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Chapter: Psychiatric Mental Health Nursing : Somatoform Disorders

Overview of Somatoform Disorders

Somatization is defined as the transference of mental experiences and states into bodily symptoms.



Somatization is defined as the transference of mental experiences and states into bodily symptoms. Somatoform disorders can be characterized as the presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for them. The three central features of somatoform disorders are as follows:


·    Physical complaints suggest major medical illness but have no demonstrable organic basis.

·    Psychologic factors and conflicts seem important in ini-tiating, exacerbating, and maintaining the symptoms.

·    Symptoms or magnified health concerns are not under the client’s conscious control (Hollifield, 2005).


Clients are convinced they harbor serious physical problems despite negative results during diagnostic test-ing. They actually experience these physical symptoms as well as the accompanying pain, distress, and func-tional limitations such symptoms induce. Clients do not willfully control the physical symptoms. Although their illnesses are psychiatric in nature, many clients do not seek help from mental health professionals. Unfortunately, many health care professionals who do not understand the nature of somatoform disorders are not sympathetic to these clients’ complaints (Andreasen & Black, 2006). Nurses must remember that these clients really experi-ence the symptoms they describe and cannot voluntarily control them.


The five specific somatoform disorders are as follows (American Psychiatric Association [APA], 2000):


·    Somatization disorder is characterized by multiple physical symptoms. It begins by 30 years of age, ex-tends over several years, and includes a combination of pain and gastrointestinal, sexual, and pseudoneurologic symptoms.


·    Conversion disorder, sometimes called conversion re-action, involves unexplained, usually sudden deficits in sensory or motor function (e.g., blindness, paralysis). These deficits suggest a neurologic disorder but are associated with psychologic factors. An attitude of la belle indifférence, a seeming lack of concern or distress, is a key feature.


·    Pain disorder has the primary physical symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychologic factors in terms of onset, severity, exacerbation, and maintenance.


·    Hypochondriasis is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). It is thought that clients with this disorder misinterpret bodily sensations or functions.


·    Body dysmorphic disorder is preoccupation with an imagined or exaggerated defect in physical appearance such as thinking one’s nose is too large or teeth are crooked and unattractive.


Somatization disorder, conversion disorder, and pain dis-order are more common in women than in men; hypochon-driasis and body dysmorphic disorder are distributed equally by gender. Somatization disorder occurs in 0.2% to 2% of the general population. Conversion disorder occurs in less than 1% of the population. Pain disorder is commonly seen in medical practice, with 10% to 15% of people in the United States reporting work disability related to back pain alone (APA, 2000). Hypochondriasis is estimated to occur in 4% to 9% of people seen in general medical practice. No statistics of the incidence of body dysmorphic disorder are available.


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