nurse can help the client to plan social contact with
others, can role-play what to talk about (other than
the client’s complaints), and can improve the client’s
confidence in making relationships. The nurse also
can help clients to identify stressful life situations and
plan strategies to deal with them. For example if a
client finds it difficult to accomplish daily household
tasks, the nurse can help him to plan a schedule with
difficult tasks followed by something client may enjoy.
Evaluation
Somatoform disorders are chronic or recurrent, so
changes are likely to occur slowly. If treatment is
effective, the client should make fewer visits to physi-
cians with physical complaints, use less medication
and more positive coping techniques, and increase
functional abilities. Improved family and social rela-
tionships are also a positive outcome that may follow
improvements in the client’s coping abilities.
COMMUNITY-BASED CARE
Health care professionals often encounter clients with
somatoform disorders in clinics, physicians’ offices, or
settings other than mental health. Building a trusting
relationship with the client, providing empathy and
support, and being sensitive to rather than dismissive
of complaints are skills that the nurse can use in any
setting where clients are seeking assistance. Making
appropriate referrals, such as a pain clinic for clients
with pain disorder, or providing information about
support groups in the community may be helpful. En-
couraging clients to find pleasurable activities or hob-
bies may help to meet their needs for attention and
security, thus diminishing the psychological needs for
somatic symptoms.
MENTAL HEALTH PROMOTION
A common theme in somatoform disorders is their
occurrence in people who do not express conflicts,
stress, and emotions verbally. They express them-
selves through physical symptoms; the resulting at-
tention and focus on their physical ailments some-
what meet their needs. As these clients are better
able to express their emotions and needs directly,
physical symptoms subside. Thus assisting them to
deal with emotional issues directly is a strategy for
mental health promotion.
Micale (2000) writes that “hysteria” and neuroses
(now called somatization disorder) have decreased in
the United States since 1900. He cites the following
reasons for this decline:
- People now have more “psychological self-
knowledge.”- The sexual confinement, emotional oppres-
sion, and social suffocation of the Victorian
era have dissipated. - The interaction of mind and body now has a
scientific foundation.
As people continue to gain knowledge about them-
selves and to express their emotional needs and de-
sires directly, the incidence of coping through physical
symptoms should continue to decline.
- The sexual confinement, emotional oppres-
SELF-AWARENESS ISSUES
Clients who cope through physical symp-
toms can be frustrating for the nurse. Initially they
are unwilling to consider that anything other than
major physical illness is the root of all their problems.
When health professionals tell clients that there is no
physical illness and refer them to mental health pro-
fessionals, the response often is anger. Clients may
express anger directly or passively at the medical com-
munity and be highly critical of the inadequate care
they believe they have received. The nurse must not
respond with anger to such outbursts or criticism.
The client’s progress is slow and painstaking, if
any happens at all. Clients coping with somatization
have been doing so for years. Changes are not rapid or
drastic. The nurse may feel frustrated because after
giving the client his or her best efforts, the client re-
turns time after time with the same focus on physical
symptoms. The nurse should be realistic about the
small successes that can be achieved in any given pe-
riod. To enhance the ongoing relationship, the nurse
must be able to accept the client and his or her con-
tinued complaints and criticisms while remaining
nonjudgmental.Points to Consider When Working
With Clients With Somatoform
Disorders- Carefully assess the client’s physical com-
plaints. Even when a client has a history of a
somatoform disorder, the nurse must not
dismiss physical complaints or assume that
they are psychological. The client actually
may have a medical condition. - Validate the client’s feelings while trying to
engage him or her in treatment; for example,
use a reflective yet engaging comment such
as “I know you’re not feeling well, but it is
important to get some exercise each day.” - Remember that the somatic complaints are
not under the client’s voluntary control. The
client will have fewer somatic complaints
when he or she improves coping skills and
interpersonal relationships.
19 SOMATOFORMDISORDERS 469