Chapter 20Somatoform and
Dissociative Disorders
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These disorders encompass mind–body
interactions in which the brain, in ways
still not well understood, sends various
signals that impinge on the patient’s
awareness, indicating a serious problem
in the body.
Sadock & Sadock, 2008
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If worrying were harmless, it would not be much of a
problem. But worrying does take its toll. And if you
stress your system with excessive worry, it is likely
to wear out earlier.
Twerski, 1995
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Learning Objectives
After studying this chapter, you should be able to
•
Discuss the following factors or theories related to
somatoform disorders: biological or genetic factors,
organ specificity theory, Selye’s general adaptation
syndrome (GAS), familial or psychosocial theory, and
learning theory
•
Explain the following theories related to dissociative
disorders: state-dependent learning theory and
psychoanalytic theory
•
Compare and contrast the clinical symptoms of
somatization and conversion disorders
•
Distinguish between dissociative amnesia and
dissociative fugue
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Learning Objectives (cont.)
• Differentiate between anxiety disorder due to a general
medical condition and psychological factors affecting a
medical condition
• Relate the importance of addressing medical issues and
cultural differences when assessing a client with a
somatoform or dissociative disorder
• Articulate at least five common nursing diagnoses
appropriate for clients exhibiting somatoform or
dissociative disorders
• Formulate a nursing plan of care for a male client with
clinical symptoms of an anxiety disorder due to a
general medical condition (pneumonia)
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Anxiety-Related Disorders
• Anxiety can occur under many guises that are not
readily recognized by the nurse or practicing
clinician. For example, clients may experience
anxiety as the result of a specific medical condition
(eg, hyperparathyroidism), as a result of treatment
for a specific medical condition (eg, thyroid
medication), or as a result of changes in employment
or lifestyle due to a medical condition (eg,
myocardial infarct).
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Etiology of Somatoform and Dissociative
Disorders
• Theories regarding somatoform disorders:
– Biological and genetic factors
– Organ specificity theory
– Selye’s general adaptation syndrome (GAS)
– Familial or psychosocial theory
– Learning theory
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Etiology of Somatoform and Dissociative
Disorders (cont.)
• Theories regarding dissociative disorders:
– State-dependent learning theory
– Psychoanalytic theory
– Other factors
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Clinical Symptoms and Diagnostic
Characteristics
• Somatoform disorders:
– Body dysmorphic disorder
– Somatization disorder
– Conversion disorder
– Pain disorder
– Hypochondriasis
– Undifferentiated somatoform disorder
– Somatoform disorder, not otherwise specified
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Clinical Symptoms and Diagnostic
Characteristics (cont.)
• Dissociative disorders:
– Dissociative amnesia
– Dissociative fugue
– Dissociative identity disorder
– Depersonalization disorder
– Dissociative disorder, not otherwise specified
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Clinical Symptoms and Diagnostic
Characteristics (cont.)
• Anxiety disorder due to a general medical condition
• Psychological factors (anxiety) affecting medical
condition
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The Nursing Process
• Assessment
• Nursing diagnoses
• Outcome identification
• Planning interventions
• Implementation
• Evaluation
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Assessment
• Assessment of clients with a comorbid medical diagnosis
• Assessment of clients with somatoform disorders
• Assessment of clients with dissociative disorders
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Nursing Diagnoses
• Activity intolerance
• Anxiety
• Acute confusion
• Impaired social interaction
• Adult failure to thrive
• Ineffective coping
• Ineffective health
maintenance
• Fatigue
• Impaired physical mobility
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Outcome Identification
Outcomes are based on the client’s ability to do the following:
• Recognize his or her own anxiety
• Identify stressors related to the present physical condition
• Identify ways to modify or eliminate the stressors
• Relate an increase in psychological and physiologic comfort
• Develop effective coping skills to avoid exacerbation of any
comorbid medical conditions, somatoform disorders, or
dissociative disorders
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Planning Interventions
After the client’s medical condition is stabilized, interventions
are planned to help the client:
• Develop insight into his or her condition
• Develop effective coping skills to reduce anxiety and avoid
exacerbation of any coexisting medical condition
• Identify supportive therapies that will reduce anxiety
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Implementation
• Assistance in meeting basic needs
• Medication management
– Medication management for somatoform disorders
– Medication management for dissociative disorders
• Interactive therapies and behavioral interventions
• Holistic approach
• Project SMART
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Evaluation
Clients who respond to treatment are able to do the
following:
• Identify anxiety-producing stressors
• Demonstrate insight into their specific disorder
• Exhibit effective coping skills
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Key Terms
• Anxiety disorder due to a
general medical condition
• General adaptation syndrome
(GAS)
• Body dysmorphic disorder
• Hypochondriasis
• Conversion disorder
• Depersonalization disorder
• Dissociative amnesia
• Dissociative disorder
• La belle indifference
• Pain disorder
• Primary gain
• Pseudoneurologic manifestation
• Dissociative fugue
• Psychological factors affecting
medical condition
• Dissociative identity disorder
• Secondary gain
• Dysmorphobia
• Somatization disorder
• Somatoform disorders
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Reflection
Reflect on the chapter-opening quote by Sadock and
Sadock. Explain the phrase “the brain…sends signals that
may impinge on the patient’s awareness, indicating a
serious problem in the body.” Cite at least three examples
of possible stress- or anxiety-induced medical problems.
• What interventions would you provide for each of
these medical problems to minimize the effect of
further stress or anxiety?
?
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