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Somatoform and Sleep
Disorders
Nursing 201
characterized
• physical symptoms suggesting medical disease
but without a demonstrable organic
pathological condition or a known
pathophysiological mechanism to account for
them.
• Somatoform disorders are more common
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In women than in men
In those who are poorly educated
In those who live in rural communities
In those who are poor
Predisposing Factors
• Theory of family dynamics
– “Psychosomatic families”
– Role modeling
• Cultural and environmental factors
– Low socioeconomic, occupational, and
educational status
• Genetic factors
– Possible inheritable predisposition
• Transactional Model of Stress/Adaptation
– The etiology of somatization disorder is more likely influenced by
multiple factors
Pain Disorder: Assessment
• The predominant disturbance in pain disorder is
severe and prolonged pain that causes
– Clinically significant distress
– Impairment in social, occupational, or other areas of
functioning
• Even when an organic pathological condition is
detected, the pain complaint may be evidenced
by correlation of a stressful situation with onset
of symptoms.
Nursing Process
• Assessment: A syndrome of multiple somatic
symptoms that cannot be explained medically
and are associated with psychosocial distress and
long-term seeking of assistance from health care
professionals.
• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation
• The disorder may be maintained by:
– Primary gains: the symptom enables the client to avoid
some unpleasant activity.
– Secondary gains: the symptom promotes emotional
support or attention for the client.
• Psychodynamic theory
– Symbolically expressing an intrapsychic conflict through
the body
• Behavior theory
– Negative reinforcement results when the pain behavior prevents an
undesirable phenomenon from occurring (i.e., provides relief from
responsibilities for the client)
• Theory of family dynamics
– “Pain games”
– Tertiary gain
• Neurophysiological theory
– Afferent pain fibers
– Serotonin/endorphins
• Neurophysiological theory
– Afferent pain fibers
– Serotonin/endorphins
Hypochondriasis: Assessment
• Unrealistic or inaccurate interpretation of
physical symptoms or sensations, leading to
preoccupation and fear of having a serious
disease
• Even in the presence of medical disease, the symptoms
grossly exceed extent of pathological condition.
• Anxiety and depression are common findings, and
obsessive-compulsive traits frequently accompany
the disorder.
Nursing Process
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Nursing Diagnosis
Planning/Implementation
Outcomes
Evaluation
Predisposing Factors
• Psychodynamic theory
– Ego-defense mechanism
– Transformation of aggressive and hostile wishes toward others into
physical complaints about self to others
– Defense against guilt
• Cognitive theory
– Hypochondriasis arises out of perceptual and cognitive
abnormalities.
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Social learning theory
– Somatic complaints are often reinforced when the
sick role relieves the client of the need to deal with a
stressful situation.
• Past experience with physical illness
– Previous experience can predispose to
hypochondriasis.
*Genetic influences
• Transactional Model of Stress/Adaptation
– The etiology of hypochondriasis is likely
influenced by multiple factors.
Conversion Disorder:
Assessment
• A loss of or change in body function resulting from a
psychological conflict, the physical symptoms of which
cannot be explained by any known medical disorder
or pathophysiological mechanism
• The client often expresses a relative lack of concern that
is out of keeping with the severity of the impairment.
This lack of concern is termed la belle indifference and
may be a clue to the physician that the problem is
psychological rather than physical.
Nursing Process
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Nursing Diagnosis
Planning/Implementation
Outcomes
Evaluation
Predisposing Factors
• Psychoanalytical theory
– Emotions associated with the traumatic event that the client
cannot express because of moral or ethical unacceptability are
“converted” into physical symptoms.
• Familial factors
– Findings suggest that conversion disorder occurs more often in
relatives of people with the disorder.
• Neurophysiological theory
– Central nervous system involved. Excessive cortical arousal creating
a negative feedback loop between the cerebral cortex and the
brainstem reticular formation.
• Behavioral theory
– Learned through positive reinforcement from cultural, social, and
interpersonal influences
• Transactional Model of Stress/Adaptation
– The etiology of conversion disorder is most
likely influenced by multiple factors.
Body Dysmorphic Disorder:
Assessment
• Characterized by the exaggerated belief that the
body is deformed or defective in some specific
way
• Common complaints involve imagined or slight
flaws of face or head
• Symptoms of depression and characteristics
associated with OCD common in people with
body dysmorphic disorder
Nursing Process
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Nursing Diagnosis
Planning/Implementation
Outcomes
Evaluation
Predisposing Factors
• Etiology unknown
– In some clients, belief is result of another more
pervasive psychiatric disorder, such as
schizophrenia, major mood disorder, or anxiety
disorder
– Classified as one of several monosymptomatic
hypochondriacal syndromes
• Defined as the fear of some physical defect
thought to be noticeable to others although
the client appears normal.
Sleep Disorders: Introduction
• About 75 percent of adult Americans suffer from a sleep
problem.
• 69% of all children experience sleep problems
• The prevalence of sleep disorders increases with
advancing age
• Sleep disorders add an estimated $28 billion to the
national health care bill.
• Common types of sleep disorders include insomnia,
hypersomnia, parasomnias, and circadian rhythm
sleep disorders
Sleep Disorders: Assessment
• Insomnia
– Difficulty falling or staying sleep
• Hypersomnia (somnolence)
– Excessive sleepiness or seeking excessive amounts of
sleep
• Narcolepsy: Similar to hypersomnia
– Characteristic manifestation: Sleep attacks; the person
cannot prevent falling asleep
• Parasomnias
– Nightmares, sleep terrors, sleep walking
• Sleep terror disorder
– Manifestations include abrupt arousal from
sleep with a piercing scream or cry
• Circadian rhythm sleep disorders
– Shift-work type
– Jet-lag type
– Delayed sleep phase type
Nursing Process
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Nursing Diagnosis
Planning/Implementation
Outcomes
Evaluation
Predisposing Factors
• Genetic or familial patterns are thought to play a
contributing role in primary insomnia, primary
hypersomnia, narcolepsy, sleep terror disorder, and
sleepwalking.
• Various medical conditions, as well as aging, have been
implicated in the etiology of insomnia.
• Psychiatric or environmental conditions can contribute to
insomnia or hypersomnia.
• Activities that interfere with the 24-hour circadian rhythm
hormonal and neurotransmitter functioning within the body
predispose people to sleep-wake schedule disturbances.
Treatment Modalities
• Somatoform disorders
– Individual psychotherapy
– Group psychotherapy
– Behavior therapy
– Psychopharmacology
Sleep disorders
– Relaxation therapy
– Biofeedback
– Pharmacotherapy
• Primary hypersomnia/narcolepsy
– Pharmacotherapy
– CNS stimulants such as amphetamines
• Parasomnias
– Centers around measures to relieve obvious stress
within the family
– Individual or family therapy
– Interventions to prevent injury