Somatic Symptom Illnesses PDF

11/16/23, 11:05 AM Realizeit for Student Somatic Symptom Illnesses Onset and Clinical Course Clients with somatic symptom disorder often experience symptoms in adolescence, though these diagnoses may not be made until early adulthood (about 25 years of age). Conversion disorder usually occurs betw...

11/16/23, 11:05 AM Realizeit for Student Somatic Symptom Illnesses Onset and Clinical Course Clients with somatic symptom disorder often experience symptoms in adolescence, though these diagnoses may not be made until early adulthood (about 25 years of age). Conversion disorder usually occurs between the ages of 10 and 35 years. Pain disorder and illness anxiety disorder can occur at any age. All somatic symptom illnesses are either chronic or recurrent, lasting for decades for many people. Clients with somatic symptom illness and conversion disorder most likely seek help from mental health professionals after they have exhausted efforts at finding a diagnosed medical condition. Clients with illness anxiety, or pain disorder, are unlikely to receive treatment in mental health settings unless they have a comorbid condition. Clients with somatic symptom illnesses tend to go from one physician or clinic to another, or they may see multiple providers at once in an effort to obtain relief of symptoms. They tend to be pessimistic about the medical establishment and often believe their disease could be diagnosed if providers were more competent. Etiology Psychosocial Theories Psychosocial theorists believe that people with somatic symptom illnesses keep stress, anxiety, or frustration inside rather than expressing them outwardly. This is called internalization. Clients express these internalized feelings and stress through physical symptoms (somatization). Both internalization and somatization are unconscious defense mechanisms. Clients are not consciously aware of the process, and they do not voluntarily control it. People with somatic symptom illnesses do not readily and directly express their feelings and emotions verbally. Some experience alexithymia, or the inability to identify emotions. This is different than an unwillingness or refusal to identify emotions. They have tremendous difficulty dealing with interpersonal conflict. When placed in situations involving conflict or emotional stress, their physical symptoms appear to worsen. The worsening of physical symptoms helps them meet psychological needs for security, attention, and affection through primary and secondary gain. Primary gains are the direct internal benefits that being sick provides, such as relief of anxiety, conflict, or distress. Secondary gains are the external or personal benefits received from others because one is sick, such as attention from family members and comfort measures https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 1/6 11/16/23, 11:05 AM Realizeit for Student (e.g., being brought tea, receiving a back rub). The person soon learns that he or she “needs to be sick” to have his or her emotional needs met. Somatization is associated most often with women, as evidenced by the old term hysteria (Greek for “wandering uterus”). Ancient theorists believed that unexplained female pains resulted from migration of the uterus throughout the woman’s body. Psychosocial theorists posit that increased incidence of somatization in women may be related to various factors: Boys in the United States are taught to be stoic and to “take it like a man,” causing them to offer fewer physical complaints as adults. Women seek medical treatment more often than men, and it is more socially acceptable for them to do so. Childhood sexual abuse, which is related to somatization, happens more frequently to girls. Women more often receive treatment for psychiatric disorders with strong somatic components such as depression. Biologic Theories Research has shown differences in the way clients with somatoform disorders regulate and interpret stimuli. These clients cannot sort relevant from irrelevant stimuli and respond equally to both types. In other words, they may experience a normal body sensation such as peristalsis and attach a pathologic rather than a normal meaning to it. Too little inhibition of sensory input amplifies awareness of physical symptoms and exaggerates response to bodily sensations. For example, minor discomfort such as muscle tightness becomes amplified because of the client’s concern and attention to the tightness. This amplified sensory awareness causes the person to experience somatic sensations as more intense, noxious, and disturbing (Black & Andreasen, 2016). Research has shown that visceral hypersensitivity is associated with the severity of gastrointestinal (GI) symptoms in large cohorts of patients with functional GI disorders in a variety of settings (Simren et al., 2018). CULTURAL CONSIDERATIONS The type and frequency of somatic symptoms and their meaning may vary across cultures. Pseudoneurologic symptoms of somatization disorder in Africa and South Asia include burning hands and feet and the nondelusional sensation of worms in the head or ants under the skin. Symptoms related to male reproduction are more common in some countries or cultures—for example, men in India often have dhat, which is a hypochondriacal concern about loss of semen. Somatic symptom disorder is rare in men in the United States but more common in Greece and Puerto Rico. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 2/6 11/16/23, 11:05 AM Realizeit for Student Many cultural concepts of distress have corresponding somatic symptoms not explained by a medical condition (Table 21.1). Koro occurs in Southeast Asia and may be related to body dysmorphic disorder. It is characterized by the belief that the penis is shrinking and will disappear into the abdomen, causing the man to die. Falling-out episodes, found in the southern United States and the Caribbean islands, are characterized by a sudden collapse during which the person cannot see or move. HwaByung is a Korean folk syndrome attributed to the suppression of anger and includes insomnia, fatigue, panic, indigestion, and generalized aches and pains. Sangue dormido (sleeping blood) occurs among Portuguese Cape Verde Islanders who report pain, numbness, tremors, paralysis, seizures, blindness, heart attacks, and miscarriages. Shenjing shuairuo occurs in China and includes physical and mental fatigue, dizziness, headache, pain, sleep disturbance, memory loss, GI problems, and sexual dysfunction (Lewis-Fernandez, Kirmayer, Guarnaccia, & Ruiz, 2017). TABLE 21.1 Cultural Concepts of Distress Syndrome Culture Dhat India Characteristics Hypochondriacal concern about semen loss Belief that penis is shrinking and will Koro Southeast Asia disappear into abdomen, resulting in death Southern Falling-out episodes United States, Sudden collapse; person cannot see Caribbean or move islands Suppressed anger causes insomnia, Hwa-Byung Korea fatigue, panic, indigestion, and generalized aches and pains https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 3/6 11/16/23, 11:05 AM Sangue dormido (sleeping blood) Realizeit for Student Portuguese Pain, numbness, tremors, paralysis, Cape Verde seizures, blindness, heart attack, Islands miscarriage Physical and mental fatigue, dizziness, headache, pain, sleep Shenjing shuairuo China disturbance, memory loss, gastrointestinal problems, sexual dysfunction Adapted from Lewis-Fernandez, R., Kirmayer, L. J., Guarnaccia, P. J., & Ruiz, P. (2017). Cultural concepts of distress. In B. J. Sadock, V. A. Sadock, & P. Ruiz (Eds.), Comprehensive textbook of psychiatry (Vol. 2, 10th ed., pp. 2443–2460). Philadelphia, PA: Lippincott Williams & Wilkins/Wolters Kluwer. The presence of a host of somatic symptoms can also be associated with other diagnoses. Zhao and colleagues (2018) found that patients in China diagnosed with major depression sought treatment in various medical settings. They reported experiencing insomnia, weight loss, low appetite, circulatory system complaints, headache, hyposexuality, GI complaints, and respiratory system problems. Treatment Treatment focuses on managing symptoms and improving quality of life. The health care provider must show empathy and sensitivity to the client’s physical complaints. A trusting relationship helps ensure clients stay with and receive care from one provider instead of “doctor shopping.” For many clients, depression and anxiety may accompany or result from somatic symptom illnesses. For clients with pain disorder, referral to a chronic pain clinic may be useful. Clients learn methods of pain management, such as visual imaging and relaxation. Services such as physical therapy to maintain and build muscle tone help improve functional abilities. Providers should avoid prescribing and administering narcotic analgesics to these clients because of the risk for dependence or abuse. Clients can use nonsteroidal antiinflammatory agents to help reduce pain. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 4/6 11/16/23, 11:05 AM Realizeit for Student Involvement in therapy groups is beneficial for some people with somatic symptom illnesses. Clients with somatic symptom disorder and anxiety illness disorder who participated in a structured cognitive–behavioral group showed evidence of improved physical and emotional health. The overall goals of the group were offering peer support, sharing methods of coping, and perceiving and expressing emotions. Clients with hypochondriasis who were willing to participate in cognitive–behavioral therapy and take medications were able to alter their erroneous perceptions of threat (of illness) and improve. Cognitive–behavioral therapy also produced significant improvement in clients with somatic symptom disorder (Hedman, Axelsson, Anderson, Lekander, & Ljotsson, 2016). Education or providing information has also been effective for clients with somatic illness or symptoms. Reading both internet-based educational material and books were other effective therapies (Hedman et al., 2016). In terms of prognosis, somatic symptom illnesses tend to be chronic or recurrent. With treatment, conversion disorder often remits in a few weeks but recurs in 25% of clients. Somatic symptom disorder, illness anxiety disorder, and pain disorder often last for many years, and clients report being in poor health (Black & Andreasen, 2016). Try-Its Identify theoretical causation of somatic symptom illnesses. Compare and contrast the characteristics of malingering and somatic symptom illnesses. When a client has pain disorder, powerful analgesics such as narcotics are generally contraindicated, even though the client is suffering unremitting pain. How might the nurse feel when working with this client? How does the nurse respond when the client says, “You know I’m in pain! Why won’t you do anything? Why do you let me suffer?” Discuss your thoughts regarding the care of clients with somatoform disorders. Why is it important not to dismiss medical complaints? https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 5/6 11/16/23, 11:05 AM Realizeit for Student https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 6/6