Chapter 15Chapter 15

Somatoform and Somatoform and Dissociative DisordersDissociative Disorders

Somatoform DisordersSomatoform Disorders• Physical symptoms suggest a physical Physical symptoms suggest a physical

disorderdisorder

• Diagnostic tests are negative for physical Diagnostic tests are negative for physical illnessillness

• Symptoms are linked to psychobiological Symptoms are linked to psychobiological factorsfactors

Dissociative DisordersDissociative Disorders

• Disturbances in the normally well-Disturbances in the normally well-integrated continuum of consciousness, integrated continuum of consciousness, memory, identity, and perceptionmemory, identity, and perception

Somatoform Disorders Somatoform Disorders Differentiated fromDifferentiated from

• MalingeringMalingering

– Intentionally producing symptoms to Intentionally producing symptoms to achieve an environmental goalachieve an environmental goal

• Factitious disorderFactitious disorder

– Fabrication of symptoms or self-inflicted Fabrication of symptoms or self-inflicted injury to assume the sick roleinjury to assume the sick role

• Psychosomatic illnessPsychosomatic illness

– A general medical condition affected by A general medical condition affected by stress or psychological factorsstress or psychological factors

Somatoform DisordersSomatoform Disorders

• Somatization disorderSomatization disorder

• HypochondriasisHypochondriasis

• Pain disorderPain disorder

• Body dysmorphic disorderBody dysmorphic disorder

• Conversion disorderConversion disorder

Somatization DisorderSomatization Disorder

• Most frequent symptomsMost frequent symptoms

– Pain, dysphagia, nausea, bloating, Pain, dysphagia, nausea, bloating, constipation, palpitations, dizziness, constipation, palpitations, dizziness, shortness of breathshortness of breath

• Significant functional impairmentSignificant functional impairment

• Course of illness chronic and relapsingCourse of illness chronic and relapsing

• Suicide threats and gestures commonSuicide threats and gestures common

HypochondriasisHypochondriasis

• Misinterpretation of physical sensationsMisinterpretation of physical sensations

• Diagnostic tests are negativeDiagnostic tests are negative

• Depression or anxiety disorders commonDepression or anxiety disorders common

• History of childhood trauma possibleHistory of childhood trauma possible

Pain DisorderPain Disorder

• Diagnostic testing rules out Diagnostic testing rules out organic causeorganic cause

• Discomfort leads to impairmentDiscomfort leads to impairment

• Suicide a serious risk factorSuicide a serious risk factor

• Usual sites of pain: head, face, Usual sites of pain: head, face, lower back, pelvislower back, pelvis

Body Dysmorphic DisorderBody Dysmorphic Disorder

• Preoccupation with an imagined Preoccupation with an imagined defective body partdefective body part

• Obsessional thinking and compulsive Obsessional thinking and compulsive behaviorbehavior

• Impaired social, academic, or Impaired social, academic, or occupational functioningoccupational functioning

• Major depression, OCD, and social Major depression, OCD, and social phobia commonphobia common

Conversion DisorderConversion Disorder

• Presence of deficits in voluntary motor or Presence of deficits in voluntary motor or sensory functionssensory functions

• Common symptoms: involuntary Common symptoms: involuntary movements, seizures, paralysis, abnormal movements, seizures, paralysis, abnormal gait, anesthesia, blindness, deafnessgait, anesthesia, blindness, deafness

• "La belle indifférence" versus distress"La belle indifférence" versus distress

• Comorbid conditions: depression, anxiety, Comorbid conditions: depression, anxiety, other somatoform disorders, personality other somatoform disorders, personality disordersdisorders

Somatoform Disorders: Somatoform Disorders: AssessmentAssessment

• Symptoms and unmet needsSymptoms and unmet needs

• Voluntary control of symptomsVoluntary control of symptoms

• Secondary gainsSecondary gains

• Cognitive styleCognitive style

• Ability to communicate feelings Ability to communicate feelings and emotional needsand emotional needs

• Dependence on medicationDependence on medication

Somatoform Disorders: Somatoform Disorders: Basic Level Nursing InterventionsBasic Level Nursing Interventions

• Promotion of self-care activitiesPromotion of self-care activities

• Health teachingHealth teaching

• Case managementCase management

• Psychobiological interventionsPsychobiological interventions

Somatoform Disorders: Somatoform Disorders: Advanced Practice InterventionsAdvanced Practice Interventions

• PsychotherapyPsychotherapy

Dissociative DisordersDissociative Disorders

• Depersonalization disorderDepersonalization disorder

• Dissociative amnesiaDissociative amnesia

• Dissociative fugueDissociative fugue

• Dissociative identity disorderDissociative identity disorder

Depersonalization DisorderDepersonalization Disorder

• Alteration in perception of selfAlteration in perception of self

• Disturbing experiences ofDisturbing experiences of

– Feeling a sense of deadness of the bodyFeeling a sense of deadness of the body

– Seeing oneself from a distanceSeeing oneself from a distance

– Perceiving limbs to be larger or smaller Perceiving limbs to be larger or smaller than normalthan normal

• Reality testing remains intactReality testing remains intact

Dissociative AmnesiaDissociative Amnesia

• Inability to recall important personal Inability to recall important personal informationinformation

– Generalized amnesiaGeneralized amnesia

– Localized amnesiaLocalized amnesia

– Selective amnesiaSelective amnesia

Dissociative FugueDissociative Fugue

• Sudden unexpected travel away from Sudden unexpected travel away from the customary localethe customary locale

• Inability to recall one's identity and Inability to recall one's identity and some or all of the pastsome or all of the past

• During fugue state tend to live simple, During fugue state tend to live simple, quiet livesquiet lives

• When remember former identity, When remember former identity, become amnesic for time spent in become amnesic for time spent in fugue statefugue state

Dissociative Identity DisorderDissociative Identity Disorder

• Presence of two or more distinct Presence of two or more distinct personality statespersonality states

• Primary personality (host) usually not Primary personality (host) usually not aware of altersaware of alters

• Alternate personality (alters) or Alternate personality (alters) or subpersonalities take control of behaviorsubpersonalities take control of behavior

• Alters often aware of each otherAlters often aware of each other

• Each alter thinks and behaves as a Each alter thinks and behaves as a separate individualseparate individual

Dissociative Disorders: Dissociative Disorders: AssessmentAssessment

• Identity and memoryIdentity and memory

• Client historyClient history

• MoodsMoods

• Use of alcohol and other drugsUse of alcohol and other drugs

• Impact on client and familyImpact on client and family

• Suicide riskSuicide risk

Dissociative Disorders: Dissociative Disorders: Basic Level Nursing InterventionsBasic Level Nursing Interventions

• Milieu therapyMilieu therapy

• Health teachingHealth teaching

• Psychobiological interventionsPsychobiological interventions

Dissociative Disorders: Dissociative Disorders: Advanced Practice InterventionsAdvanced Practice Interventions

• Cognitive-behavioral therapyCognitive-behavioral therapy

• Psychodynamic psychotherapyPsychodynamic psychotherapy