Psychiatric Mental Health Nursing by Videbeck

464 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

gainsare the direct external benefits that being sick
provides such as relief of anxiety, conflict, or distress.
Secondary gainsare the internal or personal bene-
fits received from others because one is sick such as at-
tention from family members and comfort measures
(e.g., being brought tea, receiving a back rub). Servan-
Schreiber et al. (2002) identify this as a “need to be
sick” to have emotional needs met.
Somatization is associated most often with
women, as evidenced by the old term hysteria(Greek
for “wandering uterus”). Ancient theorists believed
that unexplained female pains resulted from migra-
tion of the uterus throughout the woman’s body.
Psychosocial theorists posit that increased incidence
of somatization in women may be related to various
factors:

• Boys in the United States are taught to be
  stoic and to “take it like a man,” causing
  them to offer fewer physical complaints as
  adults.


• Women seek medical treatment more often
  than men do, and it is more socially accept-
  able for them to do so.


• Childhood sexual abuse, which is related to
  somatization, happens more frequently to
  girls.


• Women more often receive treatment for
  psychiatric disorders with strong somatic
  components such as depression.

Biologic Theories

Research has shown differences in the way that

clients with somatoform disorders regulate and inter-

pret stimuli. These clients cannot sort relevant from

irrelevant stimuli and respond equally to both types.

In other words, they may experience a normal body

sensation such as peristalsis and attach a pathologic

rather than a normal meaning to it (Guggenheim,

2000). Too little inhibition of sensory input amplifies

awareness of physical symptoms and exaggerates re-

sponse to bodily sensations. For example, minor dis-

comfort, such as muscle tightness, becomes amplified

because of the client’s concern and attention to the

tightness. This amplified sensory awareness causes

the person to experience somatic sensations as more

intense, noxious, and disturbing (Hardy, Warmbrodt

& Chrisman, 2001).

Somatization disorder is found in 10% to 20% of

female first-degree relatives of people with this dis-

order. Conversion symptoms are found more often in

relatives of people with conversion disorder. First-

degree relatives of those with pain disorder are more

likely to have depressive disorders, alcohol depen-

dence, and chronic pain (APA, 2000).

CULTURAL CONSIDERATIONS

The type and frequency of somatic symptoms and

their meaning may vary across cultures. Pseudo-

neurologic symptoms of somatization disorder in

Africa and South Asia include burning hands and

feet and the nondelusional sensation of worms in the

head or ants under the skin. Symptoms related to

male reproduction are more common in some coun-

tries or cultures—for example, men in India often

have dhat,which is a hypochondriacal concern about

loss of semen. Somatization disorder is rare in men

in the United States but more common in Greece and

Puerto Rico.

Many culture-bound syndromes have correspond-

ing somatic symptoms not explained by a medical

condition (Table 19-1). Korooccurs in Southeast Asia

and may be related to body dysmorphic disorder. It

Table 19-1

CULTURE-BOUNDSYNDROMES

Syndrome Culture Characteristics

Dhat

Koro

Falling-out episodes

Hwa-byung

Sangue dormido

(“sleeping blood”)

Shenjing shuariuo

Hypochondriacal concern about semen loss

Belief that penis is shrinking and will disappear into abdomen,

resulting in death

Sudden collapse; person cannot see or move

Suppressed anger causes insomnia, fatigue, panic, indiges-

tion, and generalized aches and pains

Pain, numbness, tremors, paralysis, seizures, blindness, heart

attack, miscarriage

Physical and mental fatigue, dizziness, headache, pain, sleep

disturbance, memory loss, GI problems, sexual dysfunction

India

Southeast Asia

Southern United States,

Caribbean islands

Korea

Portuguese Cape Verde

Islands

China

Adapted from Mezzich, J. E., Lin, K., & Hughes, C. C. (2000). Acute and transient psychotic disorders and

culture-bound syndromes. In B. J. Sadock & V. A. Sadock (Eds.). Comprehensive textbook of psychiatry,Vol. 1.

(7th ed., pp. 1264–1276). Philadelphia: Lippincott Williams & Wilkins. © American Psychiatric Association.

Reprinted with permission.