NCM 116 – Care of Clients with Maladaptive SEM 02
Patterns of Behavior, Acute and Chronic FINALS
Lecturer: Dr. Cefer S. Sales, RN, MD, MHM, CHA
UNIT 4 – CHAPTER 21: SOMATIC SYMPTOM ILLNESS
TOPIC OUTLINE factors in terms of onset, severity, exacerbation,
I. Introduction and maintenance.
II. Overview of Somatic Symptom Illnesses o Illness Anxiety Disorder, formerly
III. Related Disorders hypochondriasis, is preoccupation with the fear
IV. Nursing Management that one has a serious disease (disease
conviction) or will get a serious disease (disease
phobia). It is thought that clients with this disorder
INTRODUCTION
misinterpret bodily sensations or functions.
• In the early 1800s, the medical field began to consider o Conversion Disorder, sometimes called
the various social and psychological factors that conversion reaction, involves unexplained,
influence illness. The term psychosomatic began to be usually sudden deficits in sensory or motor
used to convey the connection between the mind function (e.g., blindness, paralysis). These
(psyche) and the body (soma) in states of health and deficits suggest a neurologic disorder but are
illness. associated with psychological factors. There is
• Essentially, the mind can cause the body either to
usually significant functional impairment. There
create physical symptoms or to worsen physical may be an attitude of la belle indifference, a
illnesses. Real symptoms can begin, continue, or be seeming lack of concern or distress, about the
worsened as a result of emotional factors. Examples functional loss.
include diabetes, hypertension, and colitis, all of which o Somatic symptom illnesses need to be
are medical illnesses influenced by stress and distinguished from other body-related mental
emotions. When a person is under a lot of stress or is disorders such as malingering and factitious
not coping well with stress, symptoms of these medical disorders, also known as fabricated or induced
illnesses worsen. illness, in which people feign or intentionally
• The term hysteria refers to multiple physical produce symptoms for some purpose or gain.
complaints with no organic basis; the complaints are
usually described dramatically. RELATED DISORDERS
• The concept of hysteria is believed to have originated
• Malingering means feigning physical symptoms for
in Egypt and is about 4,000 years old. In the Middle
some external gain, such as avoiding work.
Ages, hysteria was associated with witchcraft,
• Factitious Disorders are characterized by physical
demons, and sorcerers. People with hysteria, usually
symptoms that are feigned or inflicted for the sole
women, were considered evil or possessed by evil
purpose of drawing attention to oneself and gaining
spirits.
the emotional benefits of assuming the sick role.
• Paul Briquet and Jean-Martin Charcot, both French
→ The common term for factitious disorder imposed
physicians, identified hysteria as a disorder of the
on self is Munchausen Syndrome. A variation of
nervous system.
factitious disorder, imposed on others, is
commonly called Munchausen Syndrome by
OVERVIEW OF SOMATIC SYMPTOM ILLNESSES
proxy, and occurs when a person inflicts illness
Somatization is defined as the transference of
or injury on someone else to gain the attention of
mental experiences and states into bodily symptoms.
emergency medical personnel or to be a “hero”
Somatic symptom illnesses can be characterized as the
for saving the victim.
presence of physical symptoms that suggest a medical
• Internalization and Somatization are the chief
condition without a demonstrable organic basis to account
defense mechanisms seen in clients with
fully for them.
somatoform disorders.
The three central features of somatic symptom illnesses
are as follows:
ETIOLOGY
o Physical complaints suggest major medical
illness but have no demonstrable organic basis. Psychosocial Theories
o Psychological factors and conflicts seem → Psychosocial theorists believe that people with
important in initiating, exacerbating, and somatic symptom illnesses keep stress, anxiety, or
maintaining the symptoms. frustration inside rather than expressing them
o Symptoms or magnified health concerns are not outwardly. This is called internalization. Clients
under the client’s conscious control. express these internalized feelings and stress
through physical symptoms (somatization). Both
Somatic Symptom Disorders include (Esobar & internalization and somatization are unconscious
Dimsdale, 2017): defense mechanisms.
o Somatic symptom disorder is characterized by → Psychosocial theorists posit that increased incidence
one or more physical symptoms that have no of somatization in women may be related to various
organic basis. Individuals spend a lot of time and factors:
energy focused on health concerns, often believe - Boys in the United States are taught to be stoic
symptoms to be indicative of serious illness, and and to “take it like a man,” causing them to offer
experience significant distress and anxiety about fewer physical complaints as adults.
their health. - Women seek medical treatment more often than
men, and it is more socially acceptable for them
Patterns of Behavior, Acute and Chronic FINALS
Lecturer: Dr. Cefer S. Sales, RN, MD, MHM, CHA
UNIT 4 – CHAPTER 21: SOMATIC SYMPTOM ILLNESS
TOPIC OUTLINE factors in terms of onset, severity, exacerbation,
I. Introduction and maintenance.
II. Overview of Somatic Symptom Illnesses o Illness Anxiety Disorder, formerly
III. Related Disorders hypochondriasis, is preoccupation with the fear
IV. Nursing Management that one has a serious disease (disease
conviction) or will get a serious disease (disease
phobia). It is thought that clients with this disorder
INTRODUCTION
misinterpret bodily sensations or functions.
• In the early 1800s, the medical field began to consider o Conversion Disorder, sometimes called
the various social and psychological factors that conversion reaction, involves unexplained,
influence illness. The term psychosomatic began to be usually sudden deficits in sensory or motor
used to convey the connection between the mind function (e.g., blindness, paralysis). These
(psyche) and the body (soma) in states of health and deficits suggest a neurologic disorder but are
illness. associated with psychological factors. There is
• Essentially, the mind can cause the body either to
usually significant functional impairment. There
create physical symptoms or to worsen physical may be an attitude of la belle indifference, a
illnesses. Real symptoms can begin, continue, or be seeming lack of concern or distress, about the
worsened as a result of emotional factors. Examples functional loss.
include diabetes, hypertension, and colitis, all of which o Somatic symptom illnesses need to be
are medical illnesses influenced by stress and distinguished from other body-related mental
emotions. When a person is under a lot of stress or is disorders such as malingering and factitious
not coping well with stress, symptoms of these medical disorders, also known as fabricated or induced
illnesses worsen. illness, in which people feign or intentionally
• The term hysteria refers to multiple physical produce symptoms for some purpose or gain.
complaints with no organic basis; the complaints are
usually described dramatically. RELATED DISORDERS
• The concept of hysteria is believed to have originated
• Malingering means feigning physical symptoms for
in Egypt and is about 4,000 years old. In the Middle
some external gain, such as avoiding work.
Ages, hysteria was associated with witchcraft,
• Factitious Disorders are characterized by physical
demons, and sorcerers. People with hysteria, usually
symptoms that are feigned or inflicted for the sole
women, were considered evil or possessed by evil
purpose of drawing attention to oneself and gaining
spirits.
the emotional benefits of assuming the sick role.
• Paul Briquet and Jean-Martin Charcot, both French
→ The common term for factitious disorder imposed
physicians, identified hysteria as a disorder of the
on self is Munchausen Syndrome. A variation of
nervous system.
factitious disorder, imposed on others, is
commonly called Munchausen Syndrome by
OVERVIEW OF SOMATIC SYMPTOM ILLNESSES
proxy, and occurs when a person inflicts illness
Somatization is defined as the transference of
or injury on someone else to gain the attention of
mental experiences and states into bodily symptoms.
emergency medical personnel or to be a “hero”
Somatic symptom illnesses can be characterized as the
for saving the victim.
presence of physical symptoms that suggest a medical
• Internalization and Somatization are the chief
condition without a demonstrable organic basis to account
defense mechanisms seen in clients with
fully for them.
somatoform disorders.
The three central features of somatic symptom illnesses
are as follows:
ETIOLOGY
o Physical complaints suggest major medical
illness but have no demonstrable organic basis. Psychosocial Theories
o Psychological factors and conflicts seem → Psychosocial theorists believe that people with
important in initiating, exacerbating, and somatic symptom illnesses keep stress, anxiety, or
maintaining the symptoms. frustration inside rather than expressing them
o Symptoms or magnified health concerns are not outwardly. This is called internalization. Clients
under the client’s conscious control. express these internalized feelings and stress
through physical symptoms (somatization). Both
Somatic Symptom Disorders include (Esobar & internalization and somatization are unconscious
Dimsdale, 2017): defense mechanisms.
o Somatic symptom disorder is characterized by → Psychosocial theorists posit that increased incidence
one or more physical symptoms that have no of somatization in women may be related to various
organic basis. Individuals spend a lot of time and factors:
energy focused on health concerns, often believe - Boys in the United States are taught to be stoic
symptoms to be indicative of serious illness, and and to “take it like a man,” causing them to offer
experience significant distress and anxiety about fewer physical complaints as adults.
their health. - Women seek medical treatment more often than
men, and it is more socially acceptable for them
