CASE STUDY; SOMATOFORM, ANXIETY & EATING DISORDER

CASE STUDY; SOMATOFORM, ANXIETY & EATING DISORDER

a) Definition of Eating Disorders (5%)

Eating disorders are serious mental health conditions characterized by persistent disturbances in eating behaviors, thoughts, and emotions related to food, body weight, and shape. These disorders often lead to severe physical and psychological complications and can be life-threatening if untreated.

b) Five (5) Signs and Symptoms of Eating Disorders in Thandi (10%)

Severe weight loss (BMI 16.5) – Thandi is underweight, indicating malnutrition.
Body dysmorphia (insists she is "too fat") – Distorted self-perception despite being underweight.
Restrictive eating (skips meals) – Avoids food intake, leading to nutritional deficiencies.
Excessive exercise – Compensatory behavior to lose weight or prevent weight gain.
Amenorrhea (no menstruation for 4 months) – Hormonal disruption due to malnutrition.
(Additional symptoms: Social isolation during meals, fainting spells due to low energy intake.)

c) Four (4) Common Types of Eating Disorders (40%)

1. Anorexia Nervosa

Characteristics: Extreme food restriction, fear of weight gain, distorted body image.
Subtypes:
- Restrictive type: Severe calorie limitation.
- Binge-purge type: May involve vomiting/laxatives after small meals.
Effects: Malnutrition, osteoporosis, heart complications.

2. Bulimia Nervosa

Characteristics: Recurrent binge eating followed by purging (vomiting, laxatives, excessive exercise).
Key difference from anorexia: Often normal or slightly high BMI.
Effects: Electrolyte imbalance, dental erosion, esophageal damage.

3. Binge Eating Disorder (BED)

Characteristics: Consuming large amounts of food rapidly without compensatory behaviors.
Effects: Obesity, diabetes, guilt/shame after episodes.

4. Avoidant/Restrictive Food Intake Disorder (ARFID)

Characteristics: Avoidance of food due to sensory issues (texture, smell) without body image concerns.
Effects: Weight loss, nutritional deficiencies (common in children).

(Other types: Orthorexia (obsession with "clean" eating), Pica (eating non-food items).

d) Five (5) Nursing Interventions for Thandi (45%)

Medical Stabilization & Nutritional Rehabilitation
- Monitor vital signs (risk of bradycardia, hypotension).
- Collaborate with a dietitian for a structured meal plan to restore weight safely.
- Administer supplements (vitamins, electrolytes) if deficient.
Psychological Support & Therapy
- Cognitive Behavioral Therapy (CBT): Address distorted thoughts about body image.
- Family-Based Therapy (FBT): Involve Thandi’s mother in meal support.
- Group therapy: Reduce isolation by connecting with peers in recovery.
Behavioral Monitoring & Meal Support
- Supervise meals to prevent food avoidance or hiding.
- Encourage small, frequent meals to reduce anxiety around eating.
- Document food intake and behaviors (e.g., exercise habits).
Education & Relapse Prevention
- Teach Thandi and her mother about the dangers of malnutrition (e.g., heart failure, bone loss).
- Identify triggers (e.g., social media, scales) and coping strategies.
- Develop a long-term follow-up plan with outpatient care.
Address Comorbid Conditions
- Screen for depression/anxiety (common in eating disorders).
- Treat amenorrhea with hormonal therapy if needed.
- Refer to a psychiatrist if suicidal ideation or severe OCD traits are present.

Conclusion

Thandi’s case aligns with anorexia nervosa, requiring a multidisciplinary approach (nurses, dietitians, therapists). Immediate priorities include weight restoration, psychological intervention, and family education to prevent relapse.

Grading Tips:

Definition (a): Must mention "disturbed eating behavior" and "mental health condition."
Symptoms (b): Link explicitly to Thandi’s case (e.g., BMI 16.5 = underweight).
Types (c): Distinguish between anorexia (restriction) and bulimia (binge-purge).
Interventions (d): Prioritize medical stability before psychotherapy.

a) Five Signs and Symptoms of Anxiety (10%)

Excessive worry or fear – Persistent, uncontrollable thoughts about potential threats.
Restlessness or agitation – Inability to relax, fidgeting, or pacing.
Physical symptoms – Tachycardia (rapid heartbeat), sweating, trembling, or shortness of breath.
Sleep disturbances – Insomnia or frequent waking due to anxious thoughts.
Cognitive impairments – Difficulty concentrating, mind going blank, or irrational fears.

(Other symptoms: Muscle tension, nausea, avoidance behaviors, panic attacks.)

b) Levels of Anxiety (20%)

Anxiety exists on a continuum from mild to severe, affecting cognition and functioning:

Mild Anxiety
- Characteristics: Slight discomfort, heightened awareness.
- Effect on functioning: Can focus but may feel tense.
- Example: Nervousness before a test.
Moderate Anxiety
- Characteristics: Increased heart rate, selective attention.
- Effect on functioning: Narrowed focus but can follow directions.
- Example: Worrying about a job interview.
Severe Anxiety
- Characteristics: Hyperventilation, dizziness, dread.
- Effect on functioning: Difficulty thinking clearly; needs reassurance.
- Example: Fear of a medical diagnosis.
Panic-Level Anxiety
- Characteristics: Overwhelming terror, dissociation, chest pain.
- Effect on functioning: Unable to process reality; may scream or freeze.
- Example: During a traumatic flashback.

c) Nursing Management of an Anxious Patient (45%)

1. Psychological Interventions

Therapeutic communication: Use calm, slow speech; validate feelings ("I see this is hard for you").
Grounding techniques: 5-4-3-2-1 method (identify 5 things you see, 4 you feel, etc.).
Cognitive Behavioral Therapy (CBT): Challenge irrational thoughts (e.g., "What’s the evidence for this fear?").

2. Environmental Modifications

Reduce stimuli (dim lights, quiet room) to prevent sensory overload.
Ensure safety (remove sharp objects if risk of self-harm).

3. Pharmacological Support

Administer PRN anxiolytics (e.g., lorazepam) for acute panic.
Monitor for side effects (drowsiness, dependency with benzodiazepines).

4. Physical Symptom Management

Teach deep breathing (inhale 4 sec, hold 4 sec, exhale 6 sec).
Encourage progressive muscle relaxation (tense/release muscle groups).

5. Long-Term Coping Strategies

Structured routine: Predictability reduces anxiety.
Referrals: Psychologist for therapy, support groups.
Family education: Teach de-escalation techniques.

d) Classification of Mental Disorders (25%)

Mental disorders are categorized by symptoms, etiology, and behavior. Major systems include:

1. ICD-11 (WHO’s International Classification of Diseases)

Categories:
- Mood disorders (e.g., depression, bipolar).
- Anxiety disorders (e.g., GAD, panic disorder).
- Schizophrenia spectrum disorders.

2. DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

Axis-like approach:
- Neurodevelopmental disorders (e.g., ADHD).
- Psychotic disorders (e.g., schizophrenia).
- Trauma-related disorders (e.g., PTSD).

3. Biopsychosocial Model

Biological: Genetic, neurotransmitter imbalances.
Psychological: Trauma, maladaptive coping.
Social: Poverty, discrimination.

4. Legal Classifications (e.g., Zambia’s Mental Health Act)

Defines "mental illness" for involuntary hospitalization.
Guides forensic psychiatry (e.g., insanity defense).

a) Definition of Somatoform Disorders (5%)

Somatoform disorders (now commonly referred to as Somatic Symptom and Related Disorders in DSM-5) are a group of mental health conditions characterized by persistent physical symptoms (e.g., pain, fatigue) that cause significant distress or impairment without a clear medical explanation. These symptoms are not intentionally produced (unlike factitious disorders) and are often linked to psychological factors such as stress, anxiety, or trauma.

b) Five (5) Signs and Symptoms of Somatoform Disorders in Mrs. N. (10%)

Unexplained Physical Symptoms (Headaches, Chest Pain, Abdominal Discomfort)
- No medical cause found despite multiple tests.
Excessive Health Anxiety
- Persistent fear of serious illness despite reassurance.
Frequent Medical Visits ("Doctor Shopping")
- Repeated clinic visits without resolution.
Resistance to Psychological Explanations
- Dismisses suggestions that stress/anxiety may contribute.
Functional Impairment
- Anxiety and frustration interfere with daily life.

c) Seven (7) Types of Somatoform/Somatic Symptom Disorders (35%)

1. Somatic Symptom Disorder (SSD)

Key Feature: Excessive focus on physical symptoms (e.g., pain, fatigue) with high anxiety about health.
Example: Mrs. N.’s persistent belief she has a serious illness despite normal tests.

2. Illness Anxiety Disorder (Hypochondriasis)

Key Feature: Preoccupation with having a severe illness without prominent physical symptoms.
Example: A patient obsessed with having cancer despite no symptoms.

3. Conversion Disorder (Functional Neurological Symptom Disorder)

Key Feature: Neurological symptoms (e.g., paralysis, blindness) with no medical cause.
Example: Sudden arm weakness after emotional trauma.

4. Factitious Disorder (Munchausen Syndrome)

Key Feature: Intentional faking or exaggeration of symptoms for emotional gain (e.g., attention).
Differentiation: Unlike somatoform disorders, symptoms are consciously produced.

5. Psychological Factors Affecting Medical Condition

Key Feature: Stress/anxiety worsens a real medical condition (e.g., asthma flares due to anxiety).

6. Pain Disorder (Now Part of SSD in DSM-5)

Key Feature: Chronic pain with psychological contributors.

7. Body Dysmorphic Disorder (BDD)

Key Feature: Obsession with perceived flaws in appearance (not strictly somatic but related).

d) Ten (10) Prevention Strategies in Community Settings (50%)

1. Public Health Education

Teach about mind-body connection (how stress affects physical health).

2. Early Screening in Primary Care

Identify at-risk individuals (frequent clinic visitors with unexplained symptoms).

3. Stress Management Programs

Promote yoga, mindfulness, and relaxation techniques.

4. Limit Unnecessary Medical Testing

Avoid reinforcing illness beliefs with repeated diagnostics.

5. Integrated Care (Mental + Physical Health)

Train doctors to recognize and refer suspected cases to therapists.

6. Cognitive Behavioral Therapy (CBT) Workshops

Address catastrophic thinking ("What if it’s cancer?").

7. Support Groups for Health Anxiety

Reduce isolation (e.g., people with similar struggles sharing coping strategies).

8. Media Literacy Campaigns

Counteract "cyberchondria" (health anxiety fueled by internet searches).

9. Family Involvement

Educate relatives to avoid excessive reassurance-seeking behaviors.

10. Workplace Mental Health Programs

Reduce job stress, a common trigger for somatic symptoms.

Key Takeaways

Somatoform disorders involve real suffering without medical causes.
Mrs. N. shows classic SSD/illness anxiety (persistent symptoms + health fears).
Prevention focuses on education, stress reduction, and avoiding reinforcement of symptoms.
Nurses play a key role in early detection and holistic care.

Key Takeaways

Anxiety symptoms (a): Focus on emotional, cognitive, and physical signs.
Levels (b): Mild → Panic, with escalating impairment.
Nursing care (c): Combine immediate calming techniques with long-term CBT.
Classification (d): DSM-5 and ICD-11 are most clinically relevant.

Matching Hallucinations (Questions 46-50)

Column I	Column II (Responses used once)
46. Auditory	C. Hearing voices without a speaker
47. Visual	G. Seeing an object without a stimulus
48. Gustatory	E. Experiencing tastes of particular foods not being eaten
49. Olfactory	A. Getting strange smells that are really not there
50. Tactile	F. Experiencing sensation on the skin without a stimulus

Unused option:

B (False idea that part of the body is non-existent) → Not a hallucination (This is a delusion, specifically somatic delusion).
D (Exaggerated feeling of self-importance or power) → Not a hallucination (This is a delusion of grandeur).

Matching Types of Schizophrenia (Questions 51-55)

Column I	Column II (Responses used once)
51. Catatonic	C. Posturing
52. Paranoid	D. Persecutory delusions
53. Disorganized	F. Exhibit facial grimaces and mannerisms
54. Simple	E. Disorientation (or B. Hoarding if referring to negative symptoms)
55. Residual	A. Occurs after repeated episodes

Clarifications:

Simple schizophrenia (54): Often marked by disorientation or hoarding (if referring to negative symptoms).
Residual schizophrenia (55): Occurs after repeated episodes with mild symptoms.
Unused option: G (Distractibility) → More common in mania than schizophrenia.

Matching Mental Disorders (Questions 56-60)

Column I	Column II (Responses used once)
56. Manic depressive psychosis	B. Singing without stopping (manic symptom)
57. Catatonic stupor	F. Patient is unresponsive, conscious, closed eyes, and refusing to eat
58. Status epilepticus	A. Seizures occur too close to each other
59. Simple schizophrenia	E. Unkempt, holding onto rubbish with poor prognosis
60. Post-epileptic automatism	D. Clouding of consciousness after a seizure

Unused option:

C (Mutism) → Already fits catatonia, but F was a better match for catatonic stupor.

Matching Disorders of Thinking (Questions 61-65)

Column I	Column II (Responses used once)
61. Delusions	E. False belief
62. Retardation of thought	B. No thinking in place (or very slow thinking)
63. Fragmented thinking	D. Disjointed ideas
64. Circumstantial thinking	C. Beating about the bush
65. Flight of ideas	A. Too many ideas flowing together

Unused option:

F (Ideas coming into your mind frequently) → Similar to flight of ideas, but A is a better match.

completed statements with the missing words:

Complete the Following Statements

What term describes acute confusion and disturbance in awareness?
Delirium
What symptoms arise when a dependent person stops using a drug?
Withdrawal symptoms
What term refers to a condition of near-unconsciousness or lack of movement?
Stupor
What syndrome includes motor immobility and behavioral abnormalities?
Catatonia
What type of emergency is caused by medical treatment itself?
Iatrogenic emergency
Which Durkheim suicide type results from lack of social bonds?
Egoistic suicide
What suicide type occurs due to excessive group integration?
Altruistic suicide
What type of suicide stems from a lack of social norms or regulation?
Anomic suicide
What suicide type results from oppressive rules or fate?
Fatalistic suicide
What is the process of becoming part of a social group?
Socialization
What term refers to societal control or structure?
Social regulation
What is assessed to determine the likelihood of a suicide attempt?
Suicide risk assessment
What term describes the systematic evaluation of a person’s condition?
Clinical assessment
What is it called when a suicide attempt is carefully planned?
Premeditated suicide attempt
What is an acute situation requiring immediate psychiatric attention?
Psychiatric emergency
What type of behavior may involve aggression or physical harm to others?
Violent behavior
What term describes deliberate injury to oneself?
Self-harm (or self-injury)
Which mental disorder is associated with impulsive behavior and euphoria?
Bipolar disorder (manic episode)
Which disorder includes symptoms like delusions and hallucinations?
Schizophrenia (or psychotic disorder)
What is a false sensory perception without external stimuli?
Hallucination
What term refers to the ability to make considered decisions or come to sensible conclusions?
Judgment
What is lacking when a person is unaware of their mental condition?
Insight
What is a common method used in suicide attempts involving medication or drugs?
Drug overdose (or poisoning)
What is the act of intentionally ending one’s own life called?
Suicide
What term refers to self-harm without the intent to die?
Non-suicidal self-injury (NSSI)
What Latin term is used for a failed suicide attempt?
Parasuicide
Which mood disorder is most associated with suicide ideation?
Major depressive disorder (MDD)
What substance can impair judgment and increase suicide risk?
Alcohol (or depressants like opioids, benzodiazepines)
What general term includes psychotropic substances that may worsen psychiatric symptoms?
Psychoactive drugs
Attempts to reduce the number of mental disorders through early screening and diagnosis is called
Preventive psychiatry (or mental health prevention)

Key Notes:

Durkheim’s suicide types (76-79) are based on social integration/regulation.
Self-harm vs. suicide (87, 94, 95): Self-harm may not intend death, while suicide does.
Psychiatric emergencies (85) include suicidal intent, violent behavior, or severe psychosis.

Somatoform Disorders: Definition, Signs, Types, and Prevention Strategies

Definition of Somatoform Disorders

Somatoform Disorders, also known as Somatic Symptom Disorders, are a group of mental health conditions characterized by physical symptoms that cannot be fully explained by a medical condition, substance use, or another mental disorder. These symptoms, such as pain, fatigue, or gastrointestinal issues, cause significant distress or impairment in social, occupational, or other areas of functioning. The hallmark of these disorders is the presence of one or more somatic symptoms accompanied by excessive thoughts, feelings, or behaviors related to these symptoms, often leading to heightened anxiety or preoccupation with health concerns. The symptoms are not intentionally produced or feigned, and individuals genuinely experience distress, which may be exacerbated by psychological factors like stress or anxiety. This definition aligns with both the older DSM-IV classification and the updated DSM-5 terminology, where these conditions are categorized under Somatic Symptom and Related Disorders (WebMD, Psychiatry.org).

Signs and Symptoms from the Scenario

In the case of Mrs. N., a 35-year-old woman presenting with persistent headaches, chest pain, and abdominal discomfort, several signs and symptoms suggest a Somatoform Disorder:

Multiple Unexplained Physical Symptoms: Mrs. N. reports headaches, chest pain, and abdominal discomfort, affecting multiple body systems, which is consistent with somatoform disorders where symptoms span various organs (WebMD).
Persistence of Symptoms Over Time: Her medical records indicate multiple clinic visits over the past year, suggesting chronic symptoms lasting more than six months, a key feature of somatoform disorders (AAFP).
Lack of Medical Explanation: All physical and laboratory tests return normal results, indicating no identifiable medical cause for her symptoms, a core criterion for somatoform disorders (Psychiatry.org).
Excessive Concern and Preoccupation with Symptoms: Despite reassurances from healthcare providers, Mrs. N. insists something is seriously wrong and demands repeated investigations, reflecting excessive worry and preoccupation typical of these disorders (Nurseslabs).
Associated Anxiety and Emotional Distress: Her anxiety and frustration, as noted in her appearance during clinic visits, align with the emotional distress often seen in somatoform disorders, where psychological factors amplify physical complaints (PMC).

These symptoms collectively suggest a diagnosis within the spectrum of Somatoform Disorders, as they cause significant distress and disruption, are not explained by medical findings, and are accompanied by excessive health-related concerns.

Types of Somatoform Disorders

Based on the DSM-IV classification, which is implied by the question’s use of “Somatoform Disorders,” seven distinct types are recognized, each with specific characteristics (AAFP). The following table summarizes these types, their descriptions, prevalence, and additional details:

Type of Somatoform Disorder	Description	Prevalence	Additional Details
Somatization Disorder	Unexplained physical symptoms beginning before age 30, lasting years, including at least 2 gastrointestinal, 4 pain, 1 pseudoneurologic, and 1 sexual symptom.	0.2–2% in women, <0.2% in men	Also known as Briquet's syndrome, 10–20% incidence in first-degree female relatives.
Undifferentiated Somatoform Disorder	6-month or longer history of 1+ unexplained physical complaints, e.g., chronic fatigue.	Not specified	Highest incidence in young women of low socioeconomic status.
Conversion Disorder	Single symptom related to voluntary motor or sensory functioning suggesting a neurologic condition, not conforming to anatomic pathways.	Not specified	More common in rural populations, lower socioeconomic status, onset rarely before 10 or after 35 years.
Pain Disorder	Pain associated with psychological factors, focus on pain with primary role of psychological factors.	Not specified	Frequent health care use, relational problems, often comorbid with depression, anxiety, or substance-related disorder.
Hypochondriasis	Misinterpretation of physical symptoms, fear of life-threatening condition, nondelusional preoccupation for at least 6 months.	2–7% in primary care outpatient setting	No consistent differences by age, sex, or culture.
Body Dysmorphic Disorder	Debilitating preoccupation with real or imagined physical defect, excessive concern even if defect is slight.	Not specified	Occurs equally in men and women.
Somatoform Disorder Not Otherwise Specified	Conditions not meeting criteria for other somatoform disorders, e.g., pseudocyesis (mistaken belief of pregnancy).	Not specified	Includes variety of conditions with misinterpreted or exaggerated physical symptoms.

These disorders share the common feature of physical symptoms causing significant distress without a clear medical basis, but they differ in the nature and focus of the symptoms. Note that in the DSM-5, some of these categories (e.g., Somatization Disorder, Hypochondriasis) have been reclassified under Somatic Symptom Disorder or Illness Anxiety Disorder, but the DSM-IV framework is used here to align with the question’s terminology (StatPearls).

Prevention Strategies in a Community Setting

Preventing the development or worsening of Somatoform Disorders in a community setting involves addressing risk factors such as stress, anxiety, and lack of mental health awareness, while promoting early intervention and holistic well-being. The following ten strategies are designed to be implemented by nurses and community health professionals to reduce the incidence and severity of these disorders:

Implement Community Education Programs: Develop workshops and campaigns to educate the public about the connection between mental and physical health, emphasizing that psychological factors can manifest as physical symptoms. This reduces stigma and encourages early help-seeking (Nurseslabs).
Train Primary Care Providers and Community Health Workers: Provide training on recognizing early signs of Somatoform Disorders, such as frequent unexplained complaints, and guide them on appropriate referrals to mental health professionals to prevent unnecessary testing (AAFP).
Develop and Distribute Informational Materials: Create brochures, posters, and online resources explaining how stress and emotions can contribute to physical symptoms, helping individuals recognize when to seek psychological support (Verywell Health).
Organize Stress Management Workshops: Offer community-based programs in schools, workplaces, and community centers to teach stress reduction techniques like mindfulness, relaxation exercises, and cognitive-behavioral strategies (PMC).
Establish Support Groups: Facilitate peer support groups for individuals with chronic unexplained symptoms, providing a safe space to share experiences and learn coping strategies, which can reduce isolation and distress (BMC Psychiatry).
Promote Access to Mental Health Services: Integrate mental health counseling into primary care settings or offer community-based therapy to address psychological factors early, preventing symptom escalation (Nurseslabs).
Encourage Regular Physical Activity and Healthy Lifestyles: Promote community fitness programs and nutritional education to improve overall mental and physical well-being, as physical health can buffer psychological stress (Verywell Health).
Conduct Screening Programs: Implement routine screenings in primary care to identify individuals with multiple unexplained symptoms, enabling early intervention before symptoms become chronic (AAFP).
Foster Collaboration Between Healthcare Providers and Mental Health Professionals: Create networks involving primary care, mental health specialists, and community organizations to ensure coordinated care and support for at-risk individuals (Nurseslabs).
Provide Family Education and Support: Educate families on recognizing and supporting loved ones with potential Somatoform Disorders, fostering a supportive environment that encourages treatment adherence and emotional support (PMC).

These strategies aim to enhance mental health literacy, reduce psychological risk factors, and promote early intervention, which are critical for preventing the onset or worsening of Somatoform Disorders in community settings. By addressing both individual and systemic factors, these approaches can mitigate the impact of these disorders on individuals and healthcare systems.