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Chapter 15
Somatoform and
Dissociative Disorders
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Somatoform Disorders
• Physical symptoms suggest a physical
disorder
• Diagnostic tests are negative for physical
illness
• Symptoms are linked to psychobiological
factors
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Dissociative Disorders
• Disturbances in the normally wellintegrated continuum of consciousness,
memory, identity, and perception
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Somatoform Disorders
Differentiated from
• Malingering
– Intentionally producing symptoms to
achieve an environmental goal
• Factitious disorder
– Fabrication of symptoms or self-inflicted
injury to assume the sick role
• Psychosomatic illness
– A general medical condition affected by
stress or psychological factors
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Somatoform Disorders
• Somatization disorder
• Hypochondriasis
• Pain disorder
• Body dysmorphic disorder
• Conversion disorder
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Somatization Disorder
• Most frequent symptoms
– Pain, dysphagia, nausea, bloating,
constipation, palpitations, dizziness,
shortness of breath
• Significant functional impairment
• Course of illness chronic and relapsing
• Suicide threats and gestures common
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Hypochondriasis
• Misinterpretation of physical sensations
• Diagnostic tests are negative
• Depression or anxiety disorders common
• History of childhood trauma possible
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Pain Disorder
• Diagnostic testing rules out
organic cause
• Discomfort leads to impairment
• Suicide a serious risk factor
• Usual sites of pain: head, face,
lower back, pelvis
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Body Dysmorphic Disorder
• Preoccupation with an imagined
defective body part
• Obsessional thinking and compulsive
behavior
• Impaired social, academic, or
occupational functioning
• Major depression, OCD, and social
phobia common
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Conversion Disorder
• Presence of deficits in voluntary motor or
sensory functions
• Common symptoms: involuntary
movements, seizures, paralysis, abnormal
gait, anesthesia, blindness, deafness
• "La belle indifférence" versus distress
• Comorbid conditions: depression, anxiety,
other somatoform disorders, personality
disorders
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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
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Somatoform Disorders:
Basic Level Nursing Interventions
• Promotion of self-care activities
• Health teaching
• Case management
• Psychobiological interventions
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Somatoform Disorders:
Advanced Practice Interventions
• Psychotherapy
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Dissociative Disorders
• Depersonalization disorder
• Dissociative amnesia
• Dissociative fugue
• Dissociative identity disorder
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Depersonalization Disorder
• Alteration in perception of self
• 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
• Reality testing remains intact
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Dissociative Amnesia
• Inability to recall important personal
information
– Generalized amnesia
– Localized amnesia
– Selective amnesia
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Dissociative Fugue
• Sudden unexpected travel away from
the customary locale
• Inability to recall one's identity and
some or all of the past
• During fugue state tend to live simple,
quiet lives
• When remember former identity,
become amnesic for time spent in
fugue state
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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
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Dissociative Disorders:
Assessment
• Identity and memory
• Client history
• Moods
• Use of alcohol and other drugs
• Impact on client and family
• Suicide risk
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Dissociative Disorders:
Basic Level Nursing Interventions
• Milieu therapy
• Health teaching
• Psychobiological interventions
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Dissociative Disorders:
Advanced Practice Interventions
• Cognitive-behavioral therapy
• Psychodynamic psychotherapy
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