Involuntary control: somatic disorders
Somatic symptom disorder
Illness Anxiety Disorder (Hypochondriasis)
Functional Neurological disorder
Somatic Symptom disorder s/s
- Hx of many physical complaints usually beginning before age 30, resulting in treatment being sought.
- S/S last 6 months
- Symptoms are not faked have at least one symptom may be described in exaggerated terms and cannot be proven scientifically
- Impaired social and occupational functioning resulting in seeking medical care from many providers
- Symptoms cannot be explained medically, have a lot of test
- Modifiers – pain
Illness Anxiety Disorder (hypochondriasis)
S/S
- Major difference between this and Somatic symptom disorder is that the symptoms are absent or extremely mild.
- So excessive worrying over symptoms that the patients may not even have.
- Calm acceptance of s/s
Functional neurological Disorder (Conversion D/O)
- One or more symptoms that suggest the presence of a neurological disorder that cannot be explained medically, but new evidence emerging
- Stress and conflicts may be associated with the onset
- “La Belle Indifference” : calmly indifferent to symptoms
- Neurologically based
VOLUNTARY CONTROL somatic disorders
- Factitious Disorder
- Malingering
Factitious Disorder S/S
- Falsify symptoms to become the patient or caregiver
- Goal is “assume the sick role”
- Have a personality disorder, significant history of abuse, usually with healthcare experience
- Tend to not be happy with negative test results.
- Munchausen syndrome and Munchausen by proxy
— do things to self
— By proxy: do things to someone else
— Nurse giving herself insulin to be hypoglycemic
Malingering S/S
- Falsifying symptoms intentionally for secondary gains:
— Housing
— Disability $
— Escaping jail time - More commonly males
How do you determine Voluntary v. Secondary:
- secondary gains:
- Receiving Test results:
— involuntary pts are happy about (-) results
— Voluntary pts not as happy with (-) results bc they knew that shit would be (-)
What do you assess for in somatic disorders
- PQRST of symptoms
- ability to perform ADLs
- safety risk of symptoms
- voluntary control of s/s
- Pt thought process / ability to communicate feelings
- Type and amount of medication pt is using
- ACEs/ risk of SI
- support network
- Secondary gains
- Cognitive style
Interventions for somatic disorders
- Offer explanations during diagnostic tests
- Redirect focus: away from symptoms to feelings or neutral topic
- Reinforce strengths/ promote independence
- Spend time with the patient when they are not having complaint
- Teach assertive communication
- Stress reduction techniques (promote healthy coping mechanisms)
Somatic therapies
Cognitive therapy:
- helps patient see how they express feelings physically
Behavior therapy:
- incentives to help patients control symptoms
Family therapy:
- places patient’s symptoms in perspective and improves interpersonal interaction
Milieu therapy:
- rejection increases symptoms, shift conversation away from symptoms (redirect), reinforce strengths, matter of fact approach to managing symptoms
Alternative coping mechanisms
Reward systems: reward pt for not complaining
