NURSING INTERVENTION:

A. Do’s: Divert attention from symptom; Provide social and

recreational activities; Reduce pressure on client; Control
A. PSYCHOSOMATIC DISORDERS: environment
Without any organic or REAL physiological “OBJECTIVE” B. Don’ts: Confront client with his illness; Feed into secondary
symptoms. gains through anticipating client needs.
 Emotional stress may exacerbate or precipitate an illness.
 The way an individual reacts to stress depends on his 2. HYPOCHONDRIASIS: Preoccupation with an imagined illness
physiological and psychological make-up. with no observable symptoms and no organic changes.
 Structural changes may take place and pose threat to life. #1 Sign is “DOCTOR SHOPPING”: Because of the inability to
accept reassurance even after exhaustive testing activities as
 Defense mechanisms include REPRESSION, PROJECTION, going from doctor to doctor to find cure.
CONVERSION and INTROJECTION.
 Synergistic relationship exists between repressed feelings ASSESS FOR:
and overexcited organs.
 Preoccupation with body functions or fear of serious disease
 Somatoform disorders result in impaired social,
misinterpretation and exaggeration of physical symptoms
occupational and other areas of functioning.
 Adoption of sick role and invalid life-style; signs of severe
regression
PSYCHOPHYSIOLOGIC DISORDER: with real symptoms!
 Lack of interest in environment history of repeated
Physical symptoms whose etiologies are in part precipitated
absences from work
by psychological factors and may involve any organ system.
 If the client is MALINGERING: Deliberately making up illness
 Cardiovascular: Hypertension, Tachycardia
to prolong hospitalization; “faking illnesses”
 Gastrointestinal: Peptic Ulcer, ulcerative colitis, Colic
 Respiratory: Asthma, Hyperventilation, Common colds,
NURSING INTERVENTION:
Hay fever
1. Show acceptance of the client.
 Skin: Blushing, Flushing, Perspiring, Dermatitis
2. Prepare for, assist in complete medical workup to reassure
 Nervous: Chronic fatigue, Migraine headaches, Exhaustion
client and rule and medical problems
 Endocrine: Dysmenorrhea, Hyperthyroidism
3. Psychotherapy, family therapy and group therapy:
 Musculoskeletal: Cramps
A combination of somatic and behavioral treatment modalities
 Others: Obesity, hyperemesis gravidarum
facilities treatment of the disorder.
 Meet physical needs giving accurate information and
NURSING CARE: Holistic or TOTAL – physical and emotional
correcting misconception.
 Understand that PHYSICAL SYMPTOMS ARE REAL and that
 Demonstrate friendly, supportive approach but NOT
the client is not faking and the TREATMENT OF PHYSICAL
focusing on the illness.
PROBLEMS DOES NOT RELIEVE EMOTIONAL PROBLEMS
 Provide diversionary activities that build self-esteem.
Develop nurse-client relationship:
 Help client refocus on topics other than the illness.
 Respect the client and his problems.
 Assist client understand how he uses illness to avoid
 Help to express feelings, Allow client to feel in control
dealing with his problems.
 Let client meet dependency needs.
 Help to work through problems and learn new coping
DEFENSE MECHANISMS IN SOMOTOFORM DISORDERS:
mechanism.
1. Denial – it is the refusal to accept reality or fact, acting as
if a painful event, thought or feeling did not exist.
TYPES OF SOMATOFORM DISORDERS / PSYCHOSOMATIC
2. Projection – it is the misattribution of a person’s
DISORDERS
undesired thoughts, feelings or impulses onto another
person who does not have those thoughts, feelings or
1. CONVERSION DISORDER: Presence of physical symptoms
impulses.
with NO identified physical etiology.
3. Conversion – it occurs where cognitive tensions manifest
CHARACERISTICS: #1 Sign “Labelle Indifference”
themselves in physical symptoms.
Can take the form of blindness, deafness, paralysis or any
4. Introjection – it occurs when a person internalizes the
other physical conditions but with no organic basis. Client
ideas or voices of other people. Unconsciously
derives primary and secondary gains from the physical
incorporating wishes, values etc. (Ex: Without her mother
symptoms.
the sister disciplines her brother)
ASSESS FOR: TWO GAINS IN CONVERSION DISORDER
1. Primary gain.
 REPRESSION: Keeps internal need or conflict out of
DEFINITION: Psychiatric disorder involving disruption in the
awareness.
usually integrated functions of consciousness, identity,
 SYMBOLISM: Symptom has symbolic value to client.
memory, or perception of the environment.
2. Secondary gain. (Not connected to the primary gain)  Client attempts to deal with anxiety by BLOCKING certain
 Additional advantages: Sympathy, attention, avoidance. areas out of the mind or deeply REPRESSING traumatic
 Reinforces maladjusted behavior. events, or by PSYCHOLOGICAL RETREAT from reality.
 A condition NOT of organic origin and usually occurs as a
result of some very painful experience.
 ASSESSMENT FINDINGS:
1. AMNESIA: Selective or generalized and continuous
loss of memory
2. FUGUE: State of dissociation involving amnesia and
actual PHYSICAL FLIGHT – transient disorientation
where client is unaware that he has traveled to
another location (Client does not remember
period of fugue.)
3. DEPERSONALIZATION: Alteration in perception or
experience of self, sense of detachment from self,
as if self is NOT REAL
4. DISSOCIATIVE IDENTITY DISORDER (MULTIPLE
PERSONALITY): Donated by two or more
personalities, each of which controls the behavior
while in the consciousness.

NURSING IMPLEMENTATION:
 Assess what form the dissociative disorder is manifesting
and degree of interference in ADL, lifestyle, and
interpersonal relations.
 Reduce anxiety-producing stimuli
 Redirect client’s attention away from self; increase
socialization / diversional activities
 Support modalities of treatment:
 Abreaction: Assisting in the recall of past, painful
experiences.
 Hypnosis; cognitive restructuring
 Behavioral therapy
 Psychopharmacology: Anti-anxiety, antidepressant

Most appropriate intervention for Dissociative Personality

Behavior includes encouraging to chart alternative personality.