1. Somatoform disorders -Affect all age groups
-Individuals learn at early age to express emotional distress through somatizaion.
-Complaints may bring them support and comfort that they may not otherwise receive.
-somatoform conditions are not uncommon in geriatric population
_Nurse or provider may be uncomfortable with therefore don’t judge and explore own feelings of anger or frustration— realize patient is in need of care

2. Causes of Somatization Disorders
Cerebral brain dysfunction typical of this disorder
Have subtle but unique abnormalities on test of non-dominant hemisphere function.
Environmental factors, genetic predisposition and heredity have been linked

3. Somatization disorders
Seen regularly by appointment so as not to require the presence of symptoms to be given medical care
Examine carefully each visit and do not subject to extensive investigations or hospitalization unless medically necessary
Most appropriate question to assess significance of somatization disorder is “Wht do you think about your problem”? (subjective data)
Most clients treated in Dr.’s office-refer to psychiatrist

4. Major challenge
Caregiver fatigue major challenge in managing the needs of clients with somatization disorders
Client can be extremely demanding, manipulative, and occasionally seductive
Care should be provided by a team of professionals to eliminate the possibility of
Cargiver fatigue

5. Major problem Failure to keep appointments with psychotherapist
Many don’t believe they are psychologically ill.
Seek different medical opinions to verify that they have a physical problem

6. Hypochondriais
Major worry—clients believe illness will recur and tend to become a major focus of individuals life an daily routine.
Often becomes difficult for them to function normally in their social and occupational role
May have a neurophysiological basis-due to reduced CNS inhibition of sensations beginning in somatic or visceral neural pathways

7. Continued
Some data indicate persons who enter therapy early in the course of this disorder have better prognosis and outcome compared to those who continue to receive only somatic evaluations and treatment
Success in treatment requires the individual abandon any belief that he has a dangerous undiagnosed condition. Greatest challenge; accomplished only after establishment of trust, reassurance regarding health and understanding a person’s perception of the body leading to overemphasis on symptoms and Illness

8. Continued
Needs to come to understand how his or her perception of bodily sensatiosn leads to overemphasis on illness or symptoms
Psychotherapy may focus on learning to ignore such symptoms through RETRAINING

9. Factitious Disorder
Involve physical or psychological symptoms that are intentionally produced to gain attention from potential caregivers.
The intention to fabricate symptoms distinguishes factitious disorders from the somatoform disorders where the individual honestly believes the symptoms represent an illness
Malingering also involves the fabrication of symptoms, but with malingering the purpose of the symptoms is to achieve some objective goal such as financial compensation or avoidng work.

10. Munchausen syndrome by proxy
Factitious disorder
Involves falsification of the illness of one’s child
Form of child abuse
Children may be exposed to unnecessary medical investigations or treatments
Childs mother may cause symptoms or change result of lab test so contact made be made with health provider

11. Conversion Disorder
Treatment is that the client often responds to direct explanation of the underlying psychological conflicts. Not true for more chronic conversion.
Chronic conversion symptoms are more difficult to treat with such an explantion and may required prolonged therapy

12. Somatization & Role Modeling Theory
Best advice is to listen to patient and build a nurse-patient relationship based on trust.
Nurses need to understand that by building such a relationship they are providing nursing care
In regard to this theory, when a client is impoverished (unable to mobilize own resources to deal with stressors) the nurse is guided to provide direct physical care

13. Jean Watson Theory of Human Caring
Unconditional positive regard
Nurse is instrumental in assisting the client to meet needs when the client is in a state of impoverishment
Nurse interacts with client without making demands for client to be something they are not
Clients unable to mobilize resources to deal with life’s stressors and needs caring support of nurses

14. Dissociative Identity Disorder
Individuals who possess two or more distinct identities at least two of which periodically take control of the individuals behavior-not at same time
Periods of amnesia are found and may be extensive
Expression of multiple identities (personalities) may be exceedingly dramatic and even colorful.
Each identity may have separate name, gender, voice or set of psychological symptoms

15. Dissociative fugue state
May experience periods of prolonged wandering
Challenge is to identify that an individual is actually in fugue state since these persons may function normally until detailed questioning reveals that they do not know who they are or why they are in a certain place
Believed to be unconscious avoidance of a particular place and unknowingly travel to a different place

16. Identity confusion
Clients with amnesia , dissociative fugue and dissociative identity disorder
There is loss of memory regarding past, or how one arrived at a particular destination or one’s identity
Each disorder is brought on by severe anxiety and creates a form of identity confusion

17. Dissociative phenomenon
Can occur when clients experience flashbacks, such as in PTSD; in fugue states; and while in an induced trance during a religious ceremony

18. Continued
Correctly intervening with a client diagnosed with DID requires that the therapist develop
considerable skill in confirming hx of severe trauma or abuse in early childhood, not contributing false memory syndrome or corroborating repressed memories
-A Client stating they found clothing in their closet they did not buy would be an indication of a client suffering from DID