NCM 117: LEC 14 (04/08/24)
SOMATIC SYMPTOM DISORDERS
Somatic symptom disorders are characterized by
physical symptoms suggesting medical disease but
without demonstrable organic pathology or known
pathophysiological mechanism to account for them.
 Psychosomatic began to be used to convey the
connection between the mind (psyche) and the
body (soma) in states of health and illness.
 Hysteria refers to multiple physical complaints
with no organic basis; the complaints are usually
described dramatically.
 Somatization is defined as the transference of
mental experiences and states into bodily
symptoms.
THREE CENTRAL FEATURES OF
SOMATIC SYMPTOM
ILLNESSES:
 Physical complaints suggest major medical
illness but have no demonstrable organic basis.
 Psychological factors and conflicts seem
important in initiating, exacerbating, and
maintaining the symptoms.
 Symptoms or magnified health concerns are not
under the client’s conscious control.
Somatic symptom and related disorders are
classified as mental disorders, by the DSM-5, when the
excessive focus on somatic symptoms is beyond any
medical explanation and it causes significant distress
and impairment in one's functioning.
SOMATIC DISORDERS
 SOMATIC SYMPTOM DISORDER is
characterized by one or more physical
symptoms that have no organic basis.
Individuals spend a lot of time and energy
focused on health concerns, often believe
symptoms to be indicative of serious illness, and
experience significant distress and anxiety about
their health.
 PAIN DISORDER has the primary physical
symptom of pain, which is generally unrelieved
by analgesics and greatly affected by
psychological factors in terms of onset, severity,
exacerbation, and maintenance.
 CONVERSION DISORDER, sometimes called
conversion reaction, involves unexplained,
usually sudden deficits in sensory or motor
function (e.g., blindness, paralysis).
These deficits suggest a neurologic
disorder but are associated with
psychological factors. There is usually
significant functional impairment. There
may be an attitude of la belle
indifférence, a seeming lack of concern or
distress, about the functional loss.
 ILLNESS ANXIETY DISORDER, formerly
hypochondriasis, is preoccupation with the fear
that one has a serious disease (disease
conviction) or will get a serious disease (disease
phobia). It is thought that clients with this
disorder misinterpret bodily sensations or
functions.
Somatic symptom illnesses are more common in women than in
men; they may represent about 5% to 7% of the general population,
but estimates can vary greatly. Because most people with illness
anxiety are seen in general medical or family practice settings, it is
difficult to make accurate estimates of occurrence. Reports of pain
are one of the most common complaints in medical practice, and it is
difficult to distinguish physical from psychological causation.
RELATED DISORDERS
FABRICATED OR INDUCED ILLNESS
Body-related mental disorders, in which people
feign or intentionally produce symptoms for some
purpose or gain.
In malingering and factitious disorders, people
willfully control the symptoms.
In somatic symptom illnesses, clients do not
voluntarily control their physical symptoms.
 MALINGERING is the intentional production of
false or grossly exaggerated physical or
psychological symptoms; it is motivated by
external incentives such as avoiding work,
evading criminal prosecution, obtaining financial
compensation, or obtaining drugs. People who
malinger can stop the physical symptoms as soon as they
have gained what they wanted.
 FACTITIOUS DISORDER, imposed on self,
occurs when a person intentionally produces or
feigns physical or psychological symptoms solely
to gain attention.
 The common term for factitious disorder
imposed on self is Munchausen
syndrome. Munchausen syndrome by proxy,
occurs when a person inflicts illness or injury on
someone else to gain the attention of emergency
medical personnel or to be a “hero” for saving the
victim.
 SOMATIC DISORDERS
ETIOLOGY
PSYCHOSOCIAL THEORIES
Psychosocial theorists believe that people with
somatic symptom illnesses keep stress, anxiety, or
frustration inside rather than expressing them
outwardly. This is called internalization. Both
internalization and somatization are unconscious
defense mechanisms.
Psychosocial theorists posit that increased incidence
of somatization in women may be related to various
factors:
 Boys in the United States are taught to be stoic
and to “take it like a man,” causing them to offer
fewer physical complaints as adults.
 Women seek medical treatment more often
than men, and it is more socially acceptable for
them to do so.
 Childhood sexual abuse, which is related to
somatization, happens more frequently to girls.
 Women more often receive treatment for
psychiatric disorders with strong somatic
components such as depression.
BIOLOGICAL THEORIES
 Research has shown differences in the way
clients with somatoform disorders regulate and
interpret stimuli.
 In other words, they may experience a normal
body sensation such as peristalsis and attach a
pathologic rather than a normal meaning to it.
 The presence of a host of somatic symptoms
can also be associated with other diagnoses.
SIGNS AND SYMPTOMS
1. Any physical symptom for which there is no
organic basis but for which evidence exists for
the implication of psychological factors.
2. Depressed mood is common.
3. Loss or alteration in physical functioning, with
no organic basis.
Examples include the following:
a. Blindness or tunnel vision
b. Paralysis
c. Anosmia (inability to smell)
d. Aphonia (inability to speak)
e. Seizures
f. Coordination disturbances
g. Pseudocyesis (false pregnancy)
h. Akinesia or dyskinesia
i. Anesthesia or paresthesia
4. "Doctor shopping."
5. Excessive use of analgesics.
6. Requests for surgery.
7. Assumption of an invalid role.
8. Impairment in social or occupational functioning
because of preoccupation with physical
complaints.
9. Psychosexual dysfunction (impotence,
dyspareunia (painful coitus), sexual
indifference).
10. Excessive dysmenorrhea.
11. Excessive anxiety and fear of having a serious
illness.
12. Objective evidence that a general medical
condition has been precipitated by or is being
perpetuated by psychological or behavioral
circumstances.
13. Conscious, intentional feigning of physical or
psychological symptoms (may be imposed on
the self or on another person).
TREATMENT
 Treatment focuses on managing symptoms and
improving quality of life.
 A trusting relationship helps ensure clients stay
with and receive care from one provider instead
of "doctor shopping."
 Antidepressants - selective serotonin reuptake
inhibitors (fluoxetine (Prozac), sertraline (Zoloft),
and paroxetine (Paxil) are most commonly used
among clients with depression and anxiety
disorders.
 For clients with pain disorder, referral to a
chronic pain clinic may be useful.
 Services such as physical therapy to maintain
and build muscle tone help improve functional
abilities.
 Clients can use nonsteroidal anti- inflammatory
agents to help reduce pain.
 Involvement in therapy groups is beneficial for
some people with somatic symptom illnesses
(cognitive-behavioral group)
 The overall goals of the group were offering
peer support, sharing methods of coping,
and perceiving and expressing emotions.
 Education or providing information has also
been effective for clients with somatic illness or
symptoms.
CLIENT AND FAMILY
EDUCATION
 Establish daily health routine, including
adequate rest, exercise, and nutrition.
 Teach about relationship of stress and physical
symptoms and mind- body relationship.
  Educate about proper nutrition, rest, and
exercise.
 Educate client in relaxation techniques:
progressive relaxation, deep breathing, guided
imagery, and distraction such as music or other
activities.
 Educate client by role-playing social situations
and interactions.
 Encourage family to provide attention and
encouragement when client has fewer
complaints.
 Encourage family to decrease special attention
when client is in "sick".
COMPLICATIONS
Somatic symptom disorder can be associated with:
 Poor health
 Problems functioning in daily life, including
physical disability
 Problems with relationships
 Problems at work or unemployment
 Other mental health disorders, such as anxiety,
depression and personality disorders
 Increased suicide risk related to depression
 Financial problems due to excessive health care
visits
ASSESSMENT
 Clients usually provide a lengthy and detailed
account of previous physical problems,
numerous diagnostic tests, and perhaps even a
number of surgical procedures.
 Clients may express dismay or anger at the
medical community with comments such as
"They just can't find out what's wrong with me"
or "They're all incompetent, and they're trying
to tell me I'm crazy!"
 Clients with somatization disorder usually
describe their complaints in colorful,
exaggerated terms, but often lack specific
information.
 Mood is often labile. Emotions are often
exaggerated, as are reports of physical
symptoms.
 Clients are unlikely to be able to think about or
respond to questions about emotional feelings.
 Clients are alert and oriented. Intellectual
functions are unimpaired.
 Clients focus only on the physical part of
themselves.
 Clients may report a lack of family support and
understanding
 Clients who somatize often have sleep pattern
disturbances, lack basic nutrition, and get no
exercise.
DIAGNOSIS
Nursing diagnoses commonly used when working
with clients who somatize include:
 Ineffective coping
 Ineffective denial
 Impaired social interaction
 Anxiety
 Disturbed sleep pattern
 Fatigue
 Pain
Clients with conversion disorder may be at risk for
disuse syndrome from having pseudoneurologic
paralysis symptoms. In other words, if clients do not use
a limb for a long time, the muscles may weaken or
undergo atrophy from lack of use.
PLANNING
Treatment outcomes may include:
 The client will identify the relationship between
stress and physical symptoms.
 The client will verbally express emotional
feelings.
 The client will follow an established daily
routine.
 The client will demonstrate alternative ways to
deal with stress, anxiety, and other feelings.
 The client will demonstrate healthier behaviors
regarding rest, activity, and nutritional intake.
IMPLEMENTATION
 Encouraging them to focus on emotional
feelings is important, though this can be difficult
for clients.
 Two categories of coping strategies are
important for clients to learn and to practice:
emotion- focused coping strategies, which help
clients relax and reduce feelings of stress, and
problem- focused coping strategies, which help
resolve or change a client's behavior or situation
or manage life stressors.
 The nurse can help the client plan social contact
with others, can role-play what to talk about
(other than the client's complaints), and can
improve the client's confidence in making
relationships.
NCM 117: LEC 14 (04/08/24)
EATING DISORDERS
Eating disorders are mental illnesses that
cause serious disturbances in a person's everyday diet.
It can manifest as eating extremely small amounts of
food or severely overeating. The condition may begin as
just eating too little or too much but obsession with
eating and food over takes over the life of a person
leading to severe changes.
TYPES OF EATING DISORDERS
 Anorexia Nervosa
 Bulimia Nervosa
 Binge Eating Disorder
 Not Otherwise Specified (NOS)
 ANOREXIA NERVOSA 
Is a life-threatening eating disorder
characterized by the client’s restriction of nutritional
intake necessary to maintain a minimally normal body
weight, intense fear of gaining weight or becoming fat,
significantly disturbed perception of the shape or size of
the body, and steadfast inability or refusal to
acknowledge the seriousness of the problem or even
that one exists.
Anorexia nervosa happens when one is
obsessed with becoming thin that they reach extreme
measures and this leads to extreme weight loss.
2 SUBGROUPS OF ANOREXIA
NERVOSA
1. BINGE EATING means consuming a large
amount of food (far greater than most people
eat at one time) in a discrete period of usually 2
hours or less.
2. PURGING involves compensatory behaviors
designed to eliminate food by means of self-
induced vomiting or misuse of laxatives,
enemas, and diuretics.
WARNING SIGNS
 Dramatic weight loss
 Refusal to eat certain foods or food categories.
 Consistent excuses to avoid situations involving
food
 Excessive and rigid exercise routine
 Withdrawal from usual friends/relatives
HEALTH RISKS W/ ANOREXIA
 Heart failure
 Kidney failure
 Low protein stores
  Digestive problems  High blood pressure
 High cholesterol
 Gall bladder disease
 BULIMIA NERVOSA 
 Diabetes
Often simply called bulimia, is an eating  Heart disease
disorder characterized by recurrent episodes of binge  Certain types of cancer
eating followed by inappropriate compensatory
behaviors to avoid weight gain, such as purging, fasting,
 NIGHT EATING SYNDROME 
or excessively exercising.
Is characterized by morning anorexia, evening
 one starts to consume large amounts of food at
hyperphagia (consuming 50% of daily calories after the
once and then is followed by purging, using
last evening meal), and nighttime awakenings (at least
laxatives, or over exercising to rid themselves of
once a night) to consume snacks.
the food they ate.
 Binging or purging episodes are often It is associated with life stress, low self-esteem,
precipitated by strong emotions and followed by anxiety, depression, and adverse reactions to weight
guilt, remorse, shame, or self-contempt. loss.

WARNING SIGNS
 EATING/ FEEDING D/O IN CHILDHOOD 
 Wrappers/containers indicating consumption of
large amounts of food  PICA, which is persistent ingestion of nonfood
 Frequent trips to bathroom after meals substances.
 Signs of vomiting e.g. staining of teeth, calluses  RUMINATION, or repeated regurgitation of
on hands food that is then rechewed, reswallowed, or spit
 Excessive and rigid exercise routine out.
 Withdrawal from usual friends/relatives

HEALTH RISKS W/ BULIMIA  ORTHOREXIA NERVOSA 

 Dental problems Sometimes called orthorexia, is an obsession

 Stomach rupture with proper or healthful eating. It is not formally
 Menstruation irregularities recognized in the DSM-5, but some believe it is a type of
anorexia or a form of OCD. Behaviors include
compulsive checking of ingredients; cutting out
 BINGE EATING DISORDER  increasing number of food groups; unusual interest in
what others eat.
 Binge eating is disorder in which someone eats
a lot amount of food at a time but they don't WHY DO PEOPLE DEVELOP
vomit.
EATING DISORDERS?
 It is characterized by recurrent episodes of
binge eating; no regular use of inappropriate Behaviors are unhealthy coping mechanisms
compensatory behaviors, such as purging or
FACTORS TO CONSIDER
excessive exercise or abuse of laxatives.
 Psychological
WARNING SIGNS  Interpersonal
 Wrappers/containers indicating consumption of  Social/Cultural
large amounts of food  Biological
 MAY be overweight for age and height  Developmental
 MAY have a long history of repeated efforts to
PSYCHOLOGICAL FACTORS
diet-feel desperate about their difficulty to
control food intake  Low self-esteem
 MAY eat throughout the day with no planned  Feelings of inadequacy or failure
mealtimes  Feeling out of control
 Response to change (puberty)
HEALTH RISKS WITH BINGE  Response to stress (sports, dance)
EATING DISORDER  Personal illness
INTERPERSONAL FACTORS  Psychopharmacology - Anti-depressants are
used primarily to treat bulimia. Drugs such as
 Troubled family and personal relationships
Desipramine, Imipramine, Amitriptyline, and
 Difficulty expressing emotions and feelings
Flouxetine were prescribed in the same dosages
 History of being teased or ridiculed based on
to treat depression.
size or weight
 History of physical or sexual abuse
APPLICATION OF THE NURSING
SOCIAL AND CULTURAL FACTORS
PROCESS
 Cultural pressures that glorify thinness and
place value on obtaining the perfect body ASSESSMENT
 Narrow definitions of beauty that include only
 History- has a history of impulsive behavior
women and men of specific body weights and
 General Appearance and Motor Behavior- slow,
shapes
lethargic and fatigued
 Cultural norms that value people on the basis of
 Mood and Affect- labile moods, sad, anxious,
physical appearance and not inner qualities and
and worried
strengths.
 Thought Process and Content- Body image
BIOLOGICAL FACTORS disturbance o
 Sensorium and Intellectual Processes- alert and
 Eating disorders often run in families (learn
oriented
coping skills and attitudes in family)
 Judgment and Insight- limited insight, poor
 Genetic component-research about brain and
judgment
eating in taking place (certain chemicals in the
 Self-Concept- Low self-esteem
brain control hunger, appetite and digestion
 Roles and Relationships- inability to fulfill roles
have been found unbalanced).
 Self-Care Considerations- relates directly to the
DEVELOPMENTAL FACTORS severity of self-starvation or purging behaviors
or both.
Two essential tasks of adolescence are the
struggle to develop autonomy and the establishment of DATA ANALYSIS
a unique identity. Autonomy, or exerting control over
Nursing diagnosis for clients with eating disorders
oneself and the environment, may be difficult in families
include:
that are over-protective or in which enmeshment (lack
of clear role boundaries) exist.  Imbalanced nutrition: Less than/more than
body requirements
 Ineffective coping
BODY IMAGE is how a person perceives his or her  Disturbed body image
body, that is, a mental self-image.  Chronic low self-esteem
BODY IMAGE DISTURBANCE occurs when there is *Other nursing diagnoses may be pertinent such as
an extreme discrepancy between one’s body image deficient fluid volume, constipation, fatigue, and activity
and the perceptions of others and extreme intolerance.
dissatisfaction with one’s body image.
OUTCOME IDENTIFICATION
Examples of expected outcomes for clients with eating
disorders include:
Bulimia Nervosa - TREATMENT  The client will establish adequate nutritional
eating patterns.
 Cognitive-Behavioral therapy- is the most
 The client will eliminate use of compensatory
effective treatment for bulimia. Strategies
behaviors such as excessive exercise and use of
designed to change the client's thinking
laxatives and diuretics.
(cognition) and actions (behavior) about food
 The client will demonstrate coping mechanisms
focus on interrupting the cycle of dieting,
not related to food.
binging, and purging and altering dysfunctional
 The client will verbalize feelings of guilt, anger,
thoughts and beliefs about food, weight, body
anxiety, or an excessive need for control.
image, and overall self- concept.
  The client will verbalize acceptance of body
image with stable body weight.

NURSING INTERVENTIONS
✓ Establishing Nutritional Eating Patterns

 Sit with the client during meals and snacks.

 Offer liquid protein supplement if client is
unable to complete meal
 Adhere to treatment program guidelines
regarding restrictions.
 Observe the client following meals and snacks
for 1 to 2 hours.
 Weigh the client daily in uniform clothing.
 Be alert for attempts to hide or discard food or
inflate weight.

✓ Helping the client identify emotions and

develop non-food-related coping strategies
 Ask the client to identify feelings.
 Self-monitoring using a journal.
 Relaxation techniques.
 Distraction
 Assist the client in changing stereotypical
beliefs.

✓ Helping the client deal with body image issues

 Recognize benefits of a more near-normal

weight.
 Assist in viewing self in ways not related to body
image.
 Identify personal strengths, interests, and
talents.

✓ Helping the client deal with body image issues