Psychiatric Mental Health Nursing by Videbeck

19 SOMATOFORMDISORDERS 475

➤ KEY POINTS

• Somatization means transforming mental
  experiences and states into bodily symptoms.


• The three central features of somatoform
  disorders are physical complaints that sug-
  gest major medical illness but have no
  demonstrable organic basis; psychological
  factors and conflicts that seem important in
  initiating, exacerbating, and maintaining
  the symptoms; and symptoms or magnified
  health concerns that are not under the
  client’s conscious control.
  
  
  • Somatoform disorders include somatization
    disorder, conversion disorder, hypochondri-
    asis, pain disorder, and body dysmorphic
    disorder
  
  
  • Malingering means feigning physical symp-
    toms for some external gain such as avoiding
    work.
  
  
  • Factitious disorders are characterized by
    physical symptoms that are feigned or
    inflicted for the sole purpose of drawing
    attention to oneself and gaining the emo-
    tional benefits of assuming the sick role.
  
  
  • Internalization and somatization are the
    chief defense mechanisms seen in somatoform
    disorders.
  
  
  • Clients with somatization disorder and con-
    version reactions eventually may be treated
    in mental health settings. Clients with other
    somatoform disorders typically are seen in
    medical settings.
  
  
  • Clients who cope with stress through soma-
    tizing are reluctant or unable to identify
    emotional feelings and interpersonal issues
    and have few coping abilities unrelated to
    physical symptoms.
  
  
  • Nursing interventions that may be effective
    with clients who somatize involve providing
    health teaching, identifying emotional feel-
    ings and stress, and using alternative coping
    strategies.
  
  
  • Coping strategies that are helpful to clients
    with somatoform disorders include relaxation
    techniques such as guided imagery and deep
    breathing, distraction such as music, and
    problem-solving strategies such as identify-
    ing stressful situations and new methods
    of managing them and role-playing social
    interactions.
  
  
  
  

I NTERNET R ESOURCES

Resource Internet Address

◗American Academy of Psychosocial Medicine http://www.apm.org

◗Hypochondria and Munchausen Syndrome http://www.diseaseworld.com

◗Body Dysmorphic Disorder http://www.sfwed.org/bdd.htm

◗Conversion Disorder http://www.emedicine.com/emerg/topic112.htm

◗Psychosomatics http://www.bma-wellness.com/psychiatry/

Psychosomatics.html

Critical Thinking Questions

1.When a client has somatoform pain disorder,

powerful analgesics such as narcotics are gen-

erally contraindicated, even though the client

is suffering unremitting pain. How might the

nurse feel when working with this client? How

does the nurse respond when the client says,

“You know I’m in pain! Why won’t you do

anything? Why do you let me suffer?”

2.Should there be limits on expensive medical

tests and procedures for clients with somato-

form disorder? Who should decide when

health care benefits are limited?

3.A mother is found to have caused a medical

crisis by giving her 6-year-old child a medica-

tion to which the child has a known severe

allergy. The mother is diagnosed as having

Munchausen’s by proxy. Should she be treated

in the mental health setting? Charged with a

criminal act? Why?