Somatoform And Dissociative Disorders

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4 Etiologies of Somatoform and Dissociative Disorders

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1.Psychoanalytic
2.Biologic
3.Behavioral
4.Cognitive

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Psychoanalytic Etiology

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suggest complaints of pain/disease/loss of function are related to aggression or sexuality

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Biologic Etiology

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change in struc/func of brain b/c of stress or trauma-alter person's perception of bodily functions

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Behavioral Etiology

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learn to use somatic symptoms to comm. helplessness and manipulate others

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Cognitive Etiology

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clients misinterpret the meaning of body functions/sensations and become overly concerned

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Somatoform Disorders

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-somatization disorder
-pain disorder
-conversion disorder
-hypochondriasis
-body dysmorphic disorder (BDD)

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Somatization Disorder

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-formerly hysteria
-treated multiple times for somatic complaints
-symptoms MUST begin before 30, not related to substance and are not able to be explained
-multiple organ systems involv
-clinical labs are normal, chronic course w/out devt of phys. signs or struct abnorm

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Pain Disorder

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-pain in one or more anatomic site
-pain severity calls for clinical attention and 1 or more sign. funct. impairment
-psychological factors play role:onset, sever. mnt of pain
*Acute: <6months
*Chronic: >6months

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Conversion Disorder

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-1 or more symptoms of deficits in voluntary motor or sensory function
-cause sign. distress or impair socially, occupational, etc.

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Hypochondriasis (6 criteria)

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1.ind. focuses on fears of SERIOUS medical conditions based on misinterpreted symptoms
2.misinterpretation of sympt continues against medical eval.
3.proccupation isn't as intense as a delusion or BDD
4.preoccupation causes sign. impairment everyday
5.duration of interference at least 6 months
6.not due to another anxiety or major depressive disorder

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Body Dysmorphic Disorder (BDD)

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-preoccupied with imagined defect or slight physical anomaly
-concern is excessive
-clinical distress
-social, occupational functioning suffers
-begins in adolescence
-high risk for suicide

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Dissociative Dissorders

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-dissociative amnesia
-dissociative fugue
-dissociative identity disorder (DID)
-depersonalization disorder

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Dissociative Amnesia

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-defining sypt. is inability to recall personal info. more than once
-usually b/c of stress or trauma

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Dissociative Fugue

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-sudden travel from home w/out being able to remember past
-confusion about personal identity or assumes a new one *(sometimes filling in the blanks)

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Dissociative Identity Disorder (DID)

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-exhibit 2 or more distinct identities/personality states
-the identities are VERY different
-at least 2 of the personalities take control of persons behavior often

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Depersonalization Disorder

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-persistent or recurring episodes of feelings of detachment or estrangement from themselves
-feeling of being "outside of your body"

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Nursing Interventions for Somatoform and Dissociative Disorders

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1.identify degree of suicidal ideation and/or depression
2.assess own level of anxiety-remain calm
3.recognize client's use of relief behaviors-focus on somatic sensations (anxiety)
4.express importance of limit to:caffeine, nicotine, CNS stimulants
5.teach client to distinguish b/w somatic sensations that are attached and compl. separ.
6.instruct client:reduce strategies and distract focus
7.aid client w/coping skills
8.client ID support people
9.aid in gaining control
10.aid in understanding imp. of medication

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Pharmacologic Interverntions for Somatoform and Dissociative Disorders

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-SSRI widely used, particularly with BDD

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Cognitive Behavioral Therapy

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-widely used to treat somatoform and dissociative disorders