Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 21 Somatic Symptom Illnesses

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 21

Somatic SymptomIllnesses

Chapter 21

Somatic SymptomIllnesses


Somatic Symptom IllnessesSomatic Symptom Illnesses

• Psychosomatic: connection between mind (psyche) and body (soma)

• Hysteria: multiple physical complaints with no organic basis– Proposal by Freud that people can convert

unexpressed emotions into physical symptoms

• Somatization: transference of mental experiences, states into body symptoms


Somatic Symptom Illnesses (cont.)Somatic Symptom Illnesses (cont.)

• Three central features

– Physical complaints suggest major medical illness but have no demonstrable organic basis

– Psychological factors and conflicts seem important in initiating, exacerbating, maintaining symptoms

– Symptoms or magnified health concerns are not under patient’s conscious control


Types of Somatic Symptom IllnessesTypes of Somatic Symptom Illnesses

• Somatic symptom illness: multiple physical symptoms—combination of pain, GI, sexual, pseudoneurologic symptoms

• Conversion disorder: unexplained sensory or motor deficits associated with psychological factors; typically involves significant functional impairment; “la belle indifference”


Types of Somatic Symptom Illnesses (cont.)Types of Somatic Symptom Illnesses (cont.)

• Pain disorder: pain unrelieved by analgesics; psychological factors influencing onset, severity, exacerbation, maintenance

• Illness anxiety disorder (hypochondriasis): disease conviction or disease phobia


Onset and Clinical CourseOnset and Clinical Course

• Symptoms usually onset in adolescence or early adulthood

• All either chronic or recurrent

• Patients go from one physician or clinic to another, or see multiple providers at once, to obtain relief of symptoms


QuestionQuestion

• Is the following statement true or false?

• A patient with a somatic symptom illness is able to voluntarily control the symptoms.


AnswerAnswer

• False

• Rationale: The symptoms of somatic symptom illness are not under the patient’s voluntary control.


Related Disorders Related Disorders

• Malingering: intentional false or grossly exaggerated symptoms; external incentives as motivation

• Factitious disorder: intentional symptoms to gain attention (Munchausen’s syndrome = imposed upon self)

– Munchausen’s syndrome by proxy = imposed upon others


Related Disorders (cont.) Related Disorders (cont.)

• Malingering and factitious disorders: willful control of symptoms; somatic symptom illnesses—no voluntary control over symptoms


EtiologyEtiology

• Psychosocial theories

– Internalization

– Primary gains: direct external benefits of being sick provide relief of anxiety, conflict, distress

– Secondary gains: person receives internal or personal benefits from others because one is sick.


Etiology (cont.)Etiology (cont.)

• Biologic theories:

– Differences in regulation, interpretation of stimuli


Cultural Considerations Cultural Considerations

• Variable in frequency, meaning across cultures (see Table 21.1)– Dhat (men in India)

– Koro (Southeast Asia)

– Falling-out episodes

– Hwa-byung (Korean folk syndrome)

– Shenjing shuariuo (China)


TreatmentTreatment

• Symptom management, improvement in quality of life

• Antidepressants for accompanying depression: SSRIs (see Table 21.2)

• Pain clinic referral for disorder

• Involvement in therapy groups


Somatic Symptom Illnesses and Nursing Process Application Somatic Symptom Illnesses and Nursing Process Application • Assessment

– Investigation of physical health status; screening (se Box 21.1)

– History: usually detailed medical history; distress about health status (except patient with conversion disorder who displays la belle indifference)

– General appearance, motor behavior

– Mood, affect: labile; exaggerated emotions


QuestionQuestion

• Is the following statement true or false?

• A patient with a factitious disorder develops symptoms primarily for attention.


AnswerAnswer

• True

• Rationale: Factitious disorder occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention.


Somatic Symptom Illnesses and Nursing Process Application (cont.)Somatic Symptom Illnesses and Nursing Process Application (cont.)

• Assessment (cont.)– Thought process, content: focus on symptoms– Sensorium, intellectual processes– Judgment, insight – Self-concept: focus on physical self– Roles, relationships: problems– Physiologic, self-care concerns (Box 21.2)



• Data analysis/nursing diagnoses• Outcome identification

– Identify relationship between stress and physical symptoms

– Verbally express emotions/feelings– Establish and follow a daily routine– Demonstrate alternate ways to deal with stress,

anxiety, and other feelings– Demonstrate healthy behaviors regarding rest,

activity, and nutritional intake



• Intervention– Provide health teaching: improved health behaviors– Help express emotions: journaling; limiting time

spent on physical complaints– Teach coping strategies

• Emotion-focused coping strategies• Problem-focused coping strategies

• Evaluation


Community-Based Care Community-Based Care

• Appropriate referrals, such as pain clinic for patients with pain disorder

• Information about community support groups

• Pleasurable activities or hobbies


QuestionQuestion

• Which of the following would be an example of a problem-focused coping strategy?

– A. Progressive relaxation– B. Deep breathing– C. Interaction role-playing– D. Guided imagery


AnswerAnswer

• C. Interaction role-playing

• Rationale: Interaction role-playing is an example of a problem-focused coping strategy.

– Progressive relaxation, deep breathing, and guided imagery are emotion-focused coping strategies.


Mental Health Promotion Mental Health Promotion

• Assist patients to deal directly with emotional issues

• Assist patients to continue gaining knowledge about themselves, their emotional needs


Self-Awareness IssuesSelf-Awareness Issues

• Deal with feelings of frustration.

• Be realistic about small successes.

• Validate patient’s feelings.

• Deal with feeling that patient “could do better if he tried.”

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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 21 Somatic Symptom Illnesses