Psychiatric Mental Health Nursing by Videbeck

462 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

• Conversion disorder, sometimes called
  conversion reaction, involves unexplained,
  usually sudden deficits in sensory or motor
  function (e.g., blindness, paralysis). These
  deficits suggest a neurologic disorder but are
  associated with psychological factors. An
  attitude of la belle indifference, a seeming
  lack of concern or distress, is a key feature.
  
  
  • Pain disorderhas the primary physical
    symptom of pain, which generally is
    unrelieved by analgesics and greatly affected
    by psychological factors in terms of onset,
    severity, exacerbation, and maintenance.
  
  
  • Hypochondriasisis preoccupation with the
    fear that one has a serious disease (disease
    conviction) or will get a serious disease
    (disease phobia). It is thought that clients
    with this disorder misinterpret bodily
    sensations or functions.
  
  
  • Body dysmorphic disorderis preoccupa-
    tion with an imagined or exaggerated defect
    in physical appearance such as thinking
    one’s nose is too large or teeth are crooked
    and unattractive.
    Somatization disorder, conversion disorder, and
    pain disorder are more common in women than in
    men; hypochondriasis and body dysmorphic disorder
    are distributed equally by gender. Somatization dis-
    order exists in 0.2% to 2% of the general population.
    Conversion disorder occurs in less than 1% of the
    population. Pain disorder is commonly seen in med-
    ical practice with 10% to 15% of people in the United
    States reporting work disability related to back pain
    alone (APA, 2000). Hypochondriasis is estimated to
    occur in 4% to 9% of people seen in general medical
    practice. No statistics of the incidence of body dys-
    morphic disorder are available.
  
  
  
  

ONSET AND CLINICAL COURSE

Clients with somatization disorder and body dysmor-

phic disorder often experience symptoms in adoles-

cence, although these diagnoses may not be made

until early adulthood (about 25 years of age). Conver-

◗ SYMPTOMS OFSOMATIZATIONDISORDER

Pain symptoms:complaints of headache; pain in

the abdomen, head, joints, back, chest, rectum;

pain during urination, menstruation, or sexual

intercourse

Gastrointestinal symptoms:nausea, bloating,

vomiting (other than during pregnancy), diar-

rhea, or intolerance of several foods

Sexual symptoms:sexual indifference, erectile or

ejaculatory dysfunction, irregular menses, ex-

cessive menstrual bleeding, vomiting through-

out pregnancy

Pseudoneurologic symptoms:conversion symp-

toms such as impaired coordination or balance,

paralysis or localized weakness, difficulty swal-

lowing or lump in throat, aphonia, urinary reten-

tion, hallucinations, loss of touch or pain sensa-

tion, double vision, blindness, deafness,

seizures; dissociative symptoms such as amne-

sia; or loss of consciousness other than fainting

Adapted from American Psychiatric Association. (2000).

DSM-IV-TR: diagnostic and statistical manual of mental

disorders text revision(4th ed.). Washington, DC: APA.

Matthew, 13, has just been transferred from a medical

unit to the adolescent psychiatric unit. He had been on

the medical unit for 3 days, undergoing extensive tests

to determine the cause of a sudden onset of blindness.

No organic pathology was discovered, and Matthew was

diagnosed with a conversion disorder.

As the nurse interviews Matthew, she notices that he

is calm and speaks of his inability to see in a matter-of-

fact manner, demonstrating no distress at his blindness.

Matthew seems to have the usual interests of a 13-year-

old, describing his activities at school and with his

friends. However, the nurse finds that Matthew has little

to say about his parents, his younger brother, or activi-

ties at home.

CLINICALVIGNETTE: CONVERSIONDISORDER

Later the nurse has a chance to talk with Matthew’s

mother when she comes to the unit after work. Soon,

Matthew’s mother is crying, telling the nurse that her

husband has a drinking problem and has been increas-

ingly violent at home. Two days before Matthew’s symp-

toms developed, Matthew witnessed one of his father’s

rages, which included breaking furniture and hitting his

wife. When Matthew tried to help his mother, his father

called him spineless and worthless and told him to go to

the basement and stay there. The nurse understands

that the violence Matthew has witnessed and his inabil-

ity to change the situation may be the triggering event

for his conversion disorder.