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Somatoform, Factitious, and Dissociative Disorders

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Title: Chapter 022 Subject: Somatoform, Factitious, and Dissociative Disorders Author: Varcarolis Description: Foundations of Psychiatric Mental Health Nursing, 6/e – PowerPoint PPT presentation

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Title: Somatoform, Factitious, and Dissociative Disorders


1
CHAPTER 22
  • Somatoform, Factitious, and Dissociative
    Disorders

2
Somatoform Disorders
  • Physical symptoms suggest a physical disorder for
    which there is no demonstrable base
  • Strong presumption that symptoms linked to
    psychobiological factors

3
Somatoform Disorders
  • Somatization disorder
  • Undifferentiated somatoform disorder
  • Conversion disorder
  • Pain disorder
  • Hypochondriasis
  • Body dysmorphic disorder
  • Somatoform disorder not otherwise specified

4
Somatization Disorder
  • Most common somatoform disorder
  • Significant functional impairment
  • Symptoms
  • Pain, GI symptoms, sexual symptoms, and
    pseudoneurological symptoms
  • Course of illness chronic and relapsing
  • Suicide threats and gestures common

5
Hypochondriasis
  • Misinterpretation of physical sensations
  • Overconcern for health and preoccupied with
    symptoms
  • Extreme worry and fear
  • Course of illness chronic and relapsing

6
Pain Disorder
  • Diagnostic testing rules out organic cause
  • Discomfort leads to impairment
  • Associated with higher rates of depression
  • Usual sites of pain are head, face, lower back,
    pelvis

7
Body Dysmorphic Disorder
  • Preoccupation with an imagined defective body
    part
  • Obsessional thinking and compulsive behavior
  • Fear of rejection by others, perfectionism, and
    conviction of being disfigured lead to emotions
    of disgust, shame and depression

8
Conversion Disorder
  • Presence of deficits in voluntary motor or
    sensory functions
  • Common symptoms paralysis, blindness, movement
    and gait disorders, numbness, paresthesias, loss
    of vision or hearing, or episodes resembling
    epilepsy
  • La belle indifférence versus distress
  • Comorbid conditions depression, anxiety, other
    somatoform disorders, personality disorders

9
Etiology
  • Biological factors
  • Genetics
  • Biochemical imbalances that cause pain to be
    experienced more intensely
  • Psychosocial factors
  • Psychoanalytic theory
  • Behavioral theory
  • Cognitive theory

10
Somatoform Disorders Assessment
  • Symptoms and unmet needs
  • Voluntary control of symptoms
  • Secondary gains
  • Cognitive style
  • Ability to communicate feelings and emotional
    needs
  • Dependence on medication

11
Somatoform DisordersImplementation
  • Basic level interventions
  • Promotion of self-care activities
  • Health teaching and health promotion
  • Case management
  • Pharmacological interventions
  • Advanced practice interventions
  • Psychotherapy

12
Factitious Disorders
  • Consciously pretend to be ill to get emotional
    needs met and attain status of patient
  • Three subtypes
  • Predominately physical symptoms
  • Predominantly psychological symptoms
  • Combinations of physical and psychological
    symptoms

13
Examples of Factitious Disorders
  • Factitious disorder with physical symptoms
  • Munchausen syndrome
  • Factitious disorder with psychological symptoms
  • Factitious disorder by proxy

14
Malingering
  • Symptoms are consciously produced or feigned
  • Have various motivations, including financial
    gain, relief of work duties, or obtaining illicit
    drugs
  • Obvious secondary gain(s)

15
Dissociative Disorders
  • Disturbances in the normally well-integrated
    continuum of consciousness, memory, identity, and
    perception
  • Unconscious defense mechanism
  • Protects individual against overwhelming anxiety

16
Depersonalization Disorder
  • Alteration in perception of self
  • Reality testing remains intact
  • Disturbing experiences of
  • Feeling a sense of deadness of the body
  • Seeing oneself from a distance
  • Perceiving limbs to be larger or smaller than
    normal

17
Dissociative Amnesia
  • Inability to recall important personal
    information
  • Often of traumatic or stressful nature
  • Generalized amnesia
  • Localized amnesia
  • Selective amnesia

18
Dissociative Fugue
  • Sudden unexpected travel away from the customary
    locale
  • Inability to recall ones identity and some or
    all of the past
  • During fugue state tend to live simple, quiet
    lives
  • When former identity remembered, become amnestic
    for time spent in fugue state

19
Dissociative Identity Disorder
  • Presence of two or more distinct personality
    states
  • Primary personality (host) usually not aware of
    alters
  • Alternate personality (alters) or
    subpersonalities take control of behavior
  • Alters often aware of each other
  • Each alter thinks and behaves as a separate
    individual

20
Dissociative Disorders Assessment
  • Identity and memory
  • History
  • Moods
  • Impact on patient and family
  • Suicide risk

21
Dissociative DisordersImplementation
  • Basic level interventions
  • Milieu therapy
  • Health teaching and health promotion
  • Pharmacological interventions
  • Advanced practice interventions
  • Cognitive-behavioral therapy
  • Psychodynamic psychotherapy

22
Personal Challenges to Professional Practice
  • Focus on your feelings and be cognizant of your
    reactions.
  • Monitor your own feelings of defensiveness,
    impatience, frustration, or anger toward the
    client.
  • Practice increased self-awareness.
  • Dont judge, criticize, or make assumptions.
  • Pain is determined and defined by the client.
  • Pain of psychic origin is as hurtful as pain of
    biologic origin.

23
Personal Challenges to Professional Practice
  • Be alert for signs of secondary gain.
  • Avoid reinforcing negative behaviors.
  • Address client with a matter-of-fact approach.
  • Reinforce adaptive vs. maladaptive behaviors.
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