1

Case presentation
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Mrs. Monika has been married for approximately 10 years

,and during all of those years she remembers being sick
all of the time .According to her husband ,she constantly
takes medications for all of her ailments. She has visited
numerous physician and none have been able to
correctly diagnose her condition. Today she visited at DH
with the complain of chest pain ,shortness of breath ,back
pain, double vision, difficulty walking due to weakness in
limb ,headaches, constipation and decreased libido.

What may be possible diagnosis ?

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Diagnosis : Somatization Disorder

Somatoform Disorder
Unit -8
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PREPARED BY : SMRITI SHRESTHA

B.SC. NURSING 3RD YEAR ,
KUSMS
 Objectives (1/3)
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General Objective:
At the end of this teaching learning session, the
students will be able to explain about: Somatization
disorder
 Objectives (2/3)
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Specific Objectives :
At the end of this session ,the student will be able to :
introduce somatoform disorder
enlist the type of somatoform disorder
define somatization disorder
list down the causes of somatization disorder
describe the ICD 10 criteria for somatization
disorder
 Objectives (3/3)
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describe the DSM IV criteria for somatization

disorder
describe the management for somatization disorder
describe the nursing management of somatization
disorder
summarization of the main point
 Introduce Somatoform Disorder
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These disorders are characterized by repeated

presentation with physical symptoms which do not
have any physical basis, and a persistent request for
investigations and treatment despite repeated
assurance by the treating doctors.
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Somatization Disorder
 Definition ( 1/1)
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Somatization disorder is characterized by chronic

multiple somatic symptoms in the absence of
physical disorder.

 The symptoms are vague, presented in a dramatic

manner and involve multiple organ systems.
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 ICD 10 Diagnostic criteria (1/1)
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A definite diagnosis requires the presence of all of the following:  

At least 2 years of multiple and variable physical symptoms
for which no adequate physical explanation has been found
 
 Persistent refusal to accept the advice or reassurance of
several doctors that there is no physical explanation for the
symptoms
 
 Some degree of impairment of social and family functioning
attributable to the nature of the symptoms and resulting
behaviour.
 DSM IV Diagnostic criteria ( 1/6)
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A. A history of many physical complaints beginning

before age 30 years that occur over a period of
several years and result in treatment being sought or
significant impairment in social, occupational, or
other important areas of functioning.
 DSM IV Diagnostic criteria ( 2/6)
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B. Each of the following criteria must have been met,

with individual symptoms occurring at any time
during the course of the disturbance:
1) Four pain symptoms:
A history of pain related to at least four different
sites or functions.
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 DSM IV Diagnostic criteria ( 3/6)
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2) Two gastrointestinal symptoms:

A history of at least two gastrointestinal symptoms

other than pain.
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 DSM IV Diagnostic criteria ( 4/6)
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3)One sexual symptom:

A history of at least one sexual or reproductive

symptom other than pain.
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 DSM IV Diagnostic criteria ( 5/7)
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4) One pseudoneurological symptom:

A history of at least one symptom or deficit

suggesting a neurological condition not limited to
pain
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 DSM IV Diagnostic criteria ( 6/7)
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C. Either (1) or (2):

1) After appropriate investigation, each of the
symptoms in Criterion B cannot be fully
explained by a known general medical
condition or the direct effects of a substance
(e.g., a drug of abuse, a medication)
 DSM IV Diagnostic criteria ( 7/7)
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2) When there is a related general medical condition,

the physical complaints or resulting social or
occupational impairment are in excess of what
would be expected from the history, physical
examination, or laboratory findings

D. The symptoms are not intentionally feigned or

produced
 Treatment ( 1/2)
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1. Supportive psychotherapy: The treatment of

choice
2. Behaviour modification
3. Relaxation therapy, with graded physical exercises
4. Drug therapy: Antidepressants and/or
benzodiazepines can be given on a short-term
basis for associated depression and/or anxiety.
 Treatment ( 2/2)
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All classes of anti depressant are to be effective

against somatoform and related disorders.
* SNRIs such as venlafaxine ,duloxetine more effective
when pain is the predominant symptom
 
 Benzodiazepines should be used with great caution,
as the risk of dependence and misuse is high in these
patients
 Nursing management (1/7)
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Nursing assessment :

History. Clients usually provide a lengthy and

detailed account of previous physical problems,
numerous diagnostic tests, and perhaps even a
number of surgical procedures.
General appearance and motor
behavior. Often, clients walk slowly or with an
unusual gait because of the pain or disability caused
by the symptoms
 Nursing management (2/7)
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Mood and affect. Mood is often labile, shifting

from seeming depressed and sad when describing
physical problems to looking bright and excited
when talking other
Assess the site and location of pain patient
complaining off
Assess the pseudoneurological symptoms like :
paralysis ,hallucination ,localized weakness.
 Nursing management (3/7)
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Nursing diagnosis :
Chronic pain related to severe level of anxiety,
repressed.
Ineffective coping related to inadequate coping
skills.
Self-care deficit related to pain, discomfort.
Deficient knowledge related to lack of interest in
learning, severe anxiety
 Nursing management (4/7)
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Nursing Management :

Develop trusting relationship

 The nurse must help the client establish a daily

routine that includes improved health behaviors.

Assisting the client to express emotions. Clients may

keep a detailed journal of their physical symptoms;
the nurse might ask them to describe the situation .
 Nursing management (5/7)
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Teaching coping strategies

- Emotion-focused strategies include progressive
relaxation, deep breathing, guided imagery, and
distractions such as music or other activities

Don’t repeatedly convince the patient that the

problem is entirely psychological
 Nursing management (6/7)
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Be supportive, and talk with patient while providing

physical care

Encourage physical activity ,Diet

counseling/balanced meals: Decrease caffeine,
alcohol, or drugs Utilize and healthy sleep strategies

Assist with ADLs as needed

 Nursing management (7/7)
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Provide symptomatic measures such as pain relief or

digestives; allow measures from complementary
medicine according to patient's wishes; explain that
these measures are temporarily helpful but less
effective than self-management.
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Assignment: write the difference between

somatization disorder and conversion disorder .
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 Reference ( 1/2)
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CowenP.Harrison P.Burns T.Shorter Oxford

Textbook of psychiatry.7th edition.Great Claredon
Street,Oxford,OX26DP,UK:Oxford University
Press;2018
Sreevani R.A guide to mental health and psychiatric
nursing .3rd Edition.delhi,India: Jaypee Brothers
medical publishers(p) LTD:2010
Ahuja N.A short textbook of psychiatric7th
edition.Delhi,India: Jaypee Brothers medical
publishers(p) Ltd;2011
 Reference ( 2/2)
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Marianne Belleza, R.N.somatoform disorder.11th feb

2021.Available from :
https://nurseslabs.com/somatoform-disorders/

Peter Henningsen Department of Psychosomatic

Medicine and Psychotherapy, University Hospital,
Technical University of Munich, GermanyDepartment of
Psychosomatic Medicine and Psychotherapy, University
Hospital, Technical University of Munich, Germany.
Dialogues Clin Neurosci. 2018 Mar .Available from :
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC60160
49/