Ch.

21: Somatic Symptom Illnesses 1

Key Terms:
o Conversion disorder: sometime called conversion reaction; involves unexplained, usually sudden deficits and
sensory or motor function related to an emotional conflict
o Disease conviction: preoccupation with the fear that one has a serious disease
o Disease phobia: pre-occupation with the fear that one will get a serious disease
o Emotion-focused coping strategies: techniques to assist clients to relax and reduce feelings of stress
o Fabricated and induced illness: factitious disorders characterized by physical symptoms that are feigned or
inflicted on one self or another person for the sole purpose of gaining attention or other emotional benefits;
also called factitious disorder, imposed on himself or others
o Fictitious disorder, imposed on self or others:
o Hypochondriasis: see illness anxiety disorder
o Hysteria: refers to multiple, recurrent physical complaints with no organic basis
o Illness anxiety disorder: preoccupation with the fear that one has a serious disease or will get a serious disease;
also called hypochondriasis
o Internalization: keeping stress, anxiety, or frustration inside rather than expressing them outwardly
o La belle indifference: a seeming lack of concern or distress; a key feature of conversion disorder
o Malingering: the intentional production of false or grossly exaggerated physical or psychological symptoms
o Munchausens syndrome: factitious disorder where the person intentionally causes injury or physical symptoms
to self to gain attention and sympathy from healthcare providers, family, and others
o Munchausens syndrome by proxy: when a person inflicts illness or injury on someone Else to gain the attention
of emergency medical personnel or to be a hero for saving the victim
o Pain disorder: has the primary physical symptom of pain, which generally is unrelieved by analgesics and greatly
affected by psychological factors in terms of onset, severity, exacerbation, and maintenance
o Primary gain: the relief of anxiety achieved by performing the specific anxiety-driven behavior; the direct
external benefits that being sick provides, such as relief of anxiety, conflict, or distress
o Problem-focused coping strategies: techniques used to resolve or change a persons behavior or situation or to
manage life stressors
o Psychosomatic: used to convey the connection between the mind (psyche) and the body (soma) in states of
health and illness
o Secondary gain: the internal or physical benefits received from others because one sick, such as attention from
family members, comfort measures, and being excused from usual responsibilities or tasks
o Somatic symptom disorder: characterized by multiple, recurrent physical symptoms in a variety of bodily
systems that have no organic or medical basis; also called somatization disorder
o Somatization: the transference of the mental experiences and states into bodily symptoms

Learning Objectives:
1. Explain what is meant by psychosomatic illness.
a. The term psychosomatic began to be used to convey the connection between the mind (psyche) and
the body (soma) in states of illness. Essentially, the mind can cause the body to either create physical

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Ch. 21: Somatic Symptom Illnesses 2
symptoms or to worsen physical illnesses. Real symptoms can begin, continue, or be worsened as a
result of emotional factors.
2. Describe somatic symptom illnesses and identify their three central features.
a. Examples include diabetes, hypertension, and colitis.
b. The three central features of somatic symptom illnesses are as follows:
i. Physical complaints suggest major medical illness but have no demonstrable organic basis.
ii. Psychological factors and conflicts seem important in initiating, exacerbating, and maintaining
the symptoms.
iii. Symptoms or magnified health concerns are not under the clients conscious control.
c. Clients are convinced they harbor serious physical problems despite negative results during diagnostic
testing. They experience physical symptoms. Many clients dont seek help from mental health
professionals.
3. Discuss the etiologic theories related to somatic symptom illnesses.
a. Psychosocial theories
i. Belief 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. Both internalization and
somatization are unconscious defense mechanisms.
b. Biologic theories
i. Research has shown differences in the way that clients with somatoform disorders regulate and
interpret stimuli. These clients cant sort relevant from irrelevant stimuli and respond equally to
both types. They may experience a normal body sensation such as peristalsis and attach a
pathological rather than a normal meaning to it.
4. Discuss the characteristics and dynamics of specific somatic symptom illnesses.
a. More common in women; reports of pain are the most common complaints; difficulty in distinguishing
physical from psychological causation.
b. Somatic symptom disorder
i. Characterized by one or more physical symptoms that have no organic basis. Individuals spend
time and energy focused on health concerns, often believe symptoms to be indicative of serious
illness, and experience significant distress and anxiety about their health.
c. Conversion disorder
i. Involved unexplained, usual sudden deficits in sensory or motor function. These deficits suggest
a neurologic disorder but are associated with psychological factors. There is usually significant
functional impairment. There may be an attitude of la belle indifference about the functional
loss.
d. Pain disorder
i. Primary physical symptom of pain, generally is unrelieved by analgesics and greatly affected by
psychological factors in terms of onset, severity, exacerbation, and maintenance.
e. Hypochondriasis or illness anxiety disorder
i. Preoccupation with the fear that one has a serious disease (disease conviction) or will get a
serious disease (disease phobia)

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Ch. 21: Somatic Symptom Illnesses 3
f. Fabricated and induced illness
i. People feign or intentionally produce symptom for some purpose or gain
g. Malingering
i. People willfully control the symptoms
ii. Motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining
financial compensation, or obtaining drugs.
iii. No physical symptoms
5. Distinguish somatic symptom illnesses from factitious disorders and malingering.
a. In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom
illnesses, clients do not voluntarily control their physical symptoms.
b. People with factitious disorders may even inflict injury on themselves to receive attention. Persons who
experience somatic disorders are unable to control their symptoms. People who experience somatic
symptom illnesses cannot stop their physical symptoms. However, people who malinger can stop the
physical symptoms as soon as they have gained what they wanted.
6. Apply the nursing process to the care of clients with somatic symptom illnesses.
a. Assessment Data
i. Denial of emotional problems
ii. Difficulty identifying and expressing feelings
iii. Lack of insight
iv. Self-preoccupation, especially with physical functioning
v. Fears of or rumination on disease
vi. Numerous somatic complaints (may involve many different organs or symptoms)
vii. Sensory complaints (pain, loss of taste sensation, olfactory complaints)
viii. Reluctance or refusal to participate in psychiatric treatment program or activities
ix. Reliance on medications or physical treatments (such as laxative dependence)
x. Extensive use of over-the-counter medications, home remedies, enemas, and so forth
xi. Ritualistic behaviors (such as exaggerated bowel routines)
xii. Tremors
xiii. Limited gratification from interpersonal relationships
xiv. Lack of emotional support system
xv. Anxiety
xvi. Secondary gains received for physical problems
xvii. History of repeated visits to physicians or hospital admissions
xviii. History of repeated medical evaluations with no findings of abnormalities
b. Interventions
i. Health Teaching
1. Establish a daily routine

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Ch. 21: Somatic Symptom Illnesses 4
2. Promote adequate nutrition and sleep
ii. Expression of emotional feelings
1. Recognize relationship between stress/coping and physical symptoms
2. Keep a journal
3. Limit time spent on physical complaints
4. Limit primary and secondary gains
iii. Coping strategies
1. Emotion-focused coping strategies such as relaxation techniques, deep breathing,
guided imagery, and distraction
2. Problem-focused coping strategies such as problem-solving strategies and role-playing
c. Evaluation/Treatment Outcomes
1. Somatic symptom illnesses are chronic or recurrent, so changes are likely to occur
slowly. If treatment is effective, the client should make fewer visits to the physician as a
result of physical complaints, use less medication and more positive coping techniques,
and increased functional abilities. Improved family and social relationships are also a
positive outcome that may follow improvements in the client's coping abilities.
Treatment outcomes for clients with a somatic symptom illness may include the
following:
2. The client will identify the relationship between stress and physical symptoms.
3. The client will verbally express emotional feelings.
4. The client will follow an established daily routine.
5. The client will develop alternative ways to deal with stress, anxiety, and other feelings.
6. The client will demonstrate healthier behaviors regarding rest, activity, and nutritional
intake.
7. Provide education to clients, families, and the community to increase knowledge and understanding of
somatic symptom disorders.
a. Established daily health routine, including adequate rest, exercise, and nutrition
b. Teach about relationship of stress and physical symptoms and mind-body relationship
c. Educate about proper nutrition, rest, and exercise
d. Educate client in relaxation techniques: Progressive relaxation, deep breathing, guided imagery, and
distractions such as music or other activities
e. Educate client by role-playing social situations and interactions.
f. Encourage family to provide attention and encouragement when client has fewer complaints.
g. Encourage family to decrease special attention when client is in sick role.
8. Evaluate your feelings, beliefs, and attitudes regarding clients with somatic symptom disorders.
a. Clients who cope through physical symptoms can be frustrating for the nurse. Initially, they are unwilling
to consider that anything other than major physical illness is the root of all their problems. The client's
progress is slow and painstaking, if any change happens at all. The nurse should be realistic about the
small successes that can be achieved in any given period. To enhance the ongoing relationship, the

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Ch. 21: Somatic Symptom Illnesses 5
nurse must be able to accept the client and his or her continued complaints and criticisms while
remaining nonjudgmental.

UNIT 4: NURSING PRACTICE FOR PSYCHIATRIC DISORDERS