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Chapter Eighteen: Somatoform Disorders, Factitious Disorders, and Malingering

Describe key characteristics of somatoform disorders

A somatoform disorder is a mental disorder in which physical symptoms or preoccupations that may present as physical disorder are
considered primarily psychologic in origin. Typically, clients present with multiple, vague physical complaints without a recognized or
demonstrated organic cause (O’brien et al., 2008, p. 355).

Differentiate among somatization disorders, hypchondriasis, factitious disorders, malingering, and pain disorders. 355- 364

Somatization disorder Expressing psychologic conflict through physical complaints or symptoms

Have long term, recurring, unexplained physical complaints and frequently utilize medical physician and
surgeons
Hypochondriasis An exaggerated, unrealistic preoccupation, based upon misinterpretation of physical sensations, of having a
serious disease that persists despite medical evaluation and reassurance
Factitious disorders Signs and symptoms of physical and/or psychiatric disorders are intentionally and consciously produced or
feigned; fabricate symptoms, self-inflicting signs/symptoms or exaggerating existing symptoms
Malingering disorders Intentional or exaggerated symptoms clearly associated with external factors such as the need to avoid work or
school; obvious manipulation by the client to obtain a specific result
Pain disorders Mental disorders in response to pain that are influenced primarily by psychologic factors, cause significant
impairment, and are considered to be out of proportion to physical symptoms.

Identify factors important in differentiating psychiatric disorders with physical symptoms and medical illnesses.
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Chapter Nineteen: Sexual Disorders and Gender Identity Disorder

Describe essential features of sexual dysfunctions and paraphilias. 374 376 382
Describe essential features of gender identify disorder. 382
Identify the nurse’s role in assessing for sexual disorders. 385
Identify opportunities for client education regarding sexuality.
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Chapter Twenty: Eating Disorders

Define anorexia nervosa, bulimia nervosa, binge eating disorder, and obesity. 390 394 397
Describe the diagnostic criteria for eating disorders. 390
Delineate treatment modalities for the different types of eating disorders.
Discuss the educational needs of clients and their families.
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Chapter Twenty-Three: Personality Disorders

Differentiate between personality traits and personality disorders

Personality traits
Personality disorders
Are enduring patterns of perceiving, relating to, and thinking about oneself and one’s environment that are
exhibited in a range of social and personal contexts (O’brien et al., 2008, p. 439).
Is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the
individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable
over time, and leads to distress in important areas of functioning (O’brien et al., 2008, p. 439).

Name the types of personality disorders

Cluster A Paranoid personality disorder (distrustful, suspicious, tends to interpret other’s motives as malevolent
Schizoid personality disorder (detached from social relationships; have restricted range of emotions)
Schizotypal personality disorder (experience acute discomfort in close relationships; have cognitive or perceptual distortions;
demonstrates eccentric behavior)
Cluster B Antisocial personality disorder( disregard and violate the rights of others)
Borderline personality disorder (has unstable interpersonal relationships, self-image, and affect, as well as marked impulsivity
Histrionic personality disorder (have excessive emotions and are attention seekers
Narcissistic personality disorder (grandiose, need admiration, lack empathy)
Cluster C Avoidant personality disorder (have social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
Dependent personality disorder ( submissive, and their clinging behavior is r/t an excessive need to be cared for
Obsessive-compulsive personality disorder ( preoccupied with orderliness, perfectionism and control)

List the behavior associated with each personality disorder

Paranoid distrustful, suspicious, tends to interpret other’s motives as malevolent

difficult to get along with; argumentative, sarcastic, hostile; have problems establishing /maintaining close
relationships; often are guarded during interviews.
Schizoid detached from social relationships; have restricted range of emotions; often described as underachievers
have profound inability to form personal relationships; show no interest in sexual relationships or marriage
Schizotypal experience acute discomfort in close relationships; have cognitive or perceptual distortions; demonstrates eccentric
behavior; socially isolated ; presence of cognitive/perceptual distortions such as magical rituals, excessive
superstitions, and their belief that they can influence events through their thoughts; frequently described by others as
odd and eccentric
Antisocial disregard and violate the rights of others; displayed some evidence of a conduct disorder; display aggression toward
people or animals, destruction of property, deceitfulness or theft, and violation of rules. Can be irresponsible,
exploitative, and guiltless; show little regard for others; make use of superficial charm to deceive/manipulate others
for personal gain (power, money, sex). Clues: dishonorable military discharge, a criminal record, serial or multiple
sexual relationship, frequent physical altercations, and an inability to support themselves.
Borderline has unstable interpersonal relationships, self-image, and affect, as well as marked impulsivity
fear of abandonment results in unstable and intense interpersonal relationships; often sabotage close relationships or
even pending successes, fearing their inability to meet the demands of the situation; show sudden and intense anger r/t
person’s rejection; mood instability; cannot tolerate risk of rejection; describe feeling empty; history of self mutilating
and suicidal behavior; Has familial pattern, increased incidence of substance abuse and anti- social personality
disorder.
Histrionic have excessive emotions and are attention seekers; express their emotions very theatrically and dramatically; have an
inordinate need to impress others with their appearance; attention-seeking behaviors including seductiveness and
somatization
Narcissistic grandiose, need admiration, lack empathy; convey a grandiose sense of self –importance; feel entitled to preferential
treatment; talk about themselves at length; extreme need for admiration; intolerance for criticism; often overreact to
criticism or defeat with deep humiliation
Avoidant have social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation; sensitive to rejection in
social situations; inhibited, anxious and low self esteem; shy and timid; extreme self consciousness; fear of
embarrassment interferes interpersonal relationship and job performance or advancement
Dependent submissive, and their clinging behavior is r/t an excessive need to be cared for; excessive reliance on others; lacks
confidence in the ability to be self reliant; incapable of making independent decisions; fearful of separation;
vulnerable when the dependent relationship is threatened; often immediately seeks a replacement relationship;
avoidance of responsibility as a result of intrinsic self doubt may impair interpersonal/occupational performance
Obsessive- preoccupied with orderliness, perfectionism and control; paying strict attention to rules, details, procedures, lists, and
compulsive schedules; tend to save everything; workaholic; leisure activities are structured.

Describe the therapeutic nursing interventions to assist clients with personality disorders
Nursing interventions for clients diagnose with personality disorders are directed at validating the client’s experience, ensuring client safety,
and teaching effective coping strategies. The interventions target the client’s behavior (O’brien et al., 2008, p. 446).
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Chapter Twenty-Four: Children and Adolescents

Identify four factors that can contribute to a child developing emotional problems or mental problems. 460
Name two types of aberrant behavior in a child. 476
Identify nursing interventions in assisting children and their families to cope with emotional problems or mental disorders. 468
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Chapter Twenty-Six: Clients with Intellectual and Development Disabilities

Define mental retardation and developmental disability in accordance with criteria established by the Developmental Disabilities Assistance
and Bill of Rights Act, American Psychiatric Association, and American Association of Mental Retardation.
Distinguish among mental retardation, pervasive developmental disorders, and other intellectual and developmental disabilities.
Identify general guidelines and considerations for working with clients with intellectual and developmental disabilities.
Identify nursing interventions in assisting clients and their families to cope with intellectual and developmental disabilities.
Describe important components in teaching clients and their families about these disorders.