SLEEP

DISTURBANCE IN
SOMATOFORM
PAIN
Al bukhari
Edho Biondi Joris
DISORDER

Concepts of Somatoform
and Dissociative Disorders

Somatoform disorders

Physical symptoms in absence of

physiological cause
Associated with increased health care use
May

progress to chronic illness (sick role)

behaviors

Dissociative disorders

Disturbances in integration of consciousness,

memory, identify, and perception
Dissociation is unconscious mechanism to
protect against overwhelming anxiety

characterized
physical symptoms suggesting medical
disease but without a demonstrable organic
pathological condition or a known
pathophysiological mechanism to account
for them.
Somatoform disorders are more common

In
In
In
In

women than in men

those who are poorly educated
those who live in rural communities
those who are poor

Somatoform Disorders:
General Information

Prevalence

Rate unknown; estimated that 38% of

primary care patients have symptoms
with no medical basis
55% of all frequent users of medical care
have psychiatric problems

Comorbidity
Depressive

disorders, anxiety disorders,

substance use, and personality disorders
common

Somatization Disorder

Diagnosis requires certain number of

symptoms accompanied by functional
impairment

Pain: head, chest, back, joints, pelvis

GI symptoms: dysphagia, nausea, bloating,
constipation
Cardiovascular symptoms: palpitations,
shortness of breath, dizziness

Comorbidity

Anxiety and depression

Hypochondriasis

Widespread phenomenon

Misinterpreting physical sensations as

evidence of serious illness

1 out of 20 patients seek medical care

Negative physical findings does not affect

patients belief that they have serious
illness

Cormorbidity

Depression, substance abuse, personality

disorder

Pain Disorder

Diagnosed when testing rules out organic

cause for symptom of pain

Evidence of significant functional impairment

Suicide becomes serious risk for patients

with chronic pain
Typical sites for pain: head, face, lower
back, and pelvis
Cormorbidity

Depression, substance abuse, personality

disorder

Body Dysmorphic Disorder

(BDD

Patient has normal appearance or minor defect but

is preoccupied with imagined defective body part
Presence of significant impairment in function
Typical characteristics
Obsessive thinking and compulsive behavior
Mirror checking and camouflaging
Feelings of shame
Withdrawal from others
Cormorbidity
Depression, OCD, social phobia

Conversion Disorder

Symptoms that affect voluntary

motor or sensory function
suggesting a physical condition

Dysfunction not congruent with

functioning of the nervous system

Patient attitude toward symptoms

Lack of concern (la belle

indiffrence) or marked distress

Common symptoms

Involuntary movements, seizures,

paralysis, abnormal gait, anesthesia,
blindness, and deafness

Cormorbidity

Depression, anxiety, other somatoform

disorders, personality disorders

Sleep Disorders:
Introduction
Females is more often with somatiform and sleep
disorder, 71%
38,7 % with sleep disorder and 13% without sleep
disorder
The prevalence of sleep disorders increases with
advancing age
Common types of sleep disorders include insomnia,
hypersomnia, parasomnias, and circadian
rhythm
sleep disorders

Sleep Disorders:
Assessment

Insomnia

Hypersomnia (somnolence)

Excessive sleepiness or seeking excessive

amounts of sleep

Narcolepsy: Similar to hypersomnia

Difficulty falling or staying sleep

Characteristic manifestation: Sleep

attacks; the person cannot prevent falling
asleep

Parasomnias

Nightmares, sleep terrors, sleep walking

Sleep terror disorder

Manifestations include abrupt arousal from

sleep with a piercing scream or cry

Circadian rhythm sleep disorders

Shift-work type
Jet-lag type
Delayed sleep phase type

Nursing Process
Nursing Diagnosis
Planning/Implementation
Outcomes
Evaluation

Predisposing Factors

Genetic or familial patterns are thought to play a

contributing role in primary insomnia, primary
hypersomnia, narcolepsy, sleep terror disorder,
and sleepwalking.

Various medical conditions, as well as aging,

have been implicated in the etiology of insomnia.

Psychiatric or environmental conditions can contribute to

insomnia or hypersomnia.
Activities that interfere with the 24-hour circadian rhythm
hormonal and neurotransmitter functioning within the
body
predispose people to sleep-wake schedule disturbances.

Treatment Modalities

Somatoform disorders
Individual psychotherapy

Group psychotherapy

Behavior therapy

Psychopharmacology
Sleep disorders
Relaxation therapy
Biofeedback
Pharmacotherapy

Primary hypersomnia/narcolepsy

Pharmacotherapy
CNS stimulants such as amphetamines

Parasomnias

Centers around measures to relieve

obvious stress within the family
Individual or family therapy
Interventions to prevent injury

Thanks