Somatic & Dissociative Disorders PDF

S O M AT I C A N D D I S S O C I AT I V E DISORDERS NSG212 Julie Allender, RN  Objectives ❖ Explore epidemiological and etiological risk factors that contribute to clients experiencing somatic symptom and dissociative disorders. ❖...

S O M AT I C A N D D I S S O C I AT I V E DISORDERS NSG212 Julie Allender, RN  Objectives ❖ Explore epidemiological and etiological risk factors that contribute to clients experiencing somatic symptom and dissociative disorders. ❖ Differentiate the clinical presentation of clients experiencing somatic symptom and dissociative disorders. ❖ Identify medical treatments for people with somatic symptoms and related disorders. ❖ Identify nursing interventions for people with somatic symptoms and related disorders. What does somatic mean and why? ❖Somatic refers to the body. ❖Somatiz ation: is when emotional distress and psychological issues are exhibited in physical manifestations that cannot be explained medically. ❖Etiology: ACE’s, increased sensitivity to pain, and displaced anxiety. Somatic Symptom Disorder (SSD) ❖ Somatic Symptom Disorder is characterized by bodily symptoms that are either very distressing or that result in significant disruption of functioning and are accompanied by excessive and disproportionate thoughts, feelings, and behaviors regarding those symptoms. ❖ Based on positive signs and symptoms that disrupt a person’s activities of daily living. ❖ Types Conversion Disorder (Functional Neurological Symptom Disorder) Illness Anxiety Disorder Factitious Disorder Diagnosing SSD ❖ More than one somatic symptom that is related to a substantial disruption in activities of daily living. ❖ Extreme thoughts, behaviors, and feelings related to the somatic complaint producing at least one of the following: persistent thoughts about the symptoms, which are inconsistent with its seriousness; being overly anxious; and focusing on these symptoms for long periods. ❖ “Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent” for at least 6 months. Conversion Disorder (Functional Neurological Symptom Disorder) ❖ Anxiety converts into physical symptoms. ❖ Indifference to the loss or decrease in physical functioning that cannot be explained medically. ❖ Deeply connected to denial and defense mechanisms. ❖ Malingering Illness Anxiety Disorder ❖ Used to be called hypochondriasis. ❖ Afraid they’re GOING to get serious disease or illness, but not presently experiencing symptoms. ❖ “Professional patient” ❖ Preoccupied with the idea of being seriously ill and not being taken seriously or evaluated properly. Factitious Disorder (Munchausen's) ❖ Think Gyspy Rose ❖ Misrepresentation, simulation, or causation of signs and symptoms of a disorder or multiple disorders ❖ To self: Munchausen’s ❖ To others: Munchausen’s by proxy ❖ Gains Treatments ❖ Treatments Medication – anxiety meds Hypnosis Relaxation techniques Stress management Behavior modification Nursing Considerations ❖ The symptoms, although not supportive of organic disease, are very real to the patient. Do not, by word or action, imply to a patient that you think the patient is “ faking” the illness; it is real to the patient. The patient is truly experiencing the symptoms. Even though the patient is concerned enough about the symptoms to consult a physician, they may give the impression of really not caring about the problem. La belle indifférence is the clinical term used to describe this lack of concern. D I S S O C I AT I V E D I S O R D E R S  What does it mean to dissociate and why? ❖ Dissociation or a mental state of disconnecting from one’s thoughts, memories, and feelings ❖ Can present in a person who has experienced a history of trauma. When a client experiences dissociation, they may re-experience previous trauma, switch to an altered personality, or have flashbacks or nightmares ❖ Defense Mechanism where client unconsciously to protect from overwhelming anxiety or stress. ❖ Positive and negative presentations ❖ Three types: Depersonalization/derealization disorder Dissociative amnesia Dissociative identity disorder (DID) Depersonalization/Derealization Disorder ❖Depersonalization/derealiz ation disorder is when the client experiences a detachment from their surroundings. The client may describe feeling like they are floating out of their body or that they are in a dreamlike state. However, the client is still able to test reality. ❖ Depersonaliz ation/Derealiz ation disorder: A condition wherein an individual feels disconnected from their own self. Client may experience ❖ Derealization: where they feel detached from their environment or that objects around them are unreal. ❖ Depersonalization: where they feel like they are seeing themselves from outside of their body. Dissociative Amnesia Disorder ❖Dissociative amnesia is described as the client being unable to recall events related to their history and is not consistent with normal forgetting ❖ Dissociative Amnesia: A condition defined by the inability to remember certain experiences, which are usually stressful (American Psychiatric Association, 2013). Clinical manifestation include an inability to remember or amnesia ❖ Specific memories, or it may include much of the client’s history and even their own identity (Mangiulli et al., 2021). ❖ Often related to a stressful or traumatic event. Dissociative Identity Disorder ❖ Dissociative identity disorder (DID) involves sudden and temporary changes in consciousness, behavior, and identity. Dissociative identity disorder becomes a diagnosis when a client experiences a disruption of identity characterized by two or more distinct personality states ❖ Dissociative Identity Disorder (DID) present with two or more distinct personalities. Some clients may also report an experience that resembles possession (American Psychiatric Association, 2022). ❖ Recurrent episodes that are outside client’s control. ❖ Changes in perception, invasion into their conscious functioning or changes to sense of self. Nursing Considerations ❖ Effective therapeutic communications ❖ Empathic therapeutic relationship ❖ Develop healthy coping strategies and skills ❖ Maintain boundaries and set limits