Somatoform disorder

Somatoform Disorder Nursing Diagnosis Interventions and Care Plans

Somatoform Disorder NCLEX Review Care Plans

Nursing Study Guide on Somatoform Disorder

Somatoform disorder, also known as Somatic Symptom Disorder (SSD), is a mental health condition characterized by having significant physical symptoms brought about by psychological or emotional distress.

It can be easily described as the conversion of emotional state into physical symptoms or somatization.

A person with somatoform disorder often seeks medical advice for the symptoms they are experiencing.

However, there may or may not be any medical explanation to the symptoms they are undergoing.

Types of Somatoform Disorder

  1. Somatization disorder. It is a type of somatoform disorder that affects the person for a long time, with symptoms related to psychosocial distress. The somatic symptoms are often cannot be explained medically. 
  2. Pain disorder. This somatoform disorder is characterised by chronic distress due to prolonged and severe pain. This can affect the affected person’s occupational and social functioning, as well as activities of daily living.
  3. Hypochondriasis. In hypochondriasis, the patient can have unrealistic fear and preoccupation on having a serious illness that is often not diagnosed or proven to be existent.
  4. Conversion disorder. This somatoform disorder involves psychological distress that leads to a change in or loss of a body function.
  5. Body dysmorphic disorder. Also known as dysmorphophobia, this somatoform disorder features a person’s exaggerated belief that there is a defective of deformed body part even if there is no medical evidence to prove it.

Signs and Symptoms of Somatoform Disorder

The symptoms related to somatoform disorder may vary and can range from mild to severe.

Each can be a single symptom or a collective and may not point to any medical illness.

A symptom of somatoform disorder can indicate a particular condition like cancer. 

The symptoms are mostly more severe than that experienced by a distressed person without somatoform disorder.

They include:

  1. Continuous fear of potential illness
  2. Thinks that normal physical sensations are signs of a severe disease
  3. Thinks that symptoms are serious even if medical exam says otherwise
  4. Fears that medical assessment and treatment is inadequate
  5. Fears that physical activity can cause physical damage
  6. Constantly checks for abnormalities
  7. Frequent clinic visits do not reduce concerns rather make them worse
  8. Medical treatments do not usually work and sensitivity to medication side effects
  9. More severe symptoms than those expected of an illness

Causes and Risk Factors of Somatoform Disorder

The exact cause of somatoform disorder remains unknown. However, it is believed that the following risk factors contribute to how a person responds to symptoms and how they are perceived:

  1. Genetic and biological factors. A person can be born with increased sensitivity to pain which can then contribute to emotional distress.
  2. Learned behavior. A sick person usually gets more attention; hence the experience gives them a positive emotion of being looked after. This can in turn encourage increased level of disability.
  3. Family influence
  4. Pessimism
  5. Problems in processing emotions
  6. Other mental health condition like depression
  7. Having medical condition or is recovering from one
  8. High risk of getting a condition due to strong family history
  9. Trauma, violence, or stress
  10. Past trauma
  11. Low socio-economic background

Complications of  Somatoform Disorder

The symptoms experienced that a person with somatoform disorder is often more severe than usual.

This causes further emotional distress, hence increasing physical disability. Somatoform disorder can lead to the following:

  1. Poor health
  2. Physical disability
  3. Issues with relationships
  4. Issues with work causing unemployment
  5. Other mental health condition
  6. Higher suicide risk
  7. Financial issues due to frequent clinic visits

Diagnosis of Somatoform Disorder

  1. Physical assessment and history taking – include questions about mental health and alcohol and drug use. If there’s any identified medical condition, then treatment will be prescribed accordingly.
  2. The American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for the diagnosis of somatoform disorder. The criteria are as follows:
  3. One or more symptoms causing disability or disruption in carrying out activities of daily living
  4. Too many thoughts on the seriousness of symptoms, high levels of anxiety on symptoms, or excessive time spent worrying about symptoms or health
  5. One symptom is constantly present while others may come and go

Treatment for Somatoform Disorder

The goal of treatment for a patient with somatoform disorder is to improve quality of life and help the person function.

Since most of the symptoms are related to mental and psychological health, treatments often include psychotherapy.

  1. Treatment of underlying conditions. If a medical condition is identified in the diagnosis of somatoform disorder, then this underlying medical condition is treated. The symptoms of somatoform disorder are also addressed.
  2.  Psychotherapy. Cognitive behavioral therapy helps to identify beliefs and expectations with health and symptoms. It also helps in reducing stress and preoccupation with health and physical symptoms. It improves coping and daily functioning. It can help improve social situations and build relationships. Cognitive therapy also addresses depression and other mental health conditions. Family therapy can be included in the therapy regimen to assess family relationship and establish family support.
  3. Medications. Anti-depressants are usually prescribed by a health care provider. It helps reduce symptoms related to anxiety, depression, and pain. The healthcare team will assess whether one medication is enough, or a combination of drugs is required. If needed, the medication will be switched to a different one or is combined with something else to boost effectiveness. It can take a few weeks for the optimum results to be apparent. The health care provider should be able to discuss side effects and risks related to the prescribed medications.
  4. Lifestyle changes. The following lifestyle changes can be helpful in managing somatoform disorder:
  5. Good working relationship with care providers. Communicating well and building trust with care providers can help improve visits and therefore maximize the treatment they can offer.
  6. Increased physical activity. Exercise can have calming effect therefore improving mood and improve physical symptoms.
  7. Participation in activities. This can improve social interactions and can have an effect on mood as well.
  8. Stress management and relaxation techniques to improve symptoms
  9. Avoidance of alcohol and drugs. Substance use can make symptoms worse.

Nursing Care Plans for Somatoform Disorder

Nursing Care Plan 1

Nursing Diagnosis: Chronic Pain related to somatoform disorder as evidenced by unremarkable imaging results, verbalization of pain that cannot be explained medically, restlessness

Desired Outcome: The patient will verbalize feeling of comfort and reduced perception of pain.

InterventionRationale
Assess the patient’s vital signs and perform a full body physical exam.To establish baseline and ensure that there is no physical rationale for the patient’s complaint of pain.
Allow the patient to express his/her feelings and thoughts about pain, such as its intensity, as well as what he/she believes to trigger it, intensify it, and relieve it.Despite not having any medical reason for the pain, healthcare providers should provide a caring environment to the patient and allow expression of feelings and thoughts about it.
Use an appropriate pain scale when helping the patient determine the severity of pain.Pain is a subjective symptom; the treatment should involve the patient’s current feeling of pain.
Provide comfort measures for the patient in terms of temperature of the room, positioning of the bed, provision of pillows.To help the patient become relaxed and feel comfortable. This can also help establish rapport between the nurse and the patient.
Encourage the patient to perform relaxation techniques, such as deep breathing exercises, guided imageryTo help the patient become relaxed and feel comfortable. This can also help establish rapport between the nurse and the patient.

Nursing Care Plan 2

Nursing Diagnosis: Ineffective Coping related to somatoform disorder as evidenced by restlessness, failure to do activities of daily living as normal, verbalization of distress.

Desired Outcome: The patient will be able to cope with her current condition by re-establishing normal ADLs.

InterventionRationale
Assess the patient’s mental status. Ask questions to determine if the patient has suicidal ideations, or possible substance abuse.It is important to encourage the patient to verbalize any negative thoughts, feelings, and behaviors in order for the nurse and healthcare team to provide holistic care and keep him/her safe.
Allow the patient to express his/her feelings and thoughts about pain, such as its intensity, as well as what he/she believes to trigger it, intensify it, and relieve it.Despite not having any medical reason for the pain, healthcare providers should provide a caring environment to the patient and allow expression of feelings and thoughts about it.
Promote behavior modification by acknowledging the patient’s efforts to positively cope with his/her current condition, as well as giving more attention and time discussing positive changes in his/her symptoms.To encourage the patient to shift his/her focus and energy to positive thinking and behavior while keeping track of realistic goals and activities towards healthy coping.
Provide comfort measures for the patient in terms of temperature of the room, positioning of the bed, provision of pillows.To help the patient become relaxed and feel comfortable. This can also help establish rapport between the nurse and the patient.
Encourage the patient to perform relaxation techniques, such as deep breathing exercises, guided imageryTo help the patient become relaxed and feel comfortable. This can also help establish rapport between the nurse and the patient.

Other possible nursing diagnoses:

  1. Fear related to Perceived Illness
  2. Powerlessness
  3. Activity Intolerance

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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