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NCM105: SOMATIC

SYMPTOMS AND RELATED


DISORDERS
SOMATIZATION:
The transference of mental experience and
states into bodily symptoms
Presence of physical symptoms that suggest
medical condition with NO KNOWN
organic cause, purely in the mind
DEFENSE MECHANISMS USED:
o Repression (involuntary forgetting)
o Denial (non-acceptance of the situation)
o Displacement (transferring/venting out to
a less threatening object)
CENTRAL FEATURES:
o Psychological factors and conflicts seem
important in imitating, exacerbating and
maintaining symptoms
o Symptoms or magnified health concerns
are not under the clients control
COMMON CHARACTERISTICS OF THE
PHYSICAL SYMPTOMS:
o Real, NOT FAKE
o Occurs
unconsciously,
NOT
DELIBERATE
o No underlying structural or organic basis
o With primary or secondary gain
SOMATIC SYMPTOM DISORDER:
o Has 1 or more physical symptoms that
are distressing, NO organic basis
o Excessive thoughts, feelings or behaviors
associated with health concerns
Disproportionate persistent thoughts
about seriousness of symptoms
High level of anxiety
Excessive time and energy devoted to
symptoms
Patient seeks care from multiple MDs
1.) ILLNESS ANXIETY DISORDER OR
HYPOCHONDRIASIS
Preoccupation with having a serious illness
for 6 months
Somatic symptoms maybe present or absent

If present, mild intensity


Either repeatedly checks for signs of illness
or avoid MDs or hospitals
2.) CONVERSION DISORDER
Functional neurologic symptoms disorder
1 or more deficit or alteration in voluntary
motor or sensory function: blindness,
paralysis associated with psychological
factors
Symptom is determined by the situation that
produced it
o La Belle indifference little to no concern
over the physical symptoms that he/she is
experiencing
o Primary gain alleviation of anxiety
o Secondary gain derive external benefits
or release from responsibilities
3.) PAIN DISORDER
Severe pain in one or more anatomical sites
causing distress or impairment in
functioning
Excessive user of analgesics, but generally
relieved by it
4.) PSEUDOCYESIS
A false belief of being pregnant that is
associated with objective signs and reported
symptoms of pregnancy
5.) FACTITIOUS DISORDER
Falsification of physical or psychological
signs and symptoms, or induction of
injury or disease
Person is the one causing the injury (selfinflicted)
Associated with identified deception
ONSET: early adulthood
Individuals presents himself to others as ill,
impaired or injured; intentionally produces
symptoms
Can also seek treatment for themselves or
another following induction of injury
METHODS
OF
ILLNESS
FALSIFICATION:
o Exaggeration

Fabrication
Simulation
Induction
Deception (e.g report seizures, add blood
to urine, ingest insulin, injure oneself)
TREATMENTS:
o Supportive psychotherapy
o Family therapy
o Focus on emotional distress
o
o
o
o

A. MUNCHAUSEN SYNDROME
Inflict injury to self to gain attention
B. MUNCHAUSEN BY PROXY
Person inflicts injury on someone else to
gain attention
Common among health personnel and
primary caregivers

C. MALINGERING
Intentional production of false or grossly
exaggerated minor physical/psychological
symptoms due to incentives/motives:
o Avoid work
o Obtain drugs
o Evade prosecution
People who can malinger can stop the
physical symptoms as soon as they have
gained what they wanted

GOALS OF INTERVENTION:
To make them functional as his condition
will allow to improve quality of life
To relieve the symptoms

To encourage expression of emotion


To assists in learning more effective coping
strategies
Let the patient gain insight
NURSING MANAGEMENT:
Show empathy and sensitivity
Trusting relationship
Use a matter-of-fact attitude
Assist in describing feelings
Reinforce non-complaining behavior
Be consistent
Include patients in activities
Do not push awareness of or insight into
conflicts or problems
Refer to chronic pain clinic
Involvement in therapy group
Provide health teachings
SSRIs
are
sometimes
used
for
accompanying depression
Relaxation exercises, stress management,
meditation

OTHER SPECIFIED SOMATIC SYMPTOM


AND RELATED DISORDER:
Somatic symptoms causing clinically
significant distress or impairment do not
meet full criteria in this class:
o Brief somatic symptom less than 6mos.
o Brief illness anxiety disorder less than
6mos.
o Illness anxiety disorder without excessive
health-related behavior