Mental Health Exam 3 Concept Guide (Module 7-9)
Chapter 12 – Somatoform Disorders
Somatoform Disorders: Persistently preoccupied with and distressed by their perceived health issues
❖ Hypochondriasis → now called Illness Anxiety Disorder
➢ Signs/symptoms:
■ Preoccupied with having or eventually developing a serious illness.
■ May or may not present with somatic symptoms (usually mild)
■ High level of anxiety and alarm about their health lasting at least 6 months, and may
either excessively check for problems or avoid medical care.
■ Patients can misinterpret normal physical sensations such as sweating, abdominal
cramping, or awareness of heartbeat as indicative of disease
■ Pt believes he has the sickness, even if test results prove otherwise
❖ Conversion Disorder → also Called Functional Neuro-biological Symptom Disorder
➢ Define: a somatic symptom disorder that presents with one or more symptoms of impaired
motor or sensory function.
➢ S/Sx: weakness or paralysis, abnormal movement, swallowing or speech difficulties, seizures or
attacks, sensory loss or anesthesia, or symptoms involving the senses (blindness or loss of smell)
➢ Patients may be highly distressed or show a lack of emotional concern
■ known as la belle indifférence
➢ Nursing intervention
■ Straight forward approach
■ Support pt, but yet be assertive
❖ Body Dysmorphic Disorder:
➢ Patients with BDD usually have a normal appearance (small amount do show minor defects).
➢ They feel they never truly look perfect, or one body part looks extremely abnormal, but other
people do not see that.
➢ Feel shame, withdrawn. Plastic surgery is huge with these pts
➢ Avg onset is < 20 years
➢ Care Plan; Highest Priority--SAFETY (harm to self)
■ Risk for suicide
■ SSRIs, antidepressants, and clomipramine (a tricyclic antidepressant)
■ Cognitive behavioral therapy (CBT)
■ Atypical antipsychotic + SSRI (severe delusional form of BDD).
❖ Factitious Disorder Imposed on Self (Munchausen Syndrome)
➢ Displays as sick without obvious reward or gain (deceptive)
❖ Nursing Interventions for Somatoform Disorders:
➢ Offer explanations and support during diagnostic testing.
➢ After physical complaints have been investigated, avoid further reinforcement of the complaints.
➢ Spend time with the patient at times other than when he/she is expressing a physical complaint
■ (e.g., when talking about a pet or TV program and give the “reward” of extra attention
during those times).
➢ Observe and record frequency and intensity of somatic symptoms.
➢ Do not imply that symptoms are not real.
➢ Shift focus from somatic complaints to feelings or to neutral topics.
, Mental Health Exam 3 Concept Guide (Module 7-9)
➢ HIGHEST PRIORITY: Assess secondary gains that physical illness provides for patient:
■ Secondary gains ⇒ benefits from symptoms (i.e. Such as attention, lack of work
responsibility, or guilt of a spouse causing them to stay rather than leave the patient.)
➢ Use straightforward approach to patient exhibiting resistance or covert anger.
➢ Have patient direct all requests to a designated nurse or clinician.
➢ Show concern for patient, but avoid fostering dependency needs.
➢ Reinforce patient’s strengths and problem-solving abilities.
➢ Teach assertive communication skills and techniques & stress reduction techniques.
❖ Nursing Diagnosis for Somatoform Disorders: (Table 12-3)
➢ Amnesia or fugue related to a traumatic event → Disturbed personal identity
➢ Symptoms of depersonalization; feelings of unreality or body image distortions → Disturbed body image
➢ Alterations in consciousness, memory, or identity → Ineffective coping
➢ Abuse of substances related to dissociation → Ineffective role performance
➢ Disorganization or dysfunction in usual patterns of behavior (absence from work, withdrawal from
relationships, changes in role function) → Ineffective coping, Ineffective family coping
➢ Disturbances in memory and identity → Interrupted family processes
➢ Interrupted family processes related to amnesia or erratic and changing behavior → Impaired parenting,
Ineffective impulse control
➢ Feeling of being out of control of memory, behaviors, and awareness → Anxiety
➢ Inability to explain actions or behaviors when in an altered state → Spiritual distress, Risk for
other-directed violence, Risk for self-directed violence
➢ Obsessive fear of contracting or having a serious or terminal illness → Death, anxiety
Chapter 12 – Somatoform Disorders
Somatoform Disorders: Persistently preoccupied with and distressed by their perceived health issues
❖ Hypochondriasis → now called Illness Anxiety Disorder
➢ Signs/symptoms:
■ Preoccupied with having or eventually developing a serious illness.
■ May or may not present with somatic symptoms (usually mild)
■ High level of anxiety and alarm about their health lasting at least 6 months, and may
either excessively check for problems or avoid medical care.
■ Patients can misinterpret normal physical sensations such as sweating, abdominal
cramping, or awareness of heartbeat as indicative of disease
■ Pt believes he has the sickness, even if test results prove otherwise
❖ Conversion Disorder → also Called Functional Neuro-biological Symptom Disorder
➢ Define: a somatic symptom disorder that presents with one or more symptoms of impaired
motor or sensory function.
➢ S/Sx: weakness or paralysis, abnormal movement, swallowing or speech difficulties, seizures or
attacks, sensory loss or anesthesia, or symptoms involving the senses (blindness or loss of smell)
➢ Patients may be highly distressed or show a lack of emotional concern
■ known as la belle indifférence
➢ Nursing intervention
■ Straight forward approach
■ Support pt, but yet be assertive
❖ Body Dysmorphic Disorder:
➢ Patients with BDD usually have a normal appearance (small amount do show minor defects).
➢ They feel they never truly look perfect, or one body part looks extremely abnormal, but other
people do not see that.
➢ Feel shame, withdrawn. Plastic surgery is huge with these pts
➢ Avg onset is < 20 years
➢ Care Plan; Highest Priority--SAFETY (harm to self)
■ Risk for suicide
■ SSRIs, antidepressants, and clomipramine (a tricyclic antidepressant)
■ Cognitive behavioral therapy (CBT)
■ Atypical antipsychotic + SSRI (severe delusional form of BDD).
❖ Factitious Disorder Imposed on Self (Munchausen Syndrome)
➢ Displays as sick without obvious reward or gain (deceptive)
❖ Nursing Interventions for Somatoform Disorders:
➢ Offer explanations and support during diagnostic testing.
➢ After physical complaints have been investigated, avoid further reinforcement of the complaints.
➢ Spend time with the patient at times other than when he/she is expressing a physical complaint
■ (e.g., when talking about a pet or TV program and give the “reward” of extra attention
during those times).
➢ Observe and record frequency and intensity of somatic symptoms.
➢ Do not imply that symptoms are not real.
➢ Shift focus from somatic complaints to feelings or to neutral topics.
, Mental Health Exam 3 Concept Guide (Module 7-9)
➢ HIGHEST PRIORITY: Assess secondary gains that physical illness provides for patient:
■ Secondary gains ⇒ benefits from symptoms (i.e. Such as attention, lack of work
responsibility, or guilt of a spouse causing them to stay rather than leave the patient.)
➢ Use straightforward approach to patient exhibiting resistance or covert anger.
➢ Have patient direct all requests to a designated nurse or clinician.
➢ Show concern for patient, but avoid fostering dependency needs.
➢ Reinforce patient’s strengths and problem-solving abilities.
➢ Teach assertive communication skills and techniques & stress reduction techniques.
❖ Nursing Diagnosis for Somatoform Disorders: (Table 12-3)
➢ Amnesia or fugue related to a traumatic event → Disturbed personal identity
➢ Symptoms of depersonalization; feelings of unreality or body image distortions → Disturbed body image
➢ Alterations in consciousness, memory, or identity → Ineffective coping
➢ Abuse of substances related to dissociation → Ineffective role performance
➢ Disorganization or dysfunction in usual patterns of behavior (absence from work, withdrawal from
relationships, changes in role function) → Ineffective coping, Ineffective family coping
➢ Disturbances in memory and identity → Interrupted family processes
➢ Interrupted family processes related to amnesia or erratic and changing behavior → Impaired parenting,
Ineffective impulse control
➢ Feeling of being out of control of memory, behaviors, and awareness → Anxiety
➢ Inability to explain actions or behaviors when in an altered state → Spiritual distress, Risk for
other-directed violence, Risk for self-directed violence
➢ Obsessive fear of contracting or having a serious or terminal illness → Death, anxiety
