Psychiatric Mental Health Nursing by Videbeck

19 SOMATOFORMDISORDERS 465

is characterized by the belief that the penis is shrink-
ing, will disappear into the abdomen and cause the
man to die. Falling-out episodes, found in the south-
ern United States and the Caribbean islands, are
characterized by a sudden collapse during which the
person cannot see or move. Hwa-byungis a Korean
folk syndrome attributed to the suppression of anger
and includes insomnia, fatigue, panic, indigestion,
and generalized aches and pains. Sangue dormido
(“sleeping blood”) occurs among Portuguese Cape
Verde Islanders who report pain, numbness, tremors,
paralysis, seizures, blindness, heart attack, and mis-
carriages. Shenjing shuariuooccurs in China and
includes physical and mental fatigue, dizziness, head-
ache, pain, sleep disturbance, memory loss, gastro-
intestinal problems, and sexual dysfunction (Mezzich,
Lin & Hughes, 2000).

TREATMENT

Treatment focuses on managing symptoms and im-

proving quality of life. The health care provider must

show empathy and sensitivity to the client’s physical

complaints (Margo & Margo, 2000). A trusting rela-

tionship will help to ensure that clients stay with and

receive care from one provider instead of “doctor

shopping.”

For many clients, depression may accompany or

result from somatoform disorders. Thus antidepres-

sants help in some cases. Selective serotonin re-

uptake inhibitors, such as fluoxetine (Prozac), ser-

traline (Zoloft), and paroxetine (Paxil), are used most

commonly (Table 19-2).

For clients with pain disorder, referral to a chronic

pain clinic may be useful. Clients learn methods of

pain management such as visual imaging and relax-

ation. Services such as physical therapy to maintain

and build muscle tone help to improve functional

abilities. Providers should avoid prescribing and ad-

ministering narcotic analgesics to these clients be-

cause of the risk of dependence or abuse. Clients can

use nonsteroidal anti-inflammatory agents to help

reduce pain.

Involvement in therapy groups is beneficial for

some people with somatoform disorders. Studies of

clients with somatization disorder who participated

in a structured cognitive-behavioral group showed

evidence of improved physical and emotional health

1 year later (Guggenheim, 2000). The overall goals of

the group were offering peer support, sharing methods

of coping, and perceiving and expressing emotions.

In terms of prognosis, somatoform disorders tend

to be chronic or recurrent. Conversion disorder often

remits in a few weeks with treatment but recurs in

25% of clients. Somatization disorder, hypochondria-

sis, and pain disorder often last for many years, and

clients report being in poor health. People with body

dysmorphic disorder may be preoccupied with the

same or a different perceived body flaw throughout

their lives (APA, 2000).

APPLICATION OF THE

NURSING PROCESS

The underlying mechanism of somatization is con-

sistent for clients with somatoform disorders of all

types. This section discusses application of the nurs-

ing process for clients with somatization; differences

among the disorders are highlighted in the appropri-

ate places.

Assessment

The nurse must investigate physical health status

thoroughly to ensure that there is no underlying

pathology requiring treatment. Box 19-1 contains a

useful screening test for symptoms of somatization

disorder. When a client has been diagnosed with a so-

matoform disorder, it is important not to dismiss all

future complaints because at any time the client

could develop a physical condition that would require

medical attention.

HISTORY

Clients usually provide a lengthy and detailed account

of previous physical problems, numerous diagnostic

Table 19-2

ANTIDEPRESSANTSUSED TOTREATSOMATOFORMDISORDERS

Drug Usual dose (mg/day) Nursing Considerations

fluoxetine (Prozac)

paroxetine (Paxil)

sertraline (Zoloft)

Monitor for rash, hives, insomnia, headache, anxiety, drowsiness,

nausea, loss of appetite; avoid alcohol

Monitor for nausea, loss of appetite, dizziness, dry mouth,

somnolence or insomnia, sweating, sexual dysfunction; avoid

alcohol

Monitor for nausea, loss of appetite, diarrhea, headache,

insomnia, sexual dysfunction; avoid alcohol

20–60

20–60

50–200