manipulation



Ineffective coping related to : distored perception of body functions of symptoms, chronic pain of psychological origin, dependenc on pain relievers or anxiolytics patient will eventually be able to live a normal life


what is the overall goal in treating somatoform disorders how does the nurse help the patient with somatoform disorders when working with a patient with somatoform disorder the nurse should not take the symptoms seriously when working with a patient with somatoform disorder teh nurse should take the patients VS each time the patient complains


patient to improve overall functioning through the development of effective coping and communication strategies False , nurse should take symptoms seriously

the case manager can recommend to the MD scheduled appt every 4-6 wks and patient will have someone to contact and who is incharge congitive and behavioral





False, after VS are taken nurse should not reinforce behavior

provides incentives , motivations, an rewards to help paients control their symptoms behavioral therapy; family therapy hypnosis; anxiolytics consultation with PCP to arrange regular visits limited test, group therapy, congnitive behavioral therapy




congitive behavior therapy; antidepressants;cognitive gropu therapy; stree mangement group therapy; family; cognitive behavioral therapy; antidepressants; hypnosis cognitive behavioral therapy; antidepressants conversion and pain disorder

what therapeutic approach is used with hypochondriasis what therapeutic approach is used with pain disorder what therapeutic approach is used with BDD what disorders may benefit from hypnosis what is the difference between dissociative disorders and somatoform dissorders dissociative disorder




sudden, unexpected, unexplained travel away from the customary locale (home). inability to recall ones identity and some or all of the past. in this state they live a simple life no calling attetion to self. may assume new identity. last from few minutes to several days. when rememer former identit, usually become anmesic for time spent in fuge state (can not remember the fugue state) the presence of tow or more distinct personality states that recurrently take control of behavior.

dissociative fugue




dissociative disorders are unconscious

dissociative identiy disorder (mulitple personality disorder) IN DID is the host aware of the personalities what is DID often mis dx for how is dissociative disorders assessed


No, but the personalities are aware of each




disorder with altered mind body connections associated wit hstress and anxiety disorder from conscious awareness of painful feelings, memories, thoughts or aspects of identity, unconscious defense mechanism to protect self loss of memory sometimes concerning event that are traumatic or frightening gerneralized, localized, selective



dissociative disorder


dissociative anmesia what are the different types of amnesia depersonalization disorder

r/o medical reasons, sub. abuse, other psych disorder note changes of behavior, voice and dress referring to self by another name or in thrid person partial memory or memory gaps disorientation to time,place and person presence of blackouts note mood changes hx of abuse, subs abuse, problems with family, work etc fous on safety and crisis intervention major complain appropriate referral for treatment of the disorder




a persistent or recurrent alteration in the perception of hte self while realtiy testing REMAINS intact, may feel mechanical ,dreamy or detached form body unable to recall information regarding person whole life unable to recall information regarding certain event in a certain period unable to recall some but not all event in a certain period

the nursing planning when encounter dissociative disorder in time of crisis interventions for DD


gereral amnesia localized amnesia




selective anmesia

emotional presence druing recoll ofpainful events teaching about illness, coping skills, stress management provide safe environment psychotherapy medication psychotherapy is the best, med used to treat cormorbid sx

what is the primary and most effective treatment DDs