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7/23/2019 14 Somatoform Disorders.ppt
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Somatoform DisordersSomatoform Disorders
Adrianne Maltese, MN,GCNS-BC Adrianne Maltese, MN,GCNS-BC
7/23/2019 14 Somatoform Disorders.ppt
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Somatoform DisordersSomatoform Disorders
Three central features ofThree central features ofSomatoform Disorders:Somatoform Disorders: Physical complaints ithout or!anicPhysical complaints ithout or!anic
"asis"asis Psycholo!ical factors and conflictsPsycholo!ical factors and conflicts
seem important in initiatin!,seem important in initiatin!,e#acer"atin!, and maintainin! thee#acer"atin!, and maintainin! the
symptomssymptoms Symptoms or ma!nified healthSymptoms or ma!nified health
concerns are not under consciousconcerns are not under consciouscontrol$Gu!!enheim%&&&'control$Gu!!enheim%&&&'
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(i)e Somatoform disorders(i)e Somatoform disorders
Somati*ation disorder Somati*ation disorder C+" multiple recurrent physical complaintsC+" multiple recurrent physical complaints
o)er many yearso)er many years No or!anic etiolo!y for these complaintsNo or!anic etiolo!y for these complaints Be!ins "y a!e &Be!ins "y a!e & Pain, G, se#ual, pseudoneurolo!icPain, G, se#ual, pseudoneurolo!ic
symptoms: impaired coordination orsymptoms: impaired coordination or"alance,paralysis or locali*ed"alance,paralysis or locali*edea.ness,difficulty salloin!, aphonia,ea.ness,difficulty salloin!, aphonia,urinary retention,hallucinations, loss ofurinary retention,hallucinations, loss oftouch or pain sensation,dou"letouch or pain sensation,dou"le)ision,amnesia,sensory losses,loss of)ision,amnesia,sensory losses,loss ofconsciousness $APA %&&& DSM /-T0'consciousness $APA %&&& DSM /-T0'
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nter)entions for somati*ationnter)entions for somati*ation
Be aare of on responsesBe aare of on responses
0ule out or!anic "asis for0ule out or!anic "asis for
complaintscomplaints (ocus on an#iety reduction, mot(ocus on an#iety reduction, mot
physical symptomsphysical symptoms
Minimi*e secondary !ain$1e1Minimi*e secondary !ain$1e1increased attention andincreased attention and
decreased responsi"ilities'decreased responsi"ilities'
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nter)ention 2con)ersion d+onter)ention 2con)ersion d+o
(ocus on an#iety reduction, not(ocus on an#iety reduction, not
physical symptomsphysical symptoms
3se matter-of-fact approach3se matter-of-fact approach
4ncoura!e client to discuss4ncoura!e client to discuss
conflictconflict
Minimi*e secondary !ainsMinimi*e secondary !ains
Pro)ide di)ersionary acti)itiesPro)ide di)ersionary acti)ities
4ncoura!e e#pression of feelin!s4ncoura!e e#pression of feelin!s
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Pain Disorder Pain Disorder
C+" physical symptom of pain-C+" physical symptom of pain-one or more anatomic sitesone or more anatomic sites
May occur ith a GeneralMay occur ith a Generalmedical conditionmedical condition
Pain 2not relie)ed "y anal!esicsPain 2not relie)ed "y anal!esics 5nset,se)erity, e#acer"ation5nset,se)erity, e#acer"ation
and maintenance affected "yand maintenance affected "ypsycholo!ical stressorspsycholo!ical stressors
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Pain d+o inter)entionsPain d+o inter)entions
Pain mana!ementPain mana!ement
4ncoura!e participation in4ncoura!e participation in
acti)itiesacti)ities Pro)ide distractionsPro)ide distractions
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6ypochondriasis6ypochondriasis
Client is preoccupied ith fear that he+sheClient is preoccupied ith fear that he+shehas or ill !et a serious diseasehas or ill !et a serious disease
6istory of seein! many doctors6istory of seein! many doctors Misinterpretation of "odily sensations orMisinterpretation of "odily sensations or
functions despite medical e)aluations andfunctions despite medical e)aluations andreassurancereassurance
Preoccupation ith symptoms is not asPreoccupation ith symptoms is not asintense or distorted as in delusionalintense or distorted as in delusional
disorder disorder Si!nificant distress+impairment in functionSi!nificant distress+impairment in function Dependent "eha)iors+desires,demandsDependent "eha)iors+desires,demands
attentionattention
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6ypochondriasis inter)entions6ypochondriasis inter)entions
0ule out presence of actual0ule out presence of actual
diseasedisease
(ocus on an#iety, not physical(ocus on an#iety, not physical
symptomssymptoms Pro)ide di)ersionary acti)itiesPro)ide di)ersionary acti)ities
A)oid ne!ati)e responses to client A)oid ne!ati)e responses to client
demands+conference ith staff demands+conference ith staff Pro)ide client ith correctPro)ide client ith correct
informationinformation
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Body Dysmorphic Disorder Body Dysmorphic Disorder
Preoccupation ith ima!ined orPreoccupation ith ima!ined or
e#a!!erated defects in physicale#a!!erated defects in physical
appearanceappearance
Causes clinically si!nificantCauses clinically si!nificant
stressor impairment in social orstressor impairment in social or
occupational function7 personoccupational function7 person
may under!o repeated plasticmay under!o repeated plasticsur!eries for nose repair or tosur!eries for nose repair or to
chan!e face etc1chan!e face etc1
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Dissociati)e DisordersDissociati)e Disorders
DSS5CAT/4 AMN4SA:DSS5CAT/4 AMN4SA:
5ne or more episodes of5ne or more episodes of
ina"ility to recall personalina"ility to recall personal
informationinformation
nformation is usually of anformation is usually of a
traumatic or stressful naturetraumatic or stressful nature
Not due to effects of su"stanceNot due to effects of su"stance
a"usea"use
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Dissociati)e (u!ueDissociati)e (u!ue
C+" sudden une#pected tra)elC+" sudden une#pected tra)el
aay from home or or.aay from home or or.
3na"le to recall past$or here3na"le to recall past$or here
on has "een'on has "een'
Confused a"out personalConfused a"out personal
identity+ or assumes neidentity+ or assumes ne
identityidentity
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Dissociati)e dentity Disorder Dissociati)e dentity Disorder
ndi)idual demonstrates to orndi)idual demonstrates to or
more distinct identities ormore distinct identities or
personality statespersonality states
4ach personality is distinct4ach personality is distinct
At least to of these personality At least to of these personality
states ta.e control of thestates ta.e control of the
indi)iduals "eha)ior1indi)iduals "eha)ior1 3na"le to recall e#tensi)e personal3na"le to recall e#tensi)e personal
informationinformation