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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