02.04 Somatoform

Okay, so let’s talk about Somatoform Disorders. This is actually a group of disorders that all have the same general definition.

So, in general - Somatoform disorders occur when the patient has physical symptoms and significant worry and complaints with no organic physiological explanation. So they have a specific issue or complaint, but we do a full workup and can’t find anything that would explain their symptoms.

We’re going to talk specifically about 3 types - conversion disorder, hypochondriasis, and somatization disorder. But the one thing I want you to know for each of these is that they are all heavily rooted in anxiety. These disorders are how the patient, usually unconsciously, is attempting to cope with some kind of anxiety. So, The first is conversion disorder. Anytime you think conversion disorder I want you to think neuro symptoms. So someone with conversion disorder is essentially converting their anxiety into physical symptoms. They will present with serious neuro symptoms like blindness, paralysis, numbness, or even hearing loss. But, when we do our full work-up, we cannot find any physiological reason for their symptoms. What you may see is a child who has been bullied who suddenly stops talking or someone who’s had some sort of traumatic experience suddenly goes limp and is paralyzed. There is no physiologic cause, so once the emotional and mental issues are dealt with, the symptoms often resolve.

Hypochondriasis is a condition where the patient perceives any minor symptom as being some sort of major disease. Think of it this way, if you hear hoofbeats behind you, 99 times out of 100 it is going to be a horse. There MAY be that one time that it’s actually a zebra, but it’s unlikely. So, when you hear hoofbeats, you assume - horse. In patients with hypochondriasis, when they hear hoofbeats they immediately assume it’s a zebra. So, they may get a headache and immediately they’re convinced they have a brain tumor. It can be challenging because they are convinced it’s a serious problem. So, we make sure to do detailed assessments and diagnostics so we can help them understand that, actually, there’s something emotional underlying it.

Lastly is somatization disorder. This is more of the general somatoform disorder, also called Somatic Symptom Disorder. In this case, they’ve had multiple medical problems in multiple body systems from an early age. They’ll have a lot of pain issues, digestive issues, and even sexual or neurological symptoms - but ultimately there’s really no physiologic cause for any of it. It’s also possible that there is something wrong, but their symptoms and complaints are WAY out of proportion to the true condition. Remember, this is largely based in anxiety and sometimes is an unconscious effort to either get attention or to get out of responsibilities. But remember, it’s unconscious - the things they’re feeling are very real to them.

So the first thing we want to do, in addition to ensuring safety of everyone involved, is acknowledge those symptoms. We want the patient to realize that we recognize that their symptoms and experiences are very real to them. We give them a chance to express their issues and concerns, but we don’t want to let them cycle or fixate on them. We need to set boundaries so that we can keep them from getting too wrapped up in their condition or their symptoms. We also want to make sure we’re not encouraging them to go down the rabbit hole of thinking their condition is worse than it really is. If they have a headache, but all the scans are clear - we tell them it’s just a headache, we give some Tylenol. We DON’T say “well I knew someone who had a headache and turned out it was a stroke and she died!”. All that does is make them want to fixate on it and it can make it worse.

As far as priority nursing concepts - you’ll notice I didn’t put safety here. Now, safety is a priority for every single patient, every single time. But - patients with somatoform disorders don’t tend to be at risk for self-harm or in any kind of danger as much as others do. So, keep it in mind, but it’s not at the forefront. What we DO want to focus on is their mood and affect and helping them cope - remember, it’s usually all rooted in anxiety, so we want to try to get down to that root cause and address that.

So let’s recap - Somatoform Disorders experience physical symptoms that don’t actually have an organic cause, and this is often related to anxiety as an unconscious coping mechanism. We want to acknowledge that their experiences are very real and allow them structured time to express that. But, we want to set boundaries and keep them from going down the rabbit hole and cycling and fixating on their symptoms. Don’t encourage that.

So let’s recap - Somatoform Disorders experience physical symptoms that don’t actually have an organic cause, and this is often related to anxiety as an unconscious coping mechanism. We want to acknowledge that their experiences are very real and allow them structured time to express that. But, we want to set boundaries and keep them from going down the rabbit hole and cycling and fixating on their symptoms. Don’t encourage that.