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Chapter 22
Physical Problems, Psychological
Sources
Copyright © 2013 by Elsevier Inc. All rights reserved.
Learning Objectives
1)
2)
3)
4)
5)
Explain the purpose of the physiological stress
response.
Illustrate how stress can affect immune
system functions.
Describe five physical responses related to
the physiological stress response.
Examine three theories that explain the role of
emotions in the development of illnesses.
Compare three culturally related somatization
disorders.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 2
Learning Objectives
6)
7)
8)
9)
Explain the differences between conversion
disorders and somatization disorders.
Describe the most essential feature of
hypochondriasis.
Compare the differences between
hypochondriasis and malingering.
Plan three therapeutic goals when caring for
clients with psychophysiological disorders.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 3
Role of Emotions in Health
(p. 250)


Health is a concept that embodies the whole
person.
Animals have evolved a stress response
mechanism that protects them during times of
threat or illness.

Fight-or-flight response
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 4
Anxiety and Stress (p. 251)

Stressors of modern life are many, but outlets
for the stress response are few.


Physiological stress response
• Biochemical fight-or-flight system
General adaptation syndrome
• Biochemical reactions of the stress response and their
effects on various body systems
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 5
Anxiety and Stress cont’d.
(p. 251)



The immune system is affected by stress levels.
The psychological aspects of an individual have
a strong impact on the ability to identify and
successfully cope with stress.
Physical problems that arise from psychological
sources create disorders such as



Somatoform disorders
Psychosomatic disorders
Psychophysical disorders
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 6
Anxiety and Stress cont’d.
(p. 251)

Childhood disorders

Individuals learn how to perceive and respond to
stress in childhood.
• Children who have experienced an unstable home
environment may react to stress as adults with
exaggerated hormonal mechanisms.
• Families who emotionally support and encourage their
children to effectively cope with their stresses have few
physical complaints.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 7
Common Psychophysical
Problems (p. 252)

Psychophysical disorder



Stress-related physical problems
The body system that experiences much of the
stress response is the gastrointestinal tract.
Psychophysical theories


Stress response theory
• Individuals are biochemically patterned to react to stress.
Carl Jung’s theory
• Symbolism attached to a symptom or illness
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 8
Common Psychophysical
Problems cont’d. (p. 252)

Psychophysical theories

Erich Fromm’s theory
• Certain personality types are prone to develop certain
illnesses.

Organic weakness theory
• Every individual has one body system that is more
sensitive than other systems.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 9
Somatoform Disorders (p. 253)

Somatization

Feeling the physical symptoms in the absence of
disease or out of proportion to an ailment
• Almost 80% of basically healthy people have somatic
symptoms in any given week.


Signs and symptoms of illness may be the client’s
way of coping with emotional distress.
Emotional stress depletes the body’s energies,
resulting in decreased immune function, which can
make the person more susceptible to actual illness
and disease.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 10
Somatoform Disorders cont’d.
(p. 253)

Cultural influences



Many somatic illnesses are based on cultural or
spiritual beliefs.
Assessments and treatment plans must not
threaten or challenge these beliefs if therapeutic
interventions are to be effective.
The effective health care provider does not
hesitate to learn as much as possible about other
cultures.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 11
Somatoform Disorders cont’d.
(p. 254)

Criteria for diagnosis



No organic medical condition that explains the
symptoms can be found.
The disorder significantly disrupts or impairs one’s
level of functioning.
The client is unaware of or is unable to express
his or her emotional distress.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 12
Somatoform Disorders cont’d.
(p. 254)

Somatization disorder



Polysymptomatic disorder
• Condition is associated with many signs and symptoms.
Both genetic and environmental factors contribute
to the risk of developing a somatization disorder.
Often, clients with a somatization disorder seek
treatment from several physicians at the same
time.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 13
Somatoform Disorders cont’d.
(p. 255)

How to differentiate a somatization disorder
from a medical problem:



Involvement of multiple organ systems suggests a
somatization disorder.
The disorder is characterized by early onset and is
a chronic condition in which no physical changes
occur over time.
The absence of any significant laboratory values
indicates that the underlying problems may be
emotionally based.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 14
Conversion Disorders (p. 255)

Conversion disorder


Considered to be a somatoform disorder in which
the individual presents problems related to
sensory or motor functions
Conversion disorders appear more commonly in
• Persons of lower socioeconomic status
• Those living in rural areas
• Individuals with little health care knowledge
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 15
Conversion Disorders cont’d.
(p. 256)


Conversion disorders are thought to result
from emotional (psychic) conflict.
Signs and symptoms tend to be more in
keeping with the individual’s ideas of what the
problems should be.

La Belle indifference
• Lack of concern or indifference about signs or symptoms
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 16
Hypochondriasis (p. 257)

Hypochondriasis


A somatoform disorder in which one has an
intense fear of or preoccupation with having a
serious disease or medical condition based on
misinterpretation of body signs and symptoms
Clients commonly “doctor shop.”
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 17
Factitious Disorders and
Malingering (p. 257)


Factitious disorders and malingering differ from
somatoform disorders in that signs and symptoms
are produced intentionally.
Factitious disorder

Clients willfully produce the signs or symptoms of illness
for some form of gain.
 Factitious disorder by proxy (Munchausen’s syndrome)
involves intentionally producing signs and symptoms in
another person.

Malingering

Individual produces symptoms to meet a recognizable
goal.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 18
Implications for Care Providers
(p. 258)

Goals of care




Rule out the presence of any physical disease or
dysfunction.
Develop a trusting caregiver-client relationship.
Encourage the expression of feelings and
emotional states rather than physical complaints.
Meet physical needs when necessary, but
encourage independence.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 19
Question 1
When an individual perceives stress, the body
initiates a cascade of biochemicals and
releases the body’s four major hormones.
Which of the following is not one of the four
major stress hormones?
1)
Dopamine
2)
Epinephrine
3)
Norepinephrine
4)
Oxytocin
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 20
Question 2
The nurse is admitting a client who has a
somatic disorder that includes mal ojo. To which
culture does the client belong?
1)
Japanese
2)
Southeast Asian
3)
Hispanic
4)
East Indian
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 21
Question 3
The nurse is admitting a male client who has had many
physical complaints, with symptoms beginning at 20 years of
age and occurring over a period of several years. The
complaints have resulted in treatment and significant
impairment in social functioning. He has had four pain
symptoms, two gastrointestinal symptoms, one sexual
symptom, and one symptom that suggests a neurological
disorder. These features suggest what type of disorder?
1)
Conversion disorder
2)
Somatization disorder
3)
Hypochondriasis
4)
None of the above
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 22
Question 4
The nurse is admitting a client who needs to vent his
anger but feels that a display of anger is inappropriate.
He has now developed ulcerative colitis and high blood
pressure as a way of dealing with his anger. The client’s
illness that resulted from his inability to vent his anger is
known as:
1)
Stress response theory
2)
Symbolism
3)
Personality type
4)
Organic weakness
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 23
Question 5
The most important feature of a factitious disorder
is that:
1)
Only the client knows for sure what is really
going on
2)
The individual does not believe that he is really
sick
3)
The family and friends go along with the
disorder
4)
Symptoms are produced purposefully so that
the individual can assume the sick role
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 24