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21.1 Psychological and Behavioral Factors in Somatic Symptom Disorders

Somatic symptom disorder (SSD) is a condition that occurs when a client is focused on physical symptoms to the point of significant distress and disruption of normal functioning. Risk factors include a history of childhood trauma, family history of SSD or mental health disorders, certain personality traits, and sociocultural traits affecting views on illness. Examples of behaviors commonly associated with SSD include excessive preoccupation with physical symptoms, high utilization of health-care services, disproportionate distress and anxiety, and impairment in daily functioning. The level of impairment to the client’s daily life can vary from mild to severe, depending on the severity and frequency of the symptoms. Nursing care for clients with SSD includes a nonjudgmental approach, a thorough history and assessment, collaborative planning with the health-care team, and goal setting so the client can live the most functional life possible.

21.2 Functional Neurological Disorder

Functional neurological disorder (FND) is a condition where an individual experiences one or more altered motor or sensory neurological symptoms that cannot be attributed to a specific medical or neurological condition. Risk factors for FND include a history of trauma; previous medical conditions; other mental illness, such as anxiety or depression; family history; and certain sociocultural factors. Client symptoms include dizziness, gait disturbance, numbness and tingling, and psychogenic seizures. FND affects clients’ lives in numerous ways, including interpersonal relationships, employment status, financial status, and more. Nursing care involves a nonjudgmental approach with education to help the client understand the condition and access effective evidence-based treatments, such as CBT.

21.3 Factitious Disorder

Factitious disorder is a mental health condition in which individuals intentionally and consciously fabricate or induce physical or psychological symptoms in themselves or another. Risk factors include a history of trauma, an underlying personality disorder, and a desire for attention and sympathy. Client behaviors associated with factitious disorder include intentionally fabricating symptoms, sometimes to the point of self-injury (or injuring the victim), and manipulative behavior, especially around health-care professionals.

Factitious disorder can create serious and lifelong issues for the client and for the victim. Factitious disorder can lead to psychological disorders, permanent physical problems, dysfunctional interpersonal relationships, legal issues, and more. Nursing care for factitious disorder involves a nonjudgmental, interprofessional approach, supportive care, referral to appropriate counseling and medical services, boundaries and ethical considerations, and long-term follow up, management, and monitoring.

21.4 Illness Anxiety Disorder

Illness anxiety disorder is a mental health condition characterized by excessive worry and fear about having a serious medical condition, despite having little or no medical evidence to support the belief. Clients with illness anxiety have few to no somatic symptoms. Risk factors include anxiety or depression, childhood experiences with illness, life stressors, personality traits, and excessive use of medical information. Behaviors associated with illness anxiety disorder include intense focus on mild or normal physical sensations, regular checking of the body, frequent medical visits and excessive testing and diagnostics, too much online research, or unwarranted avoidance of activities perceived as risky for one’s health. Illness anxiety can cause disruptions in a person’s everyday functioning, having a negative impact on social and occupational functioning, emotions, and overall quality of life. Nursing care for someone with illness anxiety disorder focuses on providing support, education, and reassurance to help the individual manage their anxiety and concerns about their health and maximize functioning.


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