Psychiatric and Mental Health Nursing Somatoform and dissociative disorders Scenario Debbie is from an Asia?Pacific island. She is 36 years old and a mother of three young children. She lives with her parents, who support her financially and help her with care of her children. Debbie has been referred to the mental health clinic by her MD. She has had abdominal discomfort that keeps recurring. She has had multiple hospital admissions for investigations and exploratory surgery to identify the underlying problem. The repeated conclusion reached by the medical team is that there is no underlying physical problem. On previous episodes, Debbie was dissatisfied with the medical team?s diagnosis and asked her parents to send her overseas for further tests and surgery. Consequently, she has had multiple abdominal surgeries. The GP has followed up this trend and is now concerned that perhaps Debbie has a somatoform disorder. Her episodes of abdominal pain and discomfort seem to occur when things are not going well in her life (e.g. relationship problems, work issues, financial concerns). Debbie was born overseas. Being the younger of two children in her family, her parents gave her up for adoption to her biological aunt, who could not bear any children of her own. For many years Debbie lived with her aunt and uncle and although she knew of her biological parents, she was happy with the arrangement of adoptive parents. Her adoptive parents loved and spoiled her by showering her with toys and things that she loved. When her aunt became pregnant and had her own child, Debbie was returned to her biological parents. Debbie felt replaced and abandoned by her adoptive parents. At the same time, she felt growing resentment towards her biological parents for giving her up in the first place, and also for not granting her what she wanted. She often threw tantrums when she did not get her own way. Through adolescence Debbie became increasingly difficult to manage. Her language was foul and aggressive. She blamed her parents for everything that went wrong in her life. She became demanding, uncooperative and unpleasant. Her parents felt guilty about giving her up for adoption and always seemed to be trying to make up by giving in to her. Debbie became promiscuous as a young adult, as if always seeking ways to be loved. She became pregnant at 17 and soon had three children with different fathers. She chose not to work and relied on her parents financially and for childcare. Now that the children are older, whenever Debbie gets stressed, she takes the children to the MD or hospital with a variety of physical complaints. The doctor is concerned that Debbie is using her children to mask and complicate her somatoform disorder. Debbie?s parents have also been seen to discuss this issue. You are the nurse interviewing Debbie at the Community Mental Health Clinic. Debbie has attended this appointment as she believes this is the only way she can get into the hospital to sort out her abdominal problem. This problem has got worse since her last partner left her for a younger woman. Questions 1 What is the difference between somatoform disorder and malingering? 2 How can you explain the reason for somatoform disorder in Debbie?s case? 3 How would you approach your assessment in a therapeutic and non-judgemental way? 4 As a nurse, provide some validating statements to show acceptance of Debbie?s condition. 5 Discuss a recovery-oriented approach for Debbie?s case. What would this entail? 6 An increasingly effective intervention measure is cognitive behavior therapy. Explain how this could work in Debbie?s case. 7 Somatoform disorders are difficult to manage. How do you think your reaction might be towards someone like Debbie? Would this help Debbie?s situation?