SOMATOFORM DISORDERS  pain in the abdomen, head, joints, back, chest,

rectum,
 The term psychosomatic began to use to convey  pain during urination, menstruation, or sexual
the connection between the mind (psyche) and the intercourse.
body (soma) in states of health and illness. b. GASTROINTESTINAL SYMPTOMS:
 The term hysteria refers to multiple physical  nausea,
complaints with no organic basis: the complaints  bloating,
ae usually described dramatically. The concept of  vomiting (other than during pregnancy),
hysteria probably originated in Egypt is about  diarrhea, or
4,000 years old.  intolerance of several foods.
 Paul Briquet and Jean Martin Charcot, identified c. SEXUAL SYMPTOMS:
hysteria as a disorder of the nervous system.  sexual indifference,
 Somatization is defined as the transference of  erectile or ejaculatory dysfunction,
mental experiences and states into bodily  irregular menses,
symptoms.  excessive menstrual bleeding,
 Somatoform disorders can be characterized as the  vomiting throughout pregnancy.
presence of physical symptoms that suggests a d. PSEUDONEUROLOGIC SYMPTOMS:
medical condition without a demonstrable organic  conversion symptoms such as impaired
basis to account fully for them. The three central coordination or balance,
features of somatoform disorders are as follows:  paralysis or localized weakness,
1. Physical complaints suggest major medical  difficult swallowing or lump in throat,
illness but have no demonstrable organic basis.  aphonia,
2. Psychological factors and conflicts seem  urinary retention,
important in initiating, exacerbating, and  hallucinations,
maintaining the symptoms.  loss of touch or pain sensation,
3. Symptoms or magnified health concerns are  double vision,
not under the client’s conscious control  blindness,
(Hollified, 2015).  deafness,
 seizures;
FIVE SPECIFIC SOMATOFORM DISORDER  dissociative symptoms such as amnesia; or loss of
consciousness other than fainting.
1. SOMATIZATION DISORDER is characterized by
multiple physical symptoms. It begins by 30 years ONSET AND CLINICAL COURSE
of age, extends over several years, and includes a
combination of pain and gastrointestinal, sexual, 1. SOMATIZATION DISORDER
and pseudo-neurologic symptoms. Often experience symptoms in adolescence,
2. CONVERSION DISORDER, sometimes called although these diagnoses may not be made until early
conversion reaction, involves unexplained, usually adulthood (about 25 years of age).
sudden deficits in sensory or motor function (e.g., 2. CONVERSION DISORDER. Usually occurs
blindness, paralysis). between 10 and 35 years of age.
3. PAIN DISORDER has the primary physical 3. PAIN DISORDER. Can occur at any age.
symptoms of pain, which generally is unrelieved by 4. HYPOCHONDRIASIS. Can occur at any age.
analgesics and greatly affected by psychologic
factors in term of onset, severity, exacerbation, ASSOCIATED FEATURES/CHARACTERISTICS
and maintenance.  Stories are often vague, inconsistent, colorful and
4. HYPOCHONDRIASIS dramatic
5. BODY DYSMORPHIC DISORDER  Frequently seek care from multiple providers with
repeated work-ups
DSM-IV DIAGNOSTIC CRITERIA: SYMPTOM OF  High comorbidity with personality disorders
SOMATIZATION DISORDER (especially histrionic)
a. PAIN SYMPTOMS  More common in women
 complaints of headache  Chronic and fluctuating course
 One or more symptoms affecting voluntary motor Occurs when a person intentionally produces or feigns
or sensory function physical or psychologic symptoms solely to gain
 Resembles neurological or medical disease
 Psychological factors must be involved attention. The common term for factitious disorder is
 The symptoms are not intentionally produced MUNCHAUSEN SYNDROME.

CAUSES MUNCHAUSEN SYNDROME

Munchausen syndrome by proxy, occurs when a
 Familial history of illness
person inflicts illness or injury on someone else to gain
 Relation with antisocial personality disorder
the attention of emergency medical personnel or to be
 Weak behavioral inhibition system
a “hero” for saving the victim.

 Somatization disorder and conversion disorder BODY IDENTITY INTEGRITY DISORDER (BIID)
most likely seek help from mental health Is the term given to people who feel alienated from a
professionals part of their body and desire amputation. This
 Hypochondriasis, pain disorder and body condition is also known as amputee identity disorder
dysmorphic disorder unlikely to receive treatment and apotemnophilia or “amputation love.”
in mental health settings unless they have a
BIID is not an officially accepted Diagnostic and
comorbid condition.
Statistical Manual of Mental Disorders, fourth edition,
 Somatoform disorders tend to go from one
text revision (DSM-IV-TR) diagnosis, and there is
physician or clinic to another.
disagreement about the existence of the condition.
PREVENTION
ETIOLOGY
 Although there is no way to prevent this disorder,
PSYCHOSOCIAL THEORIES
a correct diagnosis of somatic symptom disorder
can help the person avoid excessive medical  Psychosocial theorists believe that people with
testing. somatoform disorders keep stress, anxiety, or
frustration inside (called Internalization) and
TREATMENT
express it through physical symptoms
 People with somatic symptom disorder may find it (somatization).
difficult to accept a referral to a mental health  Internalization and somatization are unconscious
professional. But mental health treatment can defense mechanisms, and people with somatoform
sometimes reduce symptoms or improve quality of disorders do not readily and directly express their
life. feelings and emotions verbally. They have difficulty
dealing with interpersonal conflict.
PROGNOSIS
 Boys in the United States are taught to be stoic and
 Medications may provide some relief. to “take it like a man,” causing them to offer fewer
physical complaints as adults.
When to call a professional  Women seek medical treatment more often than
 The earlier a person with somatic symptom men, and it is more socially acceptable for them to
disorder can be evaluated by a mental health do so.
professional, the easier it will be to help the person  Childhood sexual abuse, which is related to
deal with the consequences of the disorder. somatization, happens more frequently to girls.
 Women more often receive treatment for
RELATED DISORDER psychiatric disorders with strong somatic
components such as depression.
MALINGERING
Is the intentional production of false or grossly
BIOLOGIC THEORIES
exaggerated physical or psychologic symptoms; it is
 Research has shown differences in the way that
motivated by external incentives such as avoiding
clients with somatoform disorders regulate and
work, evading criminal prosecution, obtaining financial
interpret stimuli. These clients cannot sort relevant
compensation, or obtaining drugs.
from irrelevant stimuli and respond equally to both
FACTITIOUS DISORDER types.
 Somatization disorder is found in 10% to 20% of hands and feet and the nondelusional sensation of
female first-degree relatives of people with this worms in the head or ants under the skin.
disorder.
 Symptoms related to male reproduction are more
 Conversion symptoms are found more often in
common in some countries or cultures—for
relatives of people with conversion disorder.
example, men in India often have that, which is a
 First-degree relatives of those with pain disorder
hypochondriacal concern about loss of semen.
are more likely to have depressive disorders,
alcohol dependence, and chronic pain (APA, 2000).  Somatization disorder is rare in men in the United
States but more common in Greece and Puerto
CULTURAL CONSIDERATIONS
Rico.
 Pseudo neurologic symptoms of somatization
disorder in Africa and South Asia include burning

CULTURAL CONSIDERATIONS

Many culture-bound syndromes have corresponding somatic symptoms not explained by a medical condition
(Table 19.1).

SYNDROME CULTURE CHARACTERISTICS

Dhat India Hypochondriacal concern about semen loss.

Koro Southeast Asia Belief that penis is shrinking and will disappear
into abdomen, resulting in death.

Falling-out episodes Southern United States, Sudden Collapse; person cannot see or move
Caribbean islands

Hwa-byung Korea Suppressed anger causes insomnia, fatigue, panic,

indigestion, and generalized aches and pains.

Sangue dormido Portuguese Cape Verde Pain, numbness, tremors, paralysis, miscarriage.
(sleeping blood) islands

Shenjing shuariuo China Physical and mental fatigue, dizziness, headache,

pain

APPLICATION OF NURSING PROCESS develop a physical condition that would require

medical attention.
ASSESSMENT

When a client has been diagnosed with a

somatoform disorder, it is important not to dismiss all
future complaints because at any time the client could

HISTORY

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!”
GENERAL APPEARANCE AND MOTOR BEHAVIOR  Clients often lose jobs due to absenteeism or the
inability to perform work, may voluntarily quit
 Often, clients walk slowly or with an unusual gait
working due to poor physical health, and may
because of the pain or disability caused by the
decline to see friends or go out socially due to the
symptoms. They may exhibit a facial expression of
fear of becoming ill away from home. Life with
discomfort or physical distress.
family is frequently chaotic and unpredictable.
 They brighten and look much better as the
assessment interview begins because they have PHYSIOLOGIC AND SELF-CARE CONCERNS
the nurse’s undivided attention.
 Clients who somatize often have sleep pattern
 Clients with somatization disorder usually describe
disturbances, lack basic nutrition, and get no
their complaints in colorful, exaggerated terms but
exercise. In addition, they may be taking multiple
often lack specific information.
prescriptions for pain or other complaints.
MOOD AND AFFECT
DATA ANALYSIS
 Mood is often labile, shifting from seeming
Based on the assessment data, the nursing
depressed and sad when describing physical
diagnoses commonly used when working with clients
problems to looking bright and excited when
who somatize include the following:
talking about how they had to go to the hospital in
the middle of the night by ambulance.  Chronic pain related to severe level of anxiety,
repressed.
THOUGHT PROCESS AND CONTENT
 Ineffective coping related to inadequate coping
 Clients who somatize do not experience disordered skills.
thought processes. The content of their thinking is  Disturbed body image related to low self-esteem,
primarily about often exaggerated physical severe level of anxiety.
concerns.  Disturbed sensory perception related to regression
to, or fixation in, an earlier level of development.
Example: when they have a simple cold, they may be
 Self-care deficit related to paralysis of body part,
convinced it is pneumonia. They may even talk about
pain, discomfort.
dying and what music they want played at their
 Deficient knowledge related to lack of interest in
funeral.
learning, severe anxiety.
SENSORIUM AND INTELLECTUAL PROCESSES

 Clients are alert and oriented. Intellectual OUTCOME IDENTIFICATION

functions are unimpaired.
Treatment outcomes for clients with a somatoform
JUDGMENT AND INSIGHT disorder may include the following:
 The client will identify the relationship between
 Exaggerated responses to their physical health may stress and physical symptoms.
affect clients’ judgment. They have little or no  The client will verbally express emotional feelings.
insight into their behavior. They are firmly  The client will follow an established daily routine.
convinced their problem is entirely physical and
often believe that others don’t understand. OUTCOME IDENTIFICATION
SELF-CONCEPT 1. The client will demonstrate alternative ways to
deal with stress, anxiety, and other feelings.
 Clients focus only on the physical part of 2. The client will demonstrate healthier behaviors
themselves. They lack confidence, have little regarding rest, activity, and nutritional intake. The
success in work situations, and have difficulty client will establish adequate nutritional eating
managing daily life issues, which they relate solely patterns.
to their physical status.

ROLES AND RELATIONSHIPS INTERVENTIONS

1. Providing Health Teaching
2. Assisting the Client to Express Emotions
3. Teaching Coping Strategies
EVALUATION AND COMMUNITY BASED-CARE
1. PROVIDING HEALTH TEACHING
The nurse must help the client learn how to EVALUATION
establish a daily routine that includes improved health  Somatoform disorders are chronic or recurrent so
behaviors. changes are likely to occur slowly. IF treatment is
effective, the client should make fewer visits to
physicians as result of physical complaints.
 Use less medication and more positive coping
techniques, increase functional activities. Improve
family and social relationships.

COMMUNITY-BASED CARE
1. Building a trusting relationship with the clients
2. Providing empathy and support
3. Being sensitive rather than dismissive of
complaints
4. Making appropriate referrals
5. Providing information about support groups in the
community
6. Encouraging clients to find pleasurable activities or
hobbies
2. ASSISTING THE CLIENT TO EXPRESS
EMOTIONS MENTAL HEALTH PROMOTION
Teaching about the relationship between
stress and physical symptoms is a useful way to help  A common theme in somatoform disorders is their
clients begin to see the mind–body relationship. occurrence in people who do not express conflicts,
stress, and emotions verbally. T
3. TEACHING COPING STRATEGIES  hey express themselves through physical
Two categories of coping strategies are symptoms; the resulting attention and focus on
important for clients to learn and to practice: their physical ailments somewhat meet their
a. emotion-focused coping strategies, which needs. As these clients are better able to express
help clients relax and reduce feelings of their emotions and needs directly, physical
stress, and symptoms subside.
b. problem-focused coping strategies, which  SOMATOFORM DISORDERS. have declined over
help to resolve or change a client’s the past few decades, in part due to increased
behavior or situation or manage life knowledge of the public, increasing self-awareness
stressors. or self-knowledge, and scientific evidence of mind–
body interaction

SELF-AWARENESS ISSUES

 Clients who cope through physical symptoms can

be frustrating for the nurse. Initially, they are
unwilling to consider that anything other than
major physical illness is the root of all their
problems.
 When health professionals tell clients there is no
physical illness and refer them to mental health
professionals, the response often is anger: Clients
may express anger directly or passively at the
medical community and be highly critical of the
inadequate care they believe they have received.
 The nurse must not respond with anger to such  Internalization and somatization are the chief
outbursts or criticism. defense mechanisms seen in somatoform
disorders.
POINTS TO CONSIDER WHEN WORKING WITH CLIENTS
 Clients with somatization disorder and conversion
WITH SOMATOFORM DISORDERS
reactions eventually may be treated in mental
 Carefully assess the client’s physical complaints. health settings. Clients with other somatoform
Even when a client has a history of a somatoform disorders typically are seen in medical settings.
disorder, the nurse must not dismiss physical  Clients who cope with stress through somatizing
complaints or assume they are psychologic. The are reluctant or unable to identify emotional
client actually may have a medical condition. feelings and interpersonal issues and have few
coping abilities unrelated to physical symptoms.
 Validate the client’s feelings while trying to engage  Nursing interventions that may be effective with
him or her in treatment; for example, use a clients who somatize involve providing health
reflective yet engaging comment such as “I know teaching, identifying emotional feelings and stress,
you’re not feeling well, but it is important to get and using alternative coping strategies.
some exercise each day.”  Coping strategies that are helpful to clients with
 Remember that the somatic complaints are not somatoform disorders include relaxation
under the client’s voluntary control. The client will techniques such as guided imagery and deep
have fewer somatic complaints when he or she breathing, distractions such as music, and
improves coping skills and interpersonal problem-solving strategies such as identifying
relationship. stressful situations, learning new methods of
managing them, and role-playing social
KEY POINTS interactions.
 Somatization means transforming mental  Clients with somatization disorder actually
experiences and states into bodily symptoms. experience symptoms and the associated
 The three central features of somatoform discomfort and pain. The nurse should never try to
disorders are physical complaints that suggest confront the client about the origin of these
major medical illness but have no demonstrable symptoms until the client has learned other coping
organic basis; psychologic factors and conflicts strategies.
that seem important in initiating, exacerbating,  Somatoform disorders are chronic or recurrent, so
and maintaining the symptoms; and symptoms or progress toward treatment outcomes can be slow
magnified health concerns that are not under the and difficult
client’s conscious control.
 Somatoform disorders include somatization
disorder, conversion disorder, hypochondriasis,
pain disorder, and body dysmorphic disorder.
 Malingering means feigning physical symptoms for
some external gain such as avoiding work.
 Factitious disorders are characterized by physical
symptoms that are feigned or inflicted for the sole
purpose of drawing attention to oneself and
gaining the emotional benefits of assuming the sick
role.