Anxiety, Somatic Symptom, & Dissociative Disorders PDF
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DCLC College of Nursing
2023
NCM
Gerald Victoria, Man
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Summary
This document is a set of lecture notes or study materials for a nursing finals exam, covering anxiety-related, somatic symptom, and dissociative disorders. It details various types of these disorders and treatment approaches.
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ANXIETY-Related, SOMATIC Symptom, & DISSOCIATIVE Disorders FINALS NCM 117 GERALD VICTORIA, MAN DCLC COLLEGE OF NURSING I. ANXIETY DISORDERS ⚫ 1 Generalized Anxiety Disorder (GAD) ⚫ https://youtu.be/9mPwQTiMSj8 ⚫ 2 Panic Disorder w or w/o Agoraphobia ⚫ https://youtu.be/YxELZyA...
ANXIETY-Related, SOMATIC Symptom, & DISSOCIATIVE Disorders FINALS NCM 117 GERALD VICTORIA, MAN DCLC COLLEGE OF NURSING I. ANXIETY DISORDERS ⚫ 1 Generalized Anxiety Disorder (GAD) ⚫ https://youtu.be/9mPwQTiMSj8 ⚫ 2 Panic Disorder w or w/o Agoraphobia ⚫ https://youtu.be/YxELZyA2bJs ⚫ 3 Specific Phobia ⚫ PHOBIAS https://youtu.be/PCOg2G797ek ⚫ 4 Social Phobia ⚫ Social Anxiety Disorder https://youtu.be/QLjPrNe63kk I. ANXIETY DISORDERS ⚫ 5 Obsessive-Compulsive Disorder (OCD) ⚫ https://youtu.be/I8Jofzx_8p4 ⚫ 6 Acute Stress Disorder (ASD) ⚫ 7 Postraumatic Stress Disorder (PTSD) ⚫ https://youtu.be/hzSx4rMyVjI ⚫ 8 Anxiety Disorder due to a Medical Condition ⚫ Also watch - Panic Disorder (Panic Attacks) ⚫ https://youtu.be/YxELZyA2bJs II. SOMATOFORM Disorders https://youtu.be/oVO7tZS2ZdI ⚫Symptoms that cant be explained. ⚫1. Somatization Disorder ⚫2. Pain Disorder ⚫3. Hypochondriasis ⚫4. Conversion Disorder Watch this: ⚫ Factitious Disorder ⚫ https://youtu.be/719a0kAzeo4 ⚫ Meet Woman: Munchausens by Proxy ⚫ https://youtu.be/aEHeKfalYyw (The Doctors) ⚫ https://youtu.be/-95BKJwrgpw (The Doctors) ⚫ https://youtu.be/RGw3d6dzHuM (Unmasking) ⚫ Somatoform Disorders (Somatic Symptom, Conversion, Illness Anxiety, Factitious, Malingering) ⚫ https://youtu.be/gaAdSGVgd3Y (Dirty Medicine) ⚫ Somatic symptom disorder and other disorders (Khan Academy ) https://youtu.be/8G5WFKUzvA8 III. DISSOCIATIVE Disorders https://youtu.be/XF2zeOdE5GY ⚫1. Depersonalization & Derealization Disorder ⚫2. Dissociative Amnesia ⚫3. Dissociative Identity Disorder (Multiple Personality Disorder) I. ANXIETY DISORDERS ⚫ 1 Generalized Anxiety Disorder (GAD) ⚫ 2 Panic Disorder w or w/o Agoraphobia ⚫ 3 Specific Phobia ⚫ 4 Social Phobia ⚫ 5 Obsessive-Compulsive Disorder (OCD) ⚫ 6 Acute Stress Disorder (ASD) ⚫ 7 Postraumatic Stress Disorder (PTSD) ⚫ 8 Anxiety Disorder due to a Medical Condition A.1 Generalized Anxiety Disorder (GAD) ⚫ GAD is characterized by excessive worry & anxiety. There is difficulty in controlling the worry. Anxiety & worry are evident in 3 or more of the ff: ⚫ 1. Restlessness ⚫ 2. Fatigue ⚫ 3. Irritability ⚫ 4. Decreased ability to concentrate ⚫ 5. Muscle Tension ⚫ 6. Disturbed Sleep A.1 Generalized Anxiety Disorder (GAD) ⚫ a. Psychotherapeutic Mgmt: ⚫ Goal of NI: Reduce anxiety before problem solving & develop adaptive coping responses. ⚫ NI - Reducing Anxiety: ⚫ 1. Calm & Quiet environment. R: Reduce stimulus. ⚫ 2. Encourage Pt to identify, describe & discuss feelings. R: Increases Pt’s recognition of what’s happening & connect feelings with experiences. A.1 Generalized Anxiety Disorder (GAD) ⚫ NI - Reducing Anxiety: ⚫ 3. Listen to Pt’s expression of hopelessness & helplessness, suicidal plans. R: Assess depression & self harm. ⚫ 4. Plan & involve pts in activities (going for a walk, playing, recreational games). R: Activities may help patients to release nervous energy & discourage preoccupation with self. A.1 Generalized Anxiety Disorder (GAD) ⚫ b. Psychopharmacology: Antidepressants ⚫ Short term: Benzodiazepines (tapered down then discontinued as long term Benzodiazepine use causes dependency & tolerance). ⚫ Long term: SSRI (Selective Serotonin Reuptake Inhibitor) & SNRI (Serotonin Norepinephrine Reuptake Inhibitor). Ex. Buspirone (Buspar) is useful for cognitive symptoms, worry, irritability & apprehension. A.1 Generalized Anxiety Disorder (GAD) ⚫ c. Milieu Management ⚫ A variety of recreational activities to reduce tension & anxiety, like relaxation exercises & meditation, promotes comfort. ⚫ Cognitive therapy, focus on stress management, problem solving, self esteem, goal setting are helpful for coping with stress. A.1 Generalized Anxiety Disorder (GAD) ⚫ d. Problem Solving ⚫ 1. Discuss previous coping mechanisms. R: to reinforce effective adaptive behaviors. ⚫ 2. Discuss the meaning of problems & conflicts. R. Help pt assess stressors, explore values & define problem scope & seriousness. ⚫ 3. Supportive confrontation & teaching. R: to increase pt’s insight into negative effects of their maladaptive behavior. A.1 Generalized Anxiety Disorder (GAD) ⚫ d. Problem Solving ⚫ 4. Assist pt in exploring alternative solutions & behavior. R. To increase adaptive coping mechanisms. ⚫ 5. Role playing. R: Provide pt with opportunity to practice new behaviors. ⚫ 6. Teach relaxation exercises. R: Help pt manage, control , reduce anxiety on their own. ⚫ 7. Hobbies & Recreational activities. R: Help pt deal with routine feelings of stress & anxiety. A.2 Panic Disorder ⚫ Recurrent, unexpected panic attacks or intense fear & apprehension. Panic attacks occur in response to a situation, or trigger is r/t social & specific phobia. ⚫ Panic attacks are followed by a month or more of worry about having additional attacks, worry about results of attacks, & behavior changes r/t attacks. ⚫ Panic Disorders are possibly accompanied by Agoraphobia (pt avoids places where a panic attack has occured or could occur). A.2 Panic Disorder ⚫ a. Nursing Interventions are same as those for GAD. Specific for Panic Disorders are: ⚫ 1. Stay with Pt experiencing panic attack & acknowledge the pt’s discomfort. ⚫ 2. Maintain a calm style & demeanor. Speak in short, simple sentences. Give 1 direction at a time. ⚫ 3. If hyperventillating, provide a brown paper bag & focus on breathing with the pt. ⚫ 4. Allow pt to pace or cry. R: Releases tension. A.2 Panic Disorder ⚫ a. Nursing Interventions ⚫ 5. Communicate to pt that you are in control and will not let anything hapen to them. ⚫ 6. Move or direct pt to a quiet, less stimulating environment. Do not touch pt: touch can increase feelings of panic. ⚫ 7. Ask pt to express their perceptions or fears about what is happening to them. R: to help pt reduce anxiety to more manageable & comfortable level. A.2 Panic Disorder ⚫ b. Psychopharmacology ⚫ Short Term: Benzodiazepines-Alprazolam (Xanax) & Lorazepam (Ativan) decrease symptoms. ⚫ Long Term: SSRI & SNRI ⚫ Note: Give a simple explanation about the disorder to convince pts that the meds are needed (to decrease SNS activation). ⚫ c. Milieu Mgmt: ⚫ When panic levels decrease, gross motor activities (ballgames, walking) decrease tension & anxiety >. A.2 Panic Disorder with Agoraphobia ⚫ Assessment ⚫ Areas of strength are managing role as mother, homemaker, secretary, socially active with friends, in good health. ⚫ NDianosis: ⚫ Fear of Dying R/T fear of heart attack. ⚫ Anxiety: Panic R/T life stress AEB somatic symptoms & fear of dying. ⚫ Self-Esteem Disturbance R/T feelings of helplessness AEB inability to function. ⚫ Fear related to avoidance AEB inability to leave home. A.2 Panic Disorder with Agoraphobia ⚫ Outcomes ⚫ Short Term Goals: ⚫ Pt will discuss fears, sense of inadequacy, helplessness & anger. ⚫ Identify relationship between anxeity & physiologic responses. Develop strategies for reducing anxiety such as relaxation techniques. Use problem solving for life stresses. A.2 Panic Disorder with Agoraphobia ⚫ Outcomes ⚫ Long Term Goals: ⚫ Pt will meet with husband & social worker to discuss marital issues. ⚫ Schedule appt with therapist for CBT, systematic desensitization, self-exposure training. ⚫ Identify schedule for attending an agoraphobia support group. A.2 Panic Disorder with Agoraphobia ⚫ Planning/Interventions: ⚫ N-Pt Rel: Empathy & supportive suppressive technique to keep anxiety at minimum. ⚫ Encourage ventillation of feelings & issues. ⚫ Identify relationship among stress, anxiety, physiologic responses. ⚫ Assist with adaptive coping mechanisms. A.2 Panic Disorder with Agoraphobia ⚫ Planning/Interventions: ⚫ Psychopharmacology: Prozac 40mg qAM. ⚫ Milieu Mgmt: ⚫ Decreased stimuli & provided quiet, calm atmosphere. Monitored anxiety level to prevent escalation. Encouraged recreational & diversional activities. Later: encourage problem solving, assertiveness, self-esteem, & stress management groups. A.2 Panic Disorder with Agoraphobia ⚫ Evaluation: ⚫ Pt reports being less anxious for past 2 days. Met with husband & social worker. ⚫ Referrals ⚫ Outpatient appointments for cognitive therapy and self-exposure training. A.3 Obsessive Compulsive Disorder ⚫ Obsession: ⚫ 1. Recurrent persistent thoughts, ideas, impulses, or images experienced as intrusive & senseless. ⚫ 2. Unsuccessful attempts to ignore or neutralize thoughts or impulses. ⚫ 3. Recognize that these thoughts are products of their own minds, are trivial & ridiculous but they cannot stop forget or control them. A.3 Obsessive Compulsive Disorder ⚫ Compulsion: ⚫ 1. Repetitive behaviors such as handwashing, locking doors, counting, touching that are performed in response to obsession. ⚫ 2. Excessive behaviors or mental acts are performed to prevent discomfort & neutralize anxiety or prevent dreaded events. Anxiety is experienced if they resist. A.3 Obsessive Compulsive Disorder ⚫ An important feature of OCD is that the OC are so severe & time consuming that they significantly interfere with: ⚫ 1 The pt’s normal routine. ⚫ 2. The pt’s occupational functioning. ⚫ 3. The pt’s social or interpersonal relationships. A.3 Obsessive Compulsive Disorder ⚫ a. NPt Relationship: ⚫ 1. Increase pt’s ability to verbalize feelings, solve problems, and make decisions concerning stressors and problems. ⚫ 2. Teach & help pt to develop adaptive coping behaviors to deal with anxiety. Slowly substitute OC with positive anxiety reducing behaviors: exercise, walking, stationary bicycle, hobbies & social activities. A.3 Obsessive Compulsive Disorder ⚫ a. NPt Relationship: ⚫ 3. Ensure basic needs of food, rest & grooming are met. R. Pts are too busy & need reminders or directions. ⚫ 4. Convey acceptance & understanding. Provide pt with time to perform rituals. R: Pt needs to keep anxiety in check or else anxiety may escalate to panic levels. Later, work to decrease rituals by setting time limits. A.3 Obsessive Compulsive Disorder ⚫ a. NPt Relationship: ⚫ 5. Explain expectations, routines, and changes. R: To prevent escalation of anxiety. ⚫ 6. Assist pt to connect behavior & feelings. R: to promote self insight. ⚫ 7. Structure simple activities, games, or tasks for patients. Recognize & reinforce non-ritualistic behaviors. R. Helps pts to focus on alternatives to their thoughts & actions & increase self esteem. A.3 Obsessive Compulsive Disorder ⚫ b. Psychopharmacology ⚫ SSRI: Fluoxetine (Prozac), Sertraline (Zoloft), Fluvoxamine (Luvox) & Paroxetine (Paxil). ⚫ c. Milieu Mgmt: Relaxation exercises, stress management, recreational or social skills, problem solving, communication or assertiveness training groups. Cognitive Therapy: when intrusive thought occurs, pt says stop and snaps a rubber band on wrist or substitute adaptive behavior like deep breathing. Deep Brain Stimulaiton is also used. A.4 Phobic Disorders ⚫ Intense, irrational fear responses (anticipated or when exposed) to an external object, activity, or situation. Phobias persist even if recognized as irrational. 3 Types: ⚫ 1. Agoraphobia: fear of public open spaces or situations where escape is difficult. ⚫ 2. Social Phobia: fear of humiliation, scrutiny, embarassment (choke, stumble). ⚫ 3. Specific Phobia: objects or situations not above. Ex. Heights, flying, animals. A.4 Phobic Disorders Psychotherapeutic Management ⚫ 1. N-PT Relationship: OPD basis treatment except in severe cases of phobia. ⚫ a. Accept pt & their fears. b.Provide safety & comfort. Provide pt with activities that increase involvement & do not increase anxiety. c. Help pt recognize that their behavior is a method of avoiding anxiety. ⚫ 2. Psychopharmacology: SSRI for anxiety, panic & depression. ⚫ 3. Behavior Therapy: Flooding, Desensitization. Exposure & Self-Exposure. A.5 Acute Stress Disorder (ASD) ⚫ 1 Exposure to a traumatic event with threat of or actual death or injury to self or others. ⚫ 2 Responses of horror, hopelessness or fear. Onset within 4wks after event. Duration 2days-4 weeks. ⚫ 3 Dissociative symptoms during or after event: ⚫ Absence of emotions, numbing, detachment. ⚫ Decreased awareness of surrounding (dazed) ⚫ Derealization or depersonalization, Amnesia ⚫ 4. Reexperiencing or reliving the traumatic event: distressings thoughts, flashback, illusions. A.5 Acute Stress Disorder (ASD) ⚫ 5. Avoidance of stimuli related to trauma: feelings, thoughts, people, conversations, places, and activities; distress when exposed to reminders of events. ⚫ 6. Increased arousal or anxiety: sleep disturbance, hypervigilance, startle response, irritability, restlessness, decreased concentration. ⚫ 7. Impairment or distress in functioning – occupational, social, etc. A.5 Post Traumatic Stress Disorder (PTSD) ⚫ Same descriptions as in ASD plus: ⚫ 3. Onset : Acute-within 6 months of event ⚫ Delayed-6 months or more after event ⚫ Duration: Acute -1 to 3months ⚫ Chronic-3 months or more ⚫ Numbing or detachment, restricted affect (detachment or not being able to love). Sense of foreshortened future (lack of future expectations). Inability to recall aspects of events. allucinations or frightening dreams. Decreased participation & interest in activities. A.5 ASD & PTSD Psychotherapeutic Management ⚫ CISM(D) or Critical Incident Stress Management or Debriefing (longer version). ⚫ 1 Be non-judgmental & honest. Offer empathy & support. Acknowledge unfairness & injustices r/t trauma. R: Building trust. ⚫ 2. Assure pt their feelings & behavior are typical reactions to trauma. Pt. May believe they are going crazy. ⚫ 3. Help pt connect trauma experience & feeling. R: Pts are often unaware of connection. A.5 ASD & PTSD Psychotherapeutic Management ⚫ 4. Help pt evaluate past behavior in context of trauma. R: Pt often have built about behavior. ⚫ 5. Encourage safe verbalization of feelings especially anger. R: To vent suppressed emotions. ⚫ 6. Encourage adaptive coping strategies, exercise, relaxation & sleep promoting techniques. R: Pt may be using maladaptive coping mechanisms. ⚫ 7. Facilitate review of the trauma & consequences. R: Review helps pt integrate feelings & memories & begin grieving process. ⚫ 8. Help pt reestablish relationships. R: for assistance and support. II. SOMATOFORM Disorders ⚫1. Complex Somatic Symptom Disorder (CSSD) ⚫ a. Hypochondriasis (illness) ⚫ b. Alexithemia ⚫2. Conversion Disorder (function) ⚫3. Body Dysmorphic Disorder (body) ⚫4. Factitious Disorder (fake) SOMATOFORM DISORDERS ⚫ Soma=body. (Somatic Symptom Disorder) ⚫ 1 Somatization is when problems or conflicts cause anxiety which is displaced into bodily symptoms. Psychological distress manifests as physical symptoms of functional & or somatic changes. ⚫ 2 Body symptoms express or communicate unexpressed needs. SOMATOFORM DISORDERS ⚫ 3 A coping technique ⚫ a. Primary Gain: Threat, Stress, & Anxiety are expressed as somatic symptoms. (Displacement). ⚫ b. Secondary Gain: To gain reward: attention & care. To punish self & others. To control or maintain relationships. ⚫ c. Rationalization of needs. II. SOMATOFORM DISORDERS ⚫ 1 Complex Somatic Symptom Disorder (CSSD) A proposed subcategory related to somatization disorder, hypochondriasis, pain disorder. ⚫ 1.1 Pts have varied & changing, diffuse physical symptoms for which there is no organic or physiologic cause. Symptoms last for 6-8 months, then vary & change from 1 system to another. II. SOMATOFORM DISORDERS ⚫ 1 Complex Somatic Symptom Disorder ⚫ 1.2 Patients perceive themselves as “sicker than sick,” disabled & cannot work, & their health is poor. ⚫ 1.3 Patients are frustrated that their Doctors are unable to validate & do not appreciate their suffering. They go Doctor shopping. ⚫ 1.4 Patients go through medical surgeries (exploratory) & develop iatrogenic illness. II. SOMATOFORM DISORDERS ⚫ 1 Complex Somatic Symptom Disorder ⚫ 1.5.A. Hypochondriasis: patients have fears of having or developing a serious illness based on misinterpretations of symptoms. Spends time & money on repeated exams looking for feared illness Ex. Cough... Sees Oncologist. ⚫ Possible Cause: Serious childhood illness (pt or family member) II. SOMATOFORM DISORDERS ⚫ 1 Complex Somatic Symptom Disorder ⚫ 1.5.B. Alexithymia: A personality trait with difficulty in identifying & expressing emotions. ⚫ 1.6.A Treatments: Patient ideally has only 1 health care provider or Doctor. Every visit, conduct a partial examination. Conservative, least intrusive treatment of SS. II. SOMATOFORM DISORDERS ⚫ 1 Complex Somatic Symptom Disorder ⚫ 1.6.B. Treatments: ⚫ B.1 Relaxation Technique ⚫ B.2 Biofeedback ⚫ B.3 Comorbid treatment (usually anxiety or depression) pain ⚫ B.4 Teach: Medications, non-medication management (distraction techniques), Emphasize positive health care practices: Exercise, Nutrition, Social interaction, Problem solving, relaxation & anxiety reduction techniques. II. SOMATOFORM Disorders ⚫ 2. Conversion Disorder (Functional Neurologic Symptoms) ⚫ 2.A. Severe emotional distress or unconscious conflict is expessed as impaired function, movement, sensation. Ex. Impaired coordination or balance, paralysis, aphonia (no sound), dysphagia, lump on throat, urinary retention, loss of touch, blindness, deafness, hallucination. II. SOMATOFORM Disorders ⚫ 2. Conversion Disorder (Functional Neurologic Symptoms) ⚫ 2.A. All symptoms but no signs. No organic basis. Tests (Laboratory, EEG etc) are all negative. The symptoms do not follow a neurologic course but follows the persons own conceptualization of the problem. ⚫ 2.B. Precipitated by stress & trauma. Evidence of neurobiologic changes in the brain responsible for loss of sensation or movement. II. SOMATOFORM Disorders ⚫ 2. Conversion Disorder (Functional Neurologic Symptoms) ⚫ 2.C. Treatment: The lack of physical sensation or movement is real for the patient. Treat the conversion symptoms as real symptoms that may have distressing psychological aspects. Acknowledging the symptoms helps the patient deal with them. As trust develops, the nurse can help patient develop problem-solving approaches. II. SOMATOFORM Disorders ⚫ 3. Body Dysmorphic Disorder BDD ⚫ 3.1. Preoccupation or focus on real (but slight) or imagined physical defect or defect in appearance in a normal appearing person. ⚫ 3.2. Examples: Large nose, thinning hair, small genitals. ⚫ 3.3 The preoccupation with defect causes significant distress & interferes with their ability to function socially, & quality of life. II. SOMATOFORM Disorders ⚫ 3. Body Dysmorphic Disorder BDD ⚫ 3.4. Patients feel so self conscious that they avoid work or public situations. Some fear that their ugly body part will malfunction. ⚫ 3.5 Surgical correction of the problem by a plastic surgeon or a dermatologist does not correct the preoccupation and distress. ⚫ 3.6 Psychological factors may trigger preoccupation. Often teased or bullied as children about a feature. II. SOMATOFORM Disorders ⚫ 3. Body Dysmorphic Disorder BDD ⚫ 3.7. NDx: Disturbed Body Image. NI: Has high risk for depression & suicide. Assess extent of preoccupation with body part & suicide. Focus on building a therapeutic relationship & support the patient’s positive physical aspects. Respect & avoid challenging preoccupation or beliefs. Address social isolation, low self esteem, support positive coping skills. DSM 5: Somatic Symptom & Related Disorders ⚫ These disorders often cause significant emotional distress for patients and are a challenge to family physicians. ⚫ Somatization Disorder, Undifferentiated Somatoform Disorder, Somatoform Disorder NOS. ⚫ Pain Disorder ⚫ Hypochondriasis ⚫ Conversion Disorder ⚫ BODY Dysmorphic Disorder, DSM 5: Somatic Symptom & Related Disorders ⚫ General Characteristics ⚫ 1 Physical Symptoms without organic basis. Ex. Blindness, paralysis, anosmia, aphonia, seizures, coordination disturbance, anesthesia or paresthesia. ⚫ 2. La belle indifference: lack of concern regarding the severity of above symptoms. ⚫ 3. Doctor hopping. DSM 5: Somatic Symptom & Related Disorders ⚫ General Characteristics ⚫ 4. Excessive analgesic use with minimal relief. ⚫ 5. Assumption of sick or invalid role. ⚫ 6. Impairment in social and occupational functioning due to pre-occupation with physical complaints. 1 SOMATIZATION DISORDERS ⚫ SOMATIZATION DISORDERS are ⚫ long term, recurrent, frequent & multiple complaints for years without physical cause. Pt sees many physicians over the years and even have exploratory unnecessary surgical procedures. ⚫ Symptoms: Nausea & Vomiting. Dizziness, SOB, Dysmennorhea, Chest Pains. II. SOMATOFORM DISORDERS ⚫ 1. SOMATIZATION DISORDERS ⚫ Impairment in social or occupational functioning may be present. Depression & anxiety, emotional abuse may be a cause. Ex. A family that is emotionally cold & harsh with insult, rejection, & physical punishment. II. SOMATOFORM DISORDERS ⚫ 1. SOMATIZATION DISORDERS ⚫ Nursing Care Principles: ⚫ 1. Non-judgmental attitude. Rule out organic pathology. Realize symptoms are real. ⚫ 2. Provide pain medications as prescribed. ⚫ 3. Give attention at times when patient is not focusing on the pain. Provide diversional activities. ⚫ 4. Do not confront client about his illness. Dont ask “how are you today?” 2 PAIN DISORDER ⚫ Complains of severe pain in 1 or more anatomic sites that causes significant distress or impairment in functioning. The location or complaint of pain does not change unlike in Somatoform Disorder. ⚫ Sometimes there is a physiologic disorder but greatly exaggerated. Sometimes there’s no organic basis but there is a Psychological factor Ex. Loss of a job = pain. Pain allows the pt to avoid something they do not want to do. 3 HYPOCHONDRIASIS ⚫ Hypochondria is a preoccupation with physical malfunctioning with delusions or imagined ill health, often associated with underlying depression. ⚫ When symptoms reach the severe form (delusion of ill health) it is classified as a disorder called hypochondriasis. Treatment is with reassurance, antidepressant drug or psychotherapy. 4. CONVERSION DISORDER ⚫ Psychological conflicts cause conversion symptoms like paralysis, blindness or seizures - a deficit or alteration in voluntary motor or sensory function that suggests a neurologic medical condition. ⚫ Primary gain refers to alleviation of anxiety that the disorder provides as conflict is kept out of awareness. ⚫ Secondary gain is received from other peoples attention. 5. Body Dysmorphic Disorder BDD ⚫ 5.1. Preoccupation or focus on real (but slight) or imagined physical defect or defect in appearance in a normal appearing person. ⚫ 5.2. Examples: Large nose, thinning hair, small genitals. ⚫ 5.3 The preoccupation with defect causes significant distress & interferes with their ability to function socially, & quality of life. SOMATIC OFORM DISORDERS ⚫ Nursing Interventions ⚫ 1 Use a matter of fact caring approach when providing care for physical symptoms. R: To decrease secondary gains & decrease focusing on symptoms. ⚫ 2. Ask pt how they are feeling and to describe feelings. R: To increase verbalization about feelings (especially negative ones) needs, anxiety rather than about somatization. II. SOMATOFORM DISORDERS ⚫ Nursing Interventions ⚫ 3. Assist pt to develop correct ways to verbalize feelings and needs. R: to increase adaptive coping through assertiveness. ⚫ 4. Use positive reinforcement, and set limits by withdrawing attention from pts when they focus on physical complaints or make unreasonable demands. R: To increase non complaining behavior. II. SOMATOFORM DISORDERS ⚫ Nursing Interventions ⚫ 5. Be consistent with pt and have all requests directed to the primary nurse providing care. R: to decrease attention-seeking or manipulative behaviors. ⚫ 6. Use diversion by including pt in milieu activities & recreational games. R: to decrease rumination about physical complaints. ⚫ 7. Do not push awareness or insight into conflicts or problems. R: To prevent an increase in anxiety & need for physical symptoms. III. DISSOCIATIVE Disorders https://youtu.be/XF2zeOdE5GY ⚫1. Depersonalization & Derealization Disorder ⚫2. Dissociative Amnesia ⚫3. Dissociative Identity Disorder (Multiple Personality Disorder) DISSOCIATIVE DISORDERS ⚫ A splitting, separation, disconnection or detachment from one’s emotions, thoughts, actions, identity, and with what’s going on in the world or environment. ⚫ An unconscious defense mechanism to protect the self by “removing” awareness or detaching from painful feelings, experiences, repressed conflicts, memories, thoughts, or aspects of identity. III. DISSOCIATIVE Disorders ⚫ Stems from trauma (childhood abuse, neglect, extreme stress, BPD) or as an adaptation to negative experiences such as war or PTSD. ⚫ Exists on a continuum from low to high intensity. ⚫ Mild manifestations: denial or detachment from parts of themselves - their thoughts, emotions, and actions. ⚫ Severe dissociation: completely unaware of what one is doing, what’s happening, who they are, and assuming different personalities. It impairs a person’s functioning in daily life. III. DISSOCIATIVE Disorders ⚫ Normal: A person is so engrossed in a book or movie that they do not hear anything or anyone around them. Forgetting or daydreaming. ⚫ Abnormal dissociative disorders: When identity, memory, or consciousness is erased, disturbed, or altered. 1. Depersonalization & Derealization ⚫ Depersonalization: Being detached from one’s body, emotions, mental processes, or being like an outside observer. Reality testing is intact. ⚫ Derealization: Feeling that the world around you or things happening are not real. III. DISSOCIATIVE Disorders ⚫2. Dissociative Amnesia ⚫Loss of memory of important personal events that are usually traumatic or stressful in nature. Persons cannot remember parts of their memories or themselves. 2. DISSOCIATIVE Amnesia ⚫ 2.1. LOCALIZED (Selective): Inability to recall events related to a limited period of time (even months or years surrounding a trauma). ⚫ 2.2. GENERALIZED: A person cannot remember their entire life history, even the non-traumatic past. Onset can be sudden, stress induced. ⚫ 2.3. DISSOCIATIVE FUGUE: Disoriented person wanders & travels. May lose deeply ingrained skills. ⚫ 2.4. SYSTEMATIC: Forgetting a category of memory such as a person, location, or part of life - anything related to the trauma. III. DISSOCIATIVE Disorders ⚫2.3. Dissociative Fugue ⚫ A temporary state where a person has memory loss (amnesia) and ends up in an unexpected place. People with this symptom can't remember who they are or details about their past. They may have confusion about personal identity or assumption of partial or completely new identity.