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Chapter 21
Somatic Symptom
Illnesses
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Somatic Symptom Illnesses
• Psychosomatic: connection between mind (psyche) and
body (soma)
• Hysteria: multiple physical complaints with no organic
basis
– Proposal by Freud that people can convert
unexpressed emotions into physical symptoms
• Somatization: transference of mental experiences, states
into body symptoms
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Somatic Symptom Illnesses (cont.)
• Three central features
– Physical complaints suggest major medical illness but
have no demonstrable organic basis
– Psychological factors and conflicts seem important in
initiating, exacerbating, maintaining symptoms
– Symptoms or magnified health concerns are not
under patient’s conscious control
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Types of Somatic Symptom Illnesses
• Somatic symptom illness: multiple physical symptoms—
combination of pain, GI, sexual, pseudoneurologic
symptoms
• Conversion disorder: unexplained sensory or motor
deficits associated with psychological factors; typically
involves significant functional impairment; “la belle
indifference”
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Types of Somatic Symptom Illnesses
(cont.)
• Pain disorder: pain unrelieved by analgesics;
psychological factors influencing onset, severity,
exacerbation, maintenance
• Illness anxiety disorder (hypochondriasis): disease
conviction or disease phobia
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Onset and Clinical Course
• Symptoms usually onset in adolescence or early
adulthood
• All either chronic or recurrent
• Patients go from one physician or clinic to another, or see
multiple providers at once, to obtain relief of symptoms
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Question
• Is the following statement true or false?
• A patient with a somatic symptom illness is able to
voluntarily control the symptoms.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• False
• Rationale: The symptoms of somatic symptom illness are
not under the patient’s voluntary control.
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Related Disorders
• Malingering: intentional false or grossly exaggerated
symptoms; external incentives as motivation
• Factitious disorder: intentional symptoms to gain
attention (Munchausen’s syndrome = imposed upon self)
– Munchausen’s syndrome by proxy = imposed upon
others
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Related Disorders (cont.)
• Malingering and factitious disorders: willful control of
symptoms; somatic symptom illnesses—no voluntary
control over symptoms
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Etiology
• Psychosocial theories
– Internalization
– Primary gains: direct external benefits of being sick
provide relief of anxiety, conflict, distress
– Secondary gains: person receives internal or
personal benefits from others because one is sick.
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Etiology (cont.)
• Biologic theories:
– Differences in regulation, interpretation of stimuli
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Cultural Considerations
• Variable in frequency, meaning across cultures (see
Table 21.1)
– Dhat (men in India)
– Koro (Southeast Asia)
– Falling-out episodes
– Hwa-byung (Korean folk syndrome)
– Shenjing shuariuo (China)
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Treatment
• Symptom management, improvement in quality of life
• Antidepressants for accompanying depression: SSRIs
(see Table 21.2)
• Pain clinic referral for disorder
• Involvement in therapy groups
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Somatic Symptom Illnesses and Nursing
Process Application
• Assessment
– Investigation of physical health status; screening (se
Box 21.1)
– History: usually detailed medical history; distress
about health status (except patient with conversion
disorder who displays la belle indifference)
– General appearance, motor behavior
– Mood, affect: labile; exaggerated emotions
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
• A patient with a factitious disorder develops symptoms
primarily for attention.
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Answer
• True
• Rationale: Factitious disorder occurs when a person
intentionally produces or feigns physical or psychological
symptoms solely to gain attention.
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Somatic Symptom Illnesses and Nursing
Process Application (cont.)
• Assessment (cont.)
– Thought process, content: focus on symptoms
– Sensorium, intellectual processes
– Judgment, insight
– Self-concept: focus on physical self
– Roles, relationships: problems
– Physiologic, self-care concerns (Box 21.2)
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Somatic Symptom Illnesses and Nursing
Process Application (cont.)
• Data analysis/nursing diagnoses
• Outcome identification
– Identify relationship between stress and physical
symptoms
– Verbally express emotions/feelings
– Establish and follow a daily routine
– Demonstrate alternate ways to deal with stress,
anxiety, and other feelings
– Demonstrate healthy behaviors regarding rest,
activity, and nutritional intake
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Somatic Symptom Illnesses and Nursing
Process Application (cont.)
• Intervention
– Provide health teaching: improved health behaviors
– Help express emotions: journaling; limiting time
spent on physical complaints
– Teach coping strategies
• Emotion-focused coping strategies
• Problem-focused coping strategies
• Evaluation
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Community-Based Care
• Appropriate referrals, such as pain clinic for patients with
pain disorder
• Information about community support groups
• Pleasurable activities or hobbies
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Question
• Which of the following would be an example of a
problem-focused coping strategy?
–
–
–
–
A. Progressive relaxation
B. Deep breathing
C. Interaction role-playing
D. Guided imagery
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Answer
•
C. Interaction role-playing
• Rationale: Interaction role-playing is an example of a
problem-focused coping strategy.
– Progressive relaxation, deep breathing, and guided
imagery are emotion-focused coping strategies.
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Mental Health Promotion
• Assist patients to deal directly with emotional issues
• Assist patients to continue gaining knowledge about
themselves, their emotional needs
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Self-Awareness Issues
• Deal with feelings of frustration.
• Be realistic about small successes.
• Validate patient’s feelings.
• Deal with feeling that patient “could do better if he tried.”
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