Somatoform disorders (psychophysical problems)

PREPARED & PRESENTED
BY
RICHARD OPOKU ASARE
M.ED (health education), B.Ed (Hons) (Health Sciences), RN
(Dip)-RMN, Cert. Ed
29-Mar-13asareor@yahoo.com ©20131
SOMATOFORM DISORDERS
(PSYCHOPHYSICAL
PROBLEMS)

OUTLINE PRESENTATION
INTRODUCTION
CHARACTERISTICS
CLASSIFICATION
a. Somatization disorder
b. Conversion
c. Hypochondriasis
d. Body dysmorphic disorder
e. Pain disorder
MALINGERING
FACTITIOUS
NURSING INTERVENTIONS

INTRODUCTION
Soma means “body,” and somatoform disorders involve
patterns in which individuals complain of body
symptoms that suggest the presence of physical
problems, but for which no organic basis can be found
that satisfactorily explains the symptoms.
That is, somatoform disorders are characterized by
persistent requests for medical attention because of
physical complaints that cannot be sufficiently explained
by medical causes.

INTRODUCTION – Cont’d
The symptoms are associated with
psychological stressors but are not
intentionally produced.
Somatoform disorders probably occur
through some mechanism that allows
unconscious conflict to manifest as physical
symptoms.

CHARACTERISTICS
The somatoform disorders are characterized by:
1.Physical symptoms without medical cause;
2.Symptoms are not intentionally produced;
3.Psychological factors are associated with
symptoms; and
4.Persistent requests for medical attention.
5.Identity disturbance
6.Perceptual disturbance, e.g., depersonalisation,
derealisation

CLASSIFICATION
There are five (5) somatoform disorders:
1.Somatization Disorder
2.Conversion (hysteria)
3.Hypochondriasis
4.Body Dysmorphic Disorder
5.Somatoform Pain disorder

Somatization Disorder
Historically referred to as Briquette’s syndrome, or
hysteria.
It is a syndrome of multiple symptoms where anxiety is
translated into physical illness or bodily complaints by the
client without sufficient medical cause and is associated with
psychosocial distress, and long term seeking of medical
treatment from healthcare professionals at the same time.
It begins before 30 years of age, sometimes as early as
adolescence or childhood.

Symptoms of Somatization
Disorder
It is characterized by the following symptoms:
a.Four pain symptoms – e.g., abdomen, head, back,
joints, extremities, chest, rectum, menstruation, sexual
intercourse, or during urination.
b.Two gastrointestinal symptoms – e.g., nausea,
vomiting, bloating, diarrhoea, or intolerance of several
different foods.

Symptoms of Somatization Disorder –
cont’d
c. One sexual symptom – e.g., irregular menses,
excessive menstrual bleeding, erectile or ejaculatory
dysfunction, sexual indifference, vomiting throughout
pregnancy.
d. One neurological symptom – e.g., paralysis, localized
weakness, lump in throat, difficulty swallowing, aphonia,
urinary retention, hallucinations, pain sensation or loss of
touch, double vision, blindness, deafness, seizures, loss
of consciousness, or amnesia.

Differentiating Somatization Disorder
from Medical Problem
Three features may help health professionals to
differentiate a somatization disorder from a medical
problem:
1.The involvement of multiple organ systems;
2.The disorder is characterized by an early onset and chronic
condition in which no physical changes occur over time;
and
3.The absence of any significant laboratory values indicates
that the underlying problems may be emotionally based.

Treatment of Somatization
Disorder
Psychotherapy
Relaxation techniques
Hypnosis
Antianxiety drugs
Antidepressants
Regular physical examination

Conversion Disorder
This is a loss of or change in body function resulting from
a psychological conflict, the physical symptoms of which
cannot be explained by any known medical disorder or
pathophysiological mechanism.
It is characterized by neurological symptoms that usually
involve sensory or voluntary motor functioning such as
functional blindness or paralysis.
Patients are unaware of the psychological basis and are
therefore unable to control their symptoms.

Conversion Disorder – Cont’d
Symptom usually occurs after a situation that produces
extreme psychological stress for the individual.
It appears suddenly, and often the person expresses a
relative lack of concern for the impairment.
This lack of concern is identified as la belle
indifference.
The symptom promotes secondary gain as a way to
obtain attention or support that might not otherwise be
forthcoming.

Conversion Disorder – Cont’d
Thus, Conversion disorder is a somatoform
disorder in which an intrapsychic conflict
or anxiety provoking impulse is
unconsciously converted into physiological
or somatic signs and symptoms

Causes – Conversion
Disorder Cont’d
Anxiety
Depression
Personality disorder, e.g.,
borderline, antisocial
Hereditary

Risk Factors – Conversion Disorder
Conversion disorder risk factors include:
Recent significant stress or emotional trauma
Being female — women are much more likely to get conversion
disorder
Being an adolescent or young adult — conversion disorder can
occur at any age, but it’s most common during adolescence or
early adulthood
Having a mental health condition, such as mood and anxiety
disorders, dissociative disorder and certain personality disorders
Having a family member with conversion disorder
A history of physical or sexual abuse
Financial problems

Symptoms– Conversion Disorder
Common symptoms can include:
Poor coordination or balance (Ataxia)
Paralysis in an arm or leg
Difficulty swallowing or “a lump in the throat”/Globus
hystericus
Inability to speak (Aphonia/Mutism)
Vision problems, including double vision and blindness
Deafness
Seizures or convulsions, i.e., hysterical fits
Loss of smell (Anosmia)

Symptoms– Conversion Disorder
(cont’d)
Other conversion disorder symptoms include:
Loss of balance
Numbness or loss of the touch sensation (Tingling)
Inability to feel pain (Anaesthesia/Paraesthesia)
Hallucinations
Difficulty with walking (Akinesia-loss of muscle tone)
Urinary retention
Tremors
Pseudocyesis
diarrhoea/constipation/profuse sweating

Differential Diagnosis – Conversion
Disorder
Myasthenia gravis — a muscle weakness disorder
Guillain-Barre syndrome — an uncommon disorder in
which your body’s immune system attacks your nerves
Neurological disorders, such as multiple sclerosis,
Parkinson’s disease and epilepsy
Stroke
Lupus
Spinal cord injury
HIV/AIDS

Treatment - Conversion
Disorder
Psychotherapy
Cognitive-Behavioural Therapy (CBT)
Biofeedback techniques
Hypnosis
Antidepressants

Hypochondriasis
This is defined as a person’s preoccupation with the fear of
contracting, or the belief of having, a serious disease that no
medical cause serves as a basis for the disease onset.
The individual always and constantly keep thinking of and
believes of having a serious disease.
The fear becomes disabling and persists despite the
appropriate reassurance that no medical cause has been
detected.
The fear is based on a misinterpretation or inaccurate
interpretation of the client’s physical symptoms.

Hypochondriasis – Cont’d
Symptoms occur for at least six (6) months to
convince patients that they have a disease.
Transient state of hypochondriasis may exist
following a true illness or the death of a loved one.
They often have a long history of “doctor
shopping” who move from one doctor to
another for the same examinations and treatment,
because they are convinced that they are not
receiving proper treatment.

Hypochondriasis – Cont’d
They reject, and often irritated by the idea that
stress or psychosocial factors play a role in their
condition. Even reading or hearing that someone
they know has been diagnosed with an illness
precipitates alarm on their part.
It is associated with depressive or anxiety disorder.
It equally affects men and women, and one’s
socioeconomic status is not a factor.

Precipitating Factors –
Hypochondriasis
Disease outbreaks
Anxiety
Depression
Media, e.g., adverts of serious
illness
Genetic

Treatment – Hypochondriasis
Psychotherapy
Hypnosis
Antidepressants, e.g., SSRIs
Regular physical examination

Body Dysmorphic Disorder
Formerly called dysmorphophobia, is characterized
by the exaggerated belief that the body is deformed or
defective in some specific way.
The most common complaints involve imagined or
slight flaws of the face or head, such as thinning hair,
acne, wrinkles, scars, vascular markings, facial swelling
or asymmetry, or excessive facial hair.
Other complaints may have to do with some aspect of
the nose, ears, eyes, mouth, lips, or teeth.

Body Dysmorphic Disorder – Cont’d
The distress may be so severe that client refuses to leave the
house, avoid work, social or public gatherings for fear of
being ridiculed.
The client’s social, occupational, or other important areas
of functioning are impaired as a result of the anxiety
associated with the imagined body defect.
His or her medical history may reflect numerous visits to
plastic surgeons and dermatologists for correction of the
imagined defect.
He or she may undergo unnecessary surgical procedures
towards this effort.

Aetiology – Body Dysmorphic
Disorder
The actual cause is unknown
Serotonin dysregulation in the brain
Endorphin deficiency
Schizophrenia
Family history of major mood or anxiety
disorders, such as depression or obsessive-
compulsive disorder

Treatment – Body Dysmorphic
Disorder
Psychotherapy
Antidepressants, e.g., SSRIs
Cosmetic treatment, such as dental,
surgical, or dermatological repairs.

Somatoform Pain Disorder
Somatoform Pain Disorder is a severe and
prolonged pain that causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning that cannot be fully explained
by medical condition.

Diagnostic Criteria for Pain
Disorder
Pain in one or more body sites is the predominant
focus of the clinical presentation and is of sufficient
severity to warrant clinical attention.
The pain causes clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
Psychological factors are judged to have an important
role in the onset, severity, intensity, or maintenance of the
pain.
The symptom is not intentionally produced or
feigned

Aetiology – Pain Disorder
Endorphin deficiency has
been implicated as one of the
causes of pain disorder.
Psychological factors

Treatment – Pain Disorder
Psychotherapy
Biofeedback training
Antidepressant medication, e.g., Amitriptyline
(Elavil)
NB: Analgesics may not be useful to reduce the
pain, and for that matter their use is ineffective.

Malingering and factitious disorders differ from
somatoform disorders in that signs and symptoms
are intentionally (deliberately) produced or feigned.
Both psychological and physical signs and symptoms
are expressed by individuals who fake illnesses.
asareor@yahoo.com ©201334
MALINGERING & FACTITIOUS
DISORDERS
29-Mar-13

MALINGERING
People who are malingering willfully produce the
symptoms of a physical illness for some form of
external or secondary gain to meet a recognizable goal.
That is, the symptoms are produce to satisfy an
external motivation.
The goal, however, in malingering is often to avoid
difficulties or dangerous situations, responsibilities,
punishment, or perhaps the police; or to receive
compensation, free room and board, or a source of
drug.

MALINGERING
For instance, a student who fakes a stomachache to be excused
from school duties is a common example of malingering.
Some security officers may produce symptoms of a serious
physical illness to the extent of being hospitalized just to avoid
being assigned to dangerous missions.
Another possible motivation is retaliation (e.g., for guilt,
financial loss, legal penalty, job loss).
However, once people get to know their motive, symptoms
usually disappear because they no longer serve a purpose.

MALINGERING
Symptoms such as low-back pain, headache, neck pain, vague
abdominal or chest pain, dizziness, amnesia, and anxiety are
typically complaint about because they are difficult to disprove.
Patients are more interested in compensation, avoidance of
responsibility, or drugs than a cure and may become angry if
given a clean bill of health.
In an inpatient setting, symptoms may wax and wane depending
on whether or not the patient is being observed (Brochert,
2002).

FACTITIOUS DISORDER
Factitious disorder, also called Munchausen’s
syndrome, is the deliberate production of signs
and symptoms of a physical illness in another
person just to assume the sick role.
In other words, factitious occurs when a person
pretends to be ill in order to assume the sick role.

FACTITIOUS DISORDER
Persons with factitious disorders may take medications to
produce dramatic side effects or pretend to have seizure
with no actual history of epilepsy.
These individuals may give dramatic and colourful
medical history; but when probed and questioned
further, they are inconsistent with their complaints.
It is slightly common in males.
The aetiology may be related to childhood abuse,
childhood hospitalisation, and/or rejecting parents.

FACTITIOUS DISORDER
The hallmark of this disorder is that the individual’s only goal in
faking illness is to assume the role of a patient (i.e., the sick
role).
There is no financial or other secondary gain (e.g., disability,
time off from work, avoiding jail), which if present would
change the diagnosis to malingering.
Patients often have a history of repeated visits to different
hospitals or clinicians in different areas, to avoid detection.
Some patients may also undergo painful procedures and even
major surgery.
Affected individuals often have normal intelligence and lack a
formal thought disorder (Brochert, 2002).

PREPARED & PRESENTED
BY
RICHARD OPOKU ASARE
MPhil, B.ed (Hons) (health Sciences), RN (Dip)-RMN, Cert. Ed
KEY NURSING INTERVENTIONS FOR
CLIENTSWITH PSYCHOPHYSICAL
PROBLEMS
asareor@yahoo.com ©201341 29-Mar-13

NURSING INTERVENTION
Early recognition of the disorders to help prevent
potentially dangerous treatments from being given.
Convey an attitude of acceptance and understanding.
Conduct a thorough evaluation of patient’s complaints.
Meet all physical needs of the client during acute
feelings of illness.
Minimize secondary gains once the acute phase of the
illness is resolved.
Avoid direct confrontation.

NURSING INTERVENTION –
Cont’d
Use the client’s level of anxiety as a gauge to determine the
amount and type of health teaching.
Acknowledge the client as a responsible adult while
indirectly addressing dependency needs.
Encourage the client to talk about his or her feelings.
Expose the patient’s motivation, at least initially, because
this approach often causes him or her to leave the hospital.
Assist the client and family to enlarge their social network.

NURSING INTERVENTION –
Cont’d
Orient client to reality, where necessary
Educate client on condition
Introduce client to Counselling
Teach client effective coping mechanism
End of Presentation
Thank you

Somatoform disorders (psychophysical problems)

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