NCM 117: LEC 14 (04/08/24) These deficits suggest a neurologic

SOMATIC SYMPTOM DISORDERS

disorder but are associated with
psychological factors. There is usually
significant functional impairment. There
Somatic symptom disorders are characterized by may be an attitude of la belle
physical symptoms suggesting medical disease but indifférence, a seeming lack of concern or
without demonstrable organic pathology or known distress, about the functional loss.
pathophysiological mechanism to account for them.  ILLNESS ANXIETY DISORDER, formerly
hypochondriasis, is preoccupation with the fear
 Psychosomatic began to be used to convey the that one has a serious disease (disease
connection between the mind (psyche) and the conviction) or will get a serious disease (disease
body (soma) in states of health and illness. phobia). It is thought that clients with this
 Hysteria refers to multiple physical complaints disorder misinterpret bodily sensations or
with no organic basis; the complaints are usually functions.
described dramatically.
Somatic symptom illnesses are more common in women than in
 Somatization is defined as the transference of
men; they may represent about 5% to 7% of the general population,
mental experiences and states into bodily but estimates can vary greatly. Because most people with illness
symptoms. anxiety are seen in general medical or family practice settings, it is
difficult to make accurate estimates of occurrence. Reports of pain
THREE CENTRAL FEATURES OF are one of the most common complaints in medical practice, and it is
difficult to distinguish physical from psychological causation.
SOMATIC SYMPTOM
ILLNESSES: RELATED DISORDERS
 Physical complaints suggest major medical FABRICATED OR INDUCED ILLNESS
illness but have no demonstrable organic basis.
Body-related mental disorders, in which people
 Psychological factors and conflicts seem
feign or intentionally produce symptoms for some
important in initiating, exacerbating, and
purpose or gain.
maintaining the symptoms.
 Symptoms or magnified health concerns are not In malingering and factitious disorders, people
under the client’s conscious control. willfully control the symptoms.

Somatic symptom and related disorders are In somatic symptom illnesses, clients do not
classified as mental disorders, by the DSM-5, when the voluntarily control their physical symptoms.
excessive focus on somatic symptoms is beyond any
 MALINGERING is the intentional production of
medical explanation and it causes significant distress
false or grossly exaggerated physical or
and impairment in one's functioning.
psychological symptoms; it is motivated by
SOMATIC DISORDERS external incentives such as avoiding work,
evading criminal prosecution, obtaining financial
 SOMATIC SYMPTOM DISORDER is compensation, or obtaining drugs. People who
characterized by one or more physical malinger can stop the physical symptoms as soon as they
symptoms that have no organic basis. have gained what they wanted.
Individuals spend a lot of time and energy  FACTITIOUS DISORDER, imposed on self,
focused on health concerns, often believe occurs when a person intentionally produces or
symptoms to be indicative of serious illness, and feigns physical or psychological symptoms solely
experience significant distress and anxiety about to gain attention.
their health.  The common term for factitious disorder
 PAIN DISORDER has the primary physical imposed on self is Munchausen
symptom of pain, which is generally unrelieved syndrome. Munchausen syndrome by proxy,
by analgesics and greatly affected by occurs when a person inflicts illness or injury on
psychological factors in terms of onset, severity, someone else to gain the attention of emergency
medical personnel or to be a “hero” for saving the
exacerbation, and maintenance.
victim.
 CONVERSION DISORDER, sometimes called
conversion reaction, involves unexplained,
usually sudden deficits in sensory or motor
function (e.g., blindness, paralysis).
 SOMATIC DISORDERS 5. Excessive use of analgesics.
6. Requests for surgery.
ETIOLOGY 7. Assumption of an invalid role.
8. Impairment in social or occupational functioning
PSYCHOSOCIAL THEORIES
because of preoccupation with physical
Psychosocial theorists believe that people with complaints.
somatic symptom illnesses keep stress, anxiety, or 9. Psychosexual dysfunction (impotence,
frustration inside rather than expressing them dyspareunia (painful coitus), sexual
outwardly. This is called internalization. Both indifference).
internalization and somatization are unconscious 10. Excessive dysmenorrhea.
defense mechanisms. 11. Excessive anxiety and fear of having a serious
illness.
Psychosocial theorists posit that increased incidence
12. Objective evidence that a general medical
of somatization in women may be related to various
condition has been precipitated by or is being
factors:
perpetuated by psychological or behavioral
 Boys in the United States are taught to be stoic circumstances.
and to “take it like a man,” causing them to offer 13. Conscious, intentional feigning of physical or
fewer physical complaints as adults. psychological symptoms (may be imposed on
 Women seek medical treatment more often the self or on another person).
than men, and it is more socially acceptable for
them to do so. TREATMENT
 Childhood sexual abuse, which is related to  Treatment focuses on managing symptoms and
somatization, happens more frequently to girls. improving quality of life.
 Women more often receive treatment for  A trusting relationship helps ensure clients stay
psychiatric disorders with strong somatic with and receive care from one provider instead
components such as depression. of "doctor shopping."
 Antidepressants - selective serotonin reuptake
BIOLOGICAL THEORIES
inhibitors (fluoxetine (Prozac), sertraline (Zoloft),
 Research has shown differences in the way and paroxetine (Paxil) are most commonly used
clients with somatoform disorders regulate and among clients with depression and anxiety
interpret stimuli. disorders.
 In other words, they may experience a normal  For clients with pain disorder, referral to a
body sensation such as peristalsis and attach a chronic pain clinic may be useful.
pathologic rather than a normal meaning to it.  Services such as physical therapy to maintain
 The presence of a host of somatic symptoms and build muscle tone help improve functional
can also be associated with other diagnoses. abilities.
 Clients can use nonsteroidal anti- inflammatory
SIGNS AND SYMPTOMS agents to help reduce pain.
 Involvement in therapy groups is beneficial for
1. Any physical symptom for which there is no
some people with somatic symptom illnesses
organic basis but for which evidence exists for
(cognitive-behavioral group)
the implication of psychological factors.
2. Depressed mood is common.  The overall goals of the group were offering
3. Loss or alteration in physical functioning, with peer support, sharing methods of coping,
no organic basis. and perceiving and expressing emotions.
Examples include the following:  Education or providing information has also
a. Blindness or tunnel vision been effective for clients with somatic illness or
b. Paralysis symptoms.
c. Anosmia (inability to smell)
CLIENT AND FAMILY
d. Aphonia (inability to speak)
e. Seizures EDUCATION
f. Coordination disturbances
 Establish daily health routine, including
g. Pseudocyesis (false pregnancy)
adequate rest, exercise, and nutrition.
h. Akinesia or dyskinesia
 Teach about relationship of stress and physical
i. Anesthesia or paresthesia
symptoms and mind- body relationship.
4. "Doctor shopping."
  Educate about proper nutrition, rest, and  Clients with somatization disorder usually
exercise. describe their complaints in colorful,
 Educate client in relaxation techniques: exaggerated terms, but often lack specific
progressive relaxation, deep breathing, guided information.
imagery, and distraction such as music or other  Mood is often labile. Emotions are often
activities. exaggerated, as are reports of physical
 Educate client by role-playing social situations symptoms.
and interactions.  Clients are unlikely to be able to think about or
 Encourage family to provide attention and respond to questions about emotional feelings.
encouragement when client has fewer  Clients are alert and oriented. Intellectual
complaints. functions are unimpaired.
 Encourage family to decrease special attention  Clients focus only on the physical part of
when client is in "sick". themselves.
 Clients may report a lack of family support and
understanding
 Clients who somatize often have sleep pattern
disturbances, lack basic nutrition, and get no
exercise.

DIAGNOSIS
Nursing diagnoses commonly used when working
with clients who somatize include:

 Ineffective coping
 Ineffective denial
 Impaired social interaction
 Anxiety
 Disturbed sleep pattern
 Fatigue
 Pain
COMPLICATIONS Clients with conversion disorder may be at risk for
disuse syndrome from having pseudoneurologic
Somatic symptom disorder can be associated with:
paralysis symptoms. In other words, if clients do not use
 Poor health a limb for a long time, the muscles may weaken or
 Problems functioning in daily life, including undergo atrophy from lack of use.
physical disability
 Problems with relationships PLANNING
 Problems at work or unemployment
Treatment outcomes may include:
 Other mental health disorders, such as anxiety,
depression and personality disorders  The client will identify the relationship between
 Increased suicide risk related to depression stress and physical symptoms.
 Financial problems due to excessive health care  The client will verbally express emotional
visits feelings.
 The client will follow an established daily
ASSESSMENT routine.
 The client will demonstrate alternative ways to
 Clients usually provide a lengthy and detailed
deal with stress, anxiety, and other feelings.
account of previous physical problems,
 The client will demonstrate healthier behaviors
numerous diagnostic tests, and perhaps even a
regarding rest, activity, and nutritional intake.
number of surgical procedures.
 Clients may express dismay or anger at the
medical community with comments such as
"They just can't find out what's wrong with me" IMPLEMENTATION
or "They're all incompetent, and they're trying
to tell me I'm crazy!"
 Encouraging them to focus on emotional Eating disorders are mental illnesses that
feelings is important, though this can be difficult cause serious disturbances in a person's everyday diet.
for clients. It can manifest as eating extremely small amounts of
 Two categories of coping strategies are food or severely overeating. The condition may begin as
important for clients to learn and to practice: just eating too little or too much but obsession with
emotion- focused coping strategies, which help eating and food over takes over the life of a person
clients relax and reduce feelings of stress, and leading to severe changes.
problem- focused coping strategies, which help
resolve or change a client's behavior or situation TYPES OF EATING DISORDERS
or manage life stressors.
 Anorexia Nervosa
 The nurse can help the client plan social contact
 Bulimia Nervosa
with others, can role-play what to talk about
 Binge Eating Disorder
(other than the client's complaints), and can
 Not Otherwise Specified (NOS)
improve the client's confidence in making
relationships.
 ANOREXIA NERVOSA 

Is a life-threatening eating disorder

characterized by the client’s restriction of nutritional
intake necessary to maintain a minimally normal body
weight, intense fear of gaining weight or becoming fat,
significantly disturbed perception of the shape or size of
the body, and steadfast inability or refusal to
acknowledge the seriousness of the problem or even
that one exists.

Anorexia nervosa happens when one is

obsessed with becoming thin that they reach extreme
measures and this leads to extreme weight loss.

2 SUBGROUPS OF ANOREXIA
NERVOSA
1. BINGE EATING means consuming a large
amount of food (far greater than most people
eat at one time) in a discrete period of usually 2
hours or less.
2. PURGING involves compensatory behaviors
designed to eliminate food by means of self-
induced vomiting or misuse of laxatives,
enemas, and diuretics.

WARNING SIGNS
 Dramatic weight loss
 Refusal to eat certain foods or food categories.
 Consistent excuses to avoid situations involving
food
 Excessive and rigid exercise routine
 Withdrawal from usual friends/relatives

HEALTH RISKS W/ ANOREXIA

 Heart failure
NCM 117: LEC 14 (04/08/24)  Kidney failure
 Low protein stores
EATING DISORDERS
  Digestive problems  High blood pressure
 High cholesterol
 Gall bladder disease
 BULIMIA NERVOSA 
 Diabetes
Often simply called bulimia, is an eating  Heart disease
disorder characterized by recurrent episodes of binge  Certain types of cancer
eating followed by inappropriate compensatory
behaviors to avoid weight gain, such as purging, fasting,
 NIGHT EATING SYNDROME 
or excessively exercising.
Is characterized by morning anorexia, evening
 one starts to consume large amounts of food at
hyperphagia (consuming 50% of daily calories after the
once and then is followed by purging, using
last evening meal), and nighttime awakenings (at least
laxatives, or over exercising to rid themselves of
once a night) to consume snacks.
the food they ate.
 Binging or purging episodes are often It is associated with life stress, low self-esteem,
precipitated by strong emotions and followed by anxiety, depression, and adverse reactions to weight
guilt, remorse, shame, or self-contempt. loss.

WARNING SIGNS
 EATING/ FEEDING D/O IN CHILDHOOD 
 Wrappers/containers indicating consumption of
large amounts of food  PICA, which is persistent ingestion of nonfood
 Frequent trips to bathroom after meals substances.
 Signs of vomiting e.g. staining of teeth, calluses  RUMINATION, or repeated regurgitation of
on hands food that is then rechewed, reswallowed, or spit
 Excessive and rigid exercise routine out.
 Withdrawal from usual friends/relatives

HEALTH RISKS W/ BULIMIA  ORTHOREXIA NERVOSA 

 Dental problems Sometimes called orthorexia, is an obsession

 Stomach rupture with proper or healthful eating. It is not formally
 Menstruation irregularities recognized in the DSM-5, but some believe it is a type of
anorexia or a form of OCD. Behaviors include
compulsive checking of ingredients; cutting out
 BINGE EATING DISORDER  increasing number of food groups; unusual interest in
what others eat.
 Binge eating is disorder in which someone eats
a lot amount of food at a time but they don't WHY DO PEOPLE DEVELOP
vomit.
EATING DISORDERS?
 It is characterized by recurrent episodes of
binge eating; no regular use of inappropriate Behaviors are unhealthy coping mechanisms
compensatory behaviors, such as purging or
FACTORS TO CONSIDER
excessive exercise or abuse of laxatives.
 Psychological
WARNING SIGNS  Interpersonal
 Wrappers/containers indicating consumption of  Social/Cultural
large amounts of food  Biological
 MAY be overweight for age and height  Developmental
 MAY have a long history of repeated efforts to
PSYCHOLOGICAL FACTORS
diet-feel desperate about their difficulty to
control food intake  Low self-esteem
 MAY eat throughout the day with no planned  Feelings of inadequacy or failure
mealtimes  Feeling out of control
 Response to change (puberty)
HEALTH RISKS WITH BINGE  Response to stress (sports, dance)
EATING DISORDER  Personal illness
INTERPERSONAL FACTORS  Psychopharmacology - Anti-depressants are
used primarily to treat bulimia. Drugs such as
 Troubled family and personal relationships
Desipramine, Imipramine, Amitriptyline, and
 Difficulty expressing emotions and feelings
Flouxetine were prescribed in the same dosages
 History of being teased or ridiculed based on
to treat depression.
size or weight
 History of physical or sexual abuse
APPLICATION OF THE NURSING
SOCIAL AND CULTURAL FACTORS
PROCESS
 Cultural pressures that glorify thinness and
place value on obtaining the perfect body ASSESSMENT
 Narrow definitions of beauty that include only
 History- has a history of impulsive behavior
women and men of specific body weights and
 General Appearance and Motor Behavior- slow,
shapes
lethargic and fatigued
 Cultural norms that value people on the basis of
 Mood and Affect- labile moods, sad, anxious,
physical appearance and not inner qualities and
and worried
strengths.
 Thought Process and Content- Body image
BIOLOGICAL FACTORS disturbance o
 Sensorium and Intellectual Processes- alert and
 Eating disorders often run in families (learn
oriented
coping skills and attitudes in family)
 Judgment and Insight- limited insight, poor
 Genetic component-research about brain and
judgment
eating in taking place (certain chemicals in the
 Self-Concept- Low self-esteem
brain control hunger, appetite and digestion
 Roles and Relationships- inability to fulfill roles
have been found unbalanced).
 Self-Care Considerations- relates directly to the
DEVELOPMENTAL FACTORS severity of self-starvation or purging behaviors
or both.
Two essential tasks of adolescence are the
struggle to develop autonomy and the establishment of DATA ANALYSIS
a unique identity. Autonomy, or exerting control over
Nursing diagnosis for clients with eating disorders
oneself and the environment, may be difficult in families
include:
that are over-protective or in which enmeshment (lack
of clear role boundaries) exist.  Imbalanced nutrition: Less than/more than
body requirements
 Ineffective coping
BODY IMAGE is how a person perceives his or her  Disturbed body image
body, that is, a mental self-image.  Chronic low self-esteem
BODY IMAGE DISTURBANCE occurs when there is *Other nursing diagnoses may be pertinent such as
an extreme discrepancy between one’s body image deficient fluid volume, constipation, fatigue, and activity
and the perceptions of others and extreme intolerance.
dissatisfaction with one’s body image.
OUTCOME IDENTIFICATION
Examples of expected outcomes for clients with eating
disorders include:
Bulimia Nervosa - TREATMENT  The client will establish adequate nutritional
eating patterns.
 Cognitive-Behavioral therapy- is the most
 The client will eliminate use of compensatory
effective treatment for bulimia. Strategies
behaviors such as excessive exercise and use of
designed to change the client's thinking
laxatives and diuretics.
(cognition) and actions (behavior) about food
 The client will demonstrate coping mechanisms
focus on interrupting the cycle of dieting,
not related to food.
binging, and purging and altering dysfunctional
 The client will verbalize feelings of guilt, anger,
thoughts and beliefs about food, weight, body
anxiety, or an excessive need for control.
image, and overall self- concept.
  The client will verbalize acceptance of body
image with stable body weight.

NURSING INTERVENTIONS
✓ Establishing Nutritional Eating Patterns

 Sit with the client during meals and snacks.

 Offer liquid protein supplement if client is
unable to complete meal
 Adhere to treatment program guidelines
regarding restrictions.
 Observe the client following meals and snacks
for 1 to 2 hours.
 Weigh the client daily in uniform clothing.
 Be alert for attempts to hide or discard food or
inflate weight.

✓ Helping the client identify emotions and

develop non-food-related coping strategies
 Ask the client to identify feelings.
 Self-monitoring using a journal.
 Relaxation techniques.
 Distraction
 Assist the client in changing stereotypical
beliefs.

✓ Helping the client deal with body image issues

 Recognize benefits of a more near-normal

weight.
 Assist in viewing self in ways not related to body
image.
 Identify personal strengths, interests, and
talents.

✓ Helping the client deal with body image issues