Somatoform Disorders

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Somatoform Disorders

• Adrianne Maltese, MN,GCNS-BC

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Somatoform Disorders

• Three central features of Somatoform Disorders
• Physical complaints without organic basis
• Psychological factors and conflicts seem
  important in initiating, exacerbating, and
  maintaining the symptoms
• Symptoms or magnified health concerns are not
  under conscious control(Guggenheim2000)

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Five Somatoform disorders

• Somatization disorder
• C/b multiple recurrent physical complaints over
  many years
• No organic etiology for these complaints
• Begins by age 30
• Pain, GI, sexual, pseudoneurologic symptoms
  impaired coordination or balance,paralysis or
  localized weakness,difficulty swallowing,
  aphonia, urinary retention,hallucinations, loss
  of touch or pain sensation,double
  vision,amnesia,sensory losses,loss of
  consciousness (APA 2000 DSM IV-TR)

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Interventions for somatization

• Be aware of own responses
• Rule out organic basis for complaints
• Focus on anxiety reduction, mot physical symptoms
• Minimize secondary gain(I.e. increased attention
  and decreased responsibilities)

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Intervention conversion d/o

• Focus on anxiety reduction, not physical symptoms
• Use matter-of-fact approach
• Encourage client to discuss conflict
• Minimize secondary gains
• Provide diversionary activities
• Encourage expression of feelings

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Pain Disorder

• C/b physical symptom of pain-one or more anatomic
  sites
• May occur with a General medical condition
• Pain not relieved by analgesics
• Onset,severity, exacerbation and maintenance
  affected by psychological stressors

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Pain d/o interventions

• Pain management
• Encourage participation in activities
• Provide distractions

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Hypochondriasis

• Client is preoccupied with fear that he/she has
  or will get a serious disease
• History of seeing many doctors
• Misinterpretation of bodily sensations or
  functions despite medical evaluations and
  reassurance
• Preoccupation with symptoms is not as intense or
  distorted as in delusional disorder
• Significant distress/impairment in function
• Dependent behaviors/desires,demands attention

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Hypochondriasis interventions

• Rule out presence of actual disease
• Focus on anxiety, not physical symptoms
• Provide diversionary activities
• Avoid negative responses to client
  demands/conference with staff
• Provide client with correct information

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Body Dysmorphic Disorder

• Preoccupation with imagined or exaggerated
  defects in physical appearance
• Causes clinically significant stressor impairment
  in social or occupational function person may
  undergo repeated plastic surgeries for nose
  repair or to change face etc.

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Dissociative Disorders

• DISSOCIATIVE AMNESIA
• One or more episodes of inability to recall
  personal information
• Information is usually of a traumatic or
  stressful nature
• Not due to effects of substance abuse

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Dissociative Fugue

• C/b sudden unexpected travel away from home or
  work
• Unable to recall past(or where on has been)
• Confused about personal identity/ or assumes new
  identity

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Dissociative Identity Disorder

• Individual demonstrates two or more distinct
  identities or personality states
• Each personality is distinct
• At least two of these personality states take
  control of the individuals behavior.
• Unable to recall extensive personal information