Somatoform Disorders

Somatoform disorders are group of disorders in which physical symptoms suggesting physical disorders for which there are no demonstrable organic findings or known physiologic mechanisms. There is a strong presumption that the symptoms are linked to psychological factors. The client focuses on the physical signs and symptoms and is unable to control the signs and symptoms. The signs and symptoms increase with psychosocial stressors.

There are three types of somatoform disorders: conversion disorder, hypchondriasis, and somatization disorder.

Conversion Disorder
Conversion disorder is a mental disorder in which an unconscious emotion conflict is expressed as an alteration or loss of physical functioning without any organic causes. The most common conversion symptoms are blindness, deafness, paralysis, and the inability to talk.


Clients with conversion disorder will have physical limitation or disability, feeling of guilt, anxiety, or frustration, low self esteem, feeling of inadequacy, unexpressed anger or conflict, and secondary gain.

Hypochondriasis
Hypochondriasis is a delusion that one is suffering from some disease for which no physical basis is evident. Hypochondriasis can cause impaired social and occupational functioning.

Clients with hypochondriasis will have frequent somatic function, complaints of fatigue and insomnia, preoccupation with physical function, anxiety, difficulty expressing feelings, extensive use of remedies or nonprescription medications, repeatedly visiting doctors, and secondary gain.

Somatization Disorder
Somatization disorder is a mental disorder characterized by complicated medical history and multiple physical complains involving multiple body systems without any organic basis. Somatization disorder can result from anxiety, fear, depression, worry or repressed anger. The client may use somatization for secondary gains such as increased attention or decreased responsibilities.

Clients with somatization disorder will have physical complaints of pain, signs of anxiety, fear and low self esteem, psychosocial symptoms, and secondary gains.

Specific Interventions for somatiform disorders:

• Assess nursing history and physical problems
• Do not reinforce the sick role and discourage verbalization about physical symptoms.
• Allow specific time period to discuss physical complaints.
• Assist client to identify alternative ways of meeting needs.
• Convey understanding that the physical symptoms are real to the client and assure that physical illness has been ruled out.
• Explore the source of anxiety and encourage verbalization of anxiety.
• Use relaxation techniques as the anxiety increases.
• Encourage diversional activities to decrease the focus on self.
• Report and assess any new physical complaint.
• Positive feedback for accomplishments.
• Establish a written contract with the client.
• Administer anti-anxiety medication as prescribed.

Obsessive Compulsive Disorder

Obsessive compulsive disorder is a type of anxiety disorder whose essential feature is recurrent obsession, persistent, intrusive ideas, thoughts, impulses or images, or compulsion. Compulsion means repetitive, purposeful and intentional behaviors performed in response to an obsession. The person may have both obsession and compulsions that can disrupt normal activities. An example of this disorder is excessive and repeated hand washing to ward off infection.

A person act compulsive behavior patterns can decrease the anxiety that associated with the obsessive thoughts and during stressful time, the ritualistic behavior will be increased. Most of the patient with obsessive compulsive disorder has variety of defense mechanism include repression, displacement, and undoing.


Cause of obsessive compulsive disorder was rare. Some reports have linked obsessive compulsive disorder to head injury and infections and about 20% of those with this disorder have motor tics related to tourette syndrome.

Intervention:

• Try to identify the situation that precipitates the behavior.
• Do not interrupt the compulsive behavior.
• Allow time for the patient to perform the compulsive rituals.
• Keep the client safety
• Make a schedule for patient that can distracts from the ritual.
• Set limit on the ritual.
• Encourage the patient to verbalize concerns.
• Establish the written contract that can assist to decrease the frequency of compulsive behavior.

Phobias

Phobia is an irrational fear of an object or situation that persist although the person may recognize it as unreasonable. It is associated with panic level anxiety if the object, situation, or activity cannot be avoided. The word of phobia is used as a combining form in many term expressing the object that inspires the fears.

Types of Phobias:

1. Acrophobia : fear of heights
2. Agoraphobia : Fear of open spaces
3. Astraphobia : Fear of electrical storms
4. Claustrophobia : Fear of closed spaces
5. Hematophobia : Fear of blood
6. Hydrophobia : Fear of water
7. Monophobia : Fear of being alone
8. Mysophobia : Fear of dirt or germs
9. Nyctophobia : Fear of darkness
10. Pyrophobia : Fear of fire
11. Social Phobia : fear of situation in which one might be embarrassed or criticized
12. Xenophobia : Fear of strangers
13. Zoophobia : Fear of animals.

How to care patient with phobias:

• Identify the basic of the anxiety
• Stay with the patient when the anxiety is high
• Encourage patient to verbalize feeling
• Desensitization : gradually introducing the patient to the feared object or situation in small doses
• Using relaxation techniques such as breathing, muscle relaxation, exercises, and visualization or pleasant situation.
• Try not to force the client to have contact with the phobic object or situation.

Model of Care: Group Therapy

There are three stages of group development: Initial stage, working stage, and termination stage. Each stage has specific character.

Initial Stage:

• This is the first stage in which the members become acquainted with each other and search for similarity between themselves.
• Trusting communication is important in this stage.
• Structuring of group norms, roles and responsibilities are taking place in this stage.

Working Stage:

• This is the second stage in which the real work of the group is accomplished.
• Member are familiar with each other, the group leader and the group roles.
• Members feel free to approach their problems and to attempt to solve their problems.

Termination Stage:

• In this stage, the group evaluates the experience and explores member’s feeling and impending separation.
• The leader provides an opportunity for members who have difficulty with termination to learn to deal more realistically with this human experiences.

There are eight model of group therapy:

1. Psychoanalytical Group Therapy

• The therapist holds a main position and each client in the group has a relationship with the therapist.
• Communication is focused on three level, unconscious, semiconscious, and conscious information.

2. Transactional Analysis

• The three ego of individual are examined in transactional analysis groups.
• The individuals in the group will communicate from the proper ego states for the situation and the responses of other.

3. Rational Emotive Therapy

• In this method, the therapist designs activities to eliminate the irrational ideas of the members.

4. Rogerian Therapy

• This therapy helps the members express their feeling toward one another during group sessions.

5. Gestalt Therapy

• This gestalt therapy emphasizes self expression, self exploration, and self awareness in the present time, and focusing on everyday problems and try to solve them.

6. Interpersonal Group Therapy

• This therapy promotes the individual’s comfort with others in the group then transfers to other relationship.

7. Self-help or Support Group Therapy

• This therapy is based on the premise that persons who have experienced a similar problem are able to help others who have the same problem.
• It also prevents the individual member from feeling lonely and isolated.
• There are so many self-help or support groups: adult children of alcoholic, al-alon, alcoholic anonymous, co-dependent anonymous, gamblers anonymous, narcotics anonymous, over-eaters anonymous, bereavement, etc.

8. Family Therapy

• This therapy assists the family members to identify and express their thoughts and feeling, define family roles and rules, try new, more productive styles of relating and restore strength to the family.

Model of Care: Cognitive Therapy

Cognitive therapy is an active, directive, time-limited , structured approach that is designed to identify reality testing and correct distorted conceptualization and the dysfunctional belief underlying these cognition.

The therapist tries to help the client to think and act more realistically and adaptively so it can reduce the psychological problem.

Model of Care: Behavior Modification

Behavior Modification is the systematic use of principles of conditioning and learning, especially operant or instrumental conditioning, to teach certain skills or to extinguish undesirable behaviors, attitudes, or phobias. There are types of behavior modification: behavior therapy, self-control therapy, desensitization, aversion therapy, modeling therapy, and operant conditioning.

Behavior Therapy:
Behavior therapy is an approach to bring about behavioral change. It includes a group of diversified approaches for dealing with maladaptive behavior.


Self-Control Therapy:
Self control therapy is a combination of cognitive and behavioral approaches. It is useful to deal with stress. The basic of this concept is that talking to oneself can direct and control action more effectively.

Desensitization:
Desensitization is the reduction of intense reactions to a stimulus by repeated exposure to the stimulus in a weaker and milder form. The exposure is increased until the fear of the object or situation is ceased.

Aversion Therapy:
Aversion therapy is also a technique to change behavior in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus with unpleasant sensations in order to stop the specific behavior.

Modeling Therapy:
In this therapy, the therapist acts as a role model for a specified behavior, and the client learns through imitation.

Operant Conditioning:
Operant conditioning is the use of consequences to modify the occurrence and form of behavior. It deals with the modification of "voluntary behavior". Reinforcement and punishment are the for this therapy.

Model of Care: Psychotherapy

Psychotherapy is treatment of emotional, behavioral, personality, and psychiatric disorders based primarily upon verbal or nonverbal communication and interventions with the patient, in contrast to treatments utilizing chemical and physical measures. Verbal means communication. Non verbal techniques include silence, body language, facial expressions, and respect for personal space.

There are three levels of psychotherapy:

1. Supportive therapy
2. Reeducative therapy
3. Reconstructive therapy

Supportive Therapy:
In supportive therapy, the client is allowed to express feelings, explore alternatives and make decision.


Reeducative Therapy:
Reeducative therapy will include a short-term psychotherapy, reality therapy, cognitive restructuring, and behavior modification, and involves learning new ways of perceiving and behaving. Reeducative therapy requires a longer period than supportive therapy.

Reconstructive Therapy:
Reconstructive therapy includes deep psychotherapy or psychoanalysis and may require 2 to 5 years of therapy or more, focusing on all aspects of the client’s life. The positive outcomes of reconstructive therapy will be a greater understanding of self and others, more emotional freedom, and the development of potential abilities.