14 somatoform disorders.ppt

7/23/2019 14 Somatoform Disorders.ppt

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Somatoform DisordersSomatoform Disorders

Adrianne Maltese, MN,GCNS-BC Adrianne Maltese, MN,GCNS-BC



Somatoform DisordersSomatoform Disorders

Three central features ofThree central features ofSomatoform Disorders:Somatoform Disorders: Physical complaints ithout or!anicPhysical complaints ithout or!anic

"asis"asis Psycholo!ical factors and conflictsPsycholo!ical factors and conflicts

seem important in initiatin!,seem important in initiatin!,e#acer"atin!, and maintainin! thee#acer"atin!, and maintainin! the

symptomssymptoms Symptoms or ma!nified healthSymptoms or ma!nified health

concerns are not under consciousconcerns are not under consciouscontrol$Gu!!enheim%&&&'control$Gu!!enheim%&&&'



(i)e Somatoform disorders(i)e Somatoform disorders

Somati*ation disorder Somati*ation disorder C+" multiple recurrent physical complaintsC+" multiple recurrent physical complaints

o)er many yearso)er many years No or!anic etiolo!y for these complaintsNo or!anic etiolo!y for these complaints Be!ins "y a!e &Be!ins "y a!e & Pain, G, se#ual, pseudoneurolo!icPain, G, se#ual, pseudoneurolo!ic

symptoms: impaired coordination orsymptoms: impaired coordination or"alance,paralysis or locali*ed"alance,paralysis or locali*edea.ness,difficulty salloin!, aphonia,ea.ness,difficulty salloin!, aphonia,urinary retention,hallucinations, loss ofurinary retention,hallucinations, loss oftouch or pain sensation,dou"letouch or pain sensation,dou"le)ision,amnesia,sensory losses,loss of)ision,amnesia,sensory losses,loss ofconsciousness $APA %&&& DSM /-T0'consciousness $APA %&&& DSM /-T0'



nter)entions for somati*ationnter)entions for somati*ation

Be aare of on responsesBe aare of on responses

0ule out or!anic "asis for0ule out or!anic "asis for

complaintscomplaints (ocus on an#iety reduction, mot(ocus on an#iety reduction, mot

physical symptomsphysical symptoms

Minimi*e secondary !ain$1e1Minimi*e secondary !ain$1e1increased attention andincreased attention and

decreased responsi"ilities'decreased responsi"ilities'



nter)ention 2con)ersion d+onter)ention 2con)ersion d+o

(ocus on an#iety reduction, not(ocus on an#iety reduction, not

physical symptomsphysical symptoms

3se matter-of-fact approach3se matter-of-fact approach

4ncoura!e client to discuss4ncoura!e client to discuss

conflictconflict

Minimi*e secondary !ainsMinimi*e secondary !ains

Pro)ide di)ersionary acti)itiesPro)ide di)ersionary acti)ities

4ncoura!e e#pression of feelin!s4ncoura!e e#pression of feelin!s



Pain Disorder Pain Disorder

C+" physical symptom of pain-C+" physical symptom of pain-one or more anatomic sitesone or more anatomic sites

May occur ith a GeneralMay occur ith a Generalmedical conditionmedical condition

Pain 2not relie)ed "y anal!esicsPain 2not relie)ed "y anal!esics 5nset,se)erity, e#acer"ation5nset,se)erity, e#acer"ation

and maintenance affected "yand maintenance affected "ypsycholo!ical stressorspsycholo!ical stressors



Pain d+o inter)entionsPain d+o inter)entions

Pain mana!ementPain mana!ement

4ncoura!e participation in4ncoura!e participation in

acti)itiesacti)ities Pro)ide distractionsPro)ide distractions



6ypochondriasis6ypochondriasis

Client is preoccupied ith fear that he+sheClient is preoccupied ith fear that he+shehas or ill !et a serious diseasehas or ill !et a serious disease

6istory of seein! many doctors6istory of seein! many doctors Misinterpretation of "odily sensations orMisinterpretation of "odily sensations or

functions despite medical e)aluations andfunctions despite medical e)aluations andreassurancereassurance

Preoccupation ith symptoms is not asPreoccupation ith symptoms is not asintense or distorted as in delusionalintense or distorted as in delusional

disorder disorder Si!nificant distress+impairment in functionSi!nificant distress+impairment in function Dependent "eha)iors+desires,demandsDependent "eha)iors+desires,demands

attentionattention



6ypochondriasis inter)entions6ypochondriasis inter)entions

0ule out presence of actual0ule out presence of actual

diseasedisease

(ocus on an#iety, not physical(ocus on an#iety, not physical

symptomssymptoms Pro)ide di)ersionary acti)itiesPro)ide di)ersionary acti)ities

A)oid ne!ati)e responses to client A)oid ne!ati)e responses to client

demands+conference ith staff demands+conference ith staff Pro)ide client ith correctPro)ide client ith correct

informationinformation



Body Dysmorphic Disorder Body Dysmorphic Disorder

Preoccupation ith ima!ined orPreoccupation ith ima!ined or

e#a!!erated defects in physicale#a!!erated defects in physical

appearanceappearance

Causes clinically si!nificantCauses clinically si!nificant

stressor impairment in social orstressor impairment in social or

occupational function7 personoccupational function7 person

may under!o repeated plasticmay under!o repeated plasticsur!eries for nose repair or tosur!eries for nose repair or to

chan!e face etc1chan!e face etc1



Dissociati)e DisordersDissociati)e Disorders

DSS5CAT/4 AMN4SA:DSS5CAT/4 AMN4SA:

5ne or more episodes of5ne or more episodes of

ina"ility to recall personalina"ility to recall personal


nformation is usually of anformation is usually of a

traumatic or stressful naturetraumatic or stressful nature

Not due to effects of su"stanceNot due to effects of su"stance

a"usea"use



Dissociati)e (u!ueDissociati)e (u!ue

C+" sudden une#pected tra)elC+" sudden une#pected tra)el

aay from home or or.aay from home or or.

3na"le to recall past$or here3na"le to recall past$or here

on has "een'on has "een'

Confused a"out personalConfused a"out personal

identity+ or assumes neidentity+ or assumes ne

identityidentity



Dissociati)e dentity Disorder Dissociati)e dentity Disorder

ndi)idual demonstrates to orndi)idual demonstrates to or

more distinct identities ormore distinct identities or

personality statespersonality states

4ach personality is distinct4ach personality is distinct

At least to of these personality At least to of these personality

states ta.e control of thestates ta.e control of the

indi)iduals "eha)ior1indi)iduals "eha)ior1 3na"le to recall e#tensi)e personal3na"le to recall e#tensi)e personal


14 somatoform disorders.ppt

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