The nurse is working with a client with a somatoform disorder. Which client outcome goal would nurse most likely establish in this situation?

Correct Answer: D. The client will express anxiety verbally rather than through physical symptoms.

The client with a somatoform disorder displaces anxiety into physical symptoms. The ability to express anxiety verbally indicates a positive change toward improved health. These disorders should be considered early in the evaluation of patients with unexplained symptoms to prevent unnecessary interventions and testing. Up to 50 percent of primary care patients present with physical symptoms that cannot be explained by a general medical condition. Some of these patients meet criteria for somatoform disorders.

• Option A: The unexplained symptoms of somatoform disorders often lead to general health anxiety; frequent or recurrent and excessive preoccupation with unexplained physical symptoms; inaccurate or exaggerated beliefs about somatic symptoms; difficult encounters with the health care system; disproportionate disability; displays of strong, often negative emotions toward the physician or office staff; unrealistic expectations; and, occasionally, resistance to or noncompliance with diagnostic or treatment efforts. These behaviors may result in more frequent office visits, unnecessary laboratory or imaging tests, or costly and potentially dangerous invasive procedures.
• Option B: The challenge in working with somatoform disorders in the primary care setting is to simultaneously exclude medical causes for physical symptoms while considering a mental health diagnosis. The diagnosis of a somatoform disorder should be considered early in the process of evaluating a patient with unexplained physical symptoms. Appropriate nonpsychiatric medical conditions should be considered, but over-evaluation and unnecessary testing should be avoided.
• Option C: Studies supporting the effectiveness of pharmacologic interventions targeting specific somatoform disorders are limited. Antidepressants are commonly used to treat depressive or anxiety disorders and may be part of the approach to treating the comorbidities of somatoform disorders. Antidepressants such as fluvoxamine (Luvox, brand not available) for treating body dysmorphic disorder, and St. John’s wort for treating somatization and undifferentiated somatoform disorders have been proposed.