466 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
tests, and perhaps even a number of surgical proce-
dures. It is likely that they have seen multiple health
care providers over several years. Clients may express
dismay or anger at the medical community with com-
ments such as “They just can’t find out what’s wrong
with me” or “They’re all incompetent, and they’re try-
ing to tell me I’m crazy!” The exception may be clients
with conversion disorder, who show little emotion
when describing physical limitations or lack of a med-
ical diagnosis (la belle indifference).
GENERAL APPEARANCE AND
MOTOR BEHAVIOR
Overall appearance usually is not remarkable. Often
clients walk slowly or with an unusual gait because
of the pain or disability caused by the symptoms. They
may exhibit a facial expression of discomfort or phys-
ical distress. In many cases, they will brighten and
look much better as the assessment interview begins
because they have the nurse’s undivided attention.
Clients with somatization disorder usually describe
their complaints in colorful, exaggerated terms but
often lack specific information.
MOOD AND AFFECT
Mood is often labile, shifting from seeming depressed
and sad when describing physical problems to look-
ing bright and excited when talking about how they
had to go to the hospital in the middle of the night by
ambulance. Emotions are often exaggerated, as are
reports of physical symptoms. Clients describing a
series of personal crises related to their physical health
may appear pleased rather than distressed about
these situations. Clients with conversion disorder dis-
play an unexpected lack of distress.
THOUGHT PROCESS AND CONTENT
Clients who somatize do not experience disordered
thought processes. The content of their thinking is
primarily about often exaggerated physical concerns;
for example, when they have a simple cold, they may
be convinced it is pneumonia. They may even talk
about dying and what music they want played at
their funeral.
Clients are unlikely to be able to think about or to
respond to questions about emotional feelings. They
will answer questions about how they feel in terms of
physical health or sensations. For example, the nurse
may ask, “How did you feel about having to quit your
job?” The client might respond “Well, I thought I’d feel
better with the extra rest, but my back pain was just
as bad as ever.”
Clients with hypochondriasis focus on the fear of
serious illness rather than the existence of illness
seen in clients with other somatoform disorders.
They are just as preoccupied with physical concerns
as other somatizing clients and are likewise very lim-
ited in their abilities to identify emotional feelings or
interpersonal issues.SENSORIUM AND INTELLECTUAL
PROCESSES
Clients are alert and oriented. Intellectual functions
are unimpaired.JUDGMENT AND INSIGHT
Exaggerated responses to their physical health may
affect clients’ judgment. They have little or no insight
into their behavior. They are firmly convinced that
their problem is entirely physical and often believe
that others don’t understand.Box 19-1
➤ ASSESSMENTQUESTIONS FORSYMPTOMS INSCREENINGTEST FORSOMATIZATIONDISORDER
- Have you ever had trouble breathing?
- Have you ever had trouble with menstrual cramps?
- Have you ever had burning sensations in your sexual organs, mouth, or rectum?
- Have you ever had difficulties swallowing or had an uncomfortable lump in your throat that stayed for at least
an hour? - Have you ever found that you could not remember what you had been doing for hours or days at a time? If yes,
did this happen even though you had not been drinking or using drugs? - Have you ever had trouble with frequent vomiting?
- Have you ever had frequent pain in your fingers or toes?
Adapted from Othmer, E., & DeSouza, C. (1983). A screening test for somatization disorder (hysteria). American Journal of
Psychiatry, 142(10), 1146–1149. © American Psychiatric Association. Reprinted with permission.