Please enable JavaScript.
Coggle requires JavaScript to display documents.
Somatic Symptom and Related Disorders - Coggle Diagram
Somatic Symptom and Related Disorders
1. Introduction & Core Concept
· Definition: Disorders where patients have distressing physical symptoms (e.g., pain, fatigue) that may not be fully explained by a medical condition.
· Key Shift (DSM-5): Diagnosis is based on the patient's excessive thoughts, feelings, and behaviors related to the symptoms, not on the absence of a medical cause.
· Guiding Model: The Biopsychosocial Model:
· Biological: Physical symptoms are real.
· Psychological: Anxiety, catastrophizing thoughts.
· Social: Stress, trauma, secondary gain.
2. Main Types of Somatic Symptom Disorders
· Somatic Symptom Disorder (SSD):
· Has: One or more distressing physical symptoms (e.g., chronic pain).
· Problem: Excessive anxiety, time, and energy devoted to the symptoms.
· Illness Anxiety Disorder (IAD):
· Has: Minimal or no physical symptoms.
· Problem: Preoccupation with having a serious illness (fear of the disease itself).
· Conversion Disorder:
· Has: Neurological symptoms (e.g., paralysis, blindness, seizures).
· Problem: Symptoms are incompatible with known neurology; triggered by psychological stress.
· Crucial Differential:
· Factitious Disorder: Intentional faking of symptoms to assume the sick role (goal: attention/sympathy). This is different from SSRDs, where symptoms are not consciously controlled.
3. Treatment Principles
· Goal: Reduce anxiety, improve coping, and increase functioning (not necessarily "cure" the symptom).
· 1. Psychotherapy (First-Line):
· Cognitive Behavioral Therapy (CBT): Challenges catastrophic health beliefs.
· Mindfulness & Relaxation: Reduces nervous system arousal.
· 2. Medication:
· Antidepressants (SSRIs/SNRIs): Treat co-occurring anxiety/depression.
· 3. Medical Management:
· Single Primary Care Provider: Prevents "doctor shopping" and unnecessary tests.
· Avoid Iatrogenic Harm: Limit repeated, invasive testing.
4. Critical Nursing Role & Interventions
· Therapeutic Communication:
· DO: Validate suffering ("I see this is very distressing for you").
· DON'T: Dismiss symptoms ("It's all in your head").
· Establish Boundaries & Relationship:
· Limit attention for "symptom talk."
· Be consistent with the care plan across all staff.
· Psychoeducation & Skill Building:
· Teach about the mind-body connection.
· Actively teach coping skills (deep breathing, distraction).
· Promote Function:
· Focus on achievable goals (e.g., walking, attending therapy).
· Documentation:
· Be objective (report what you see, not what you suspect).
· Focus on behaviors and functional status.