Repeated, multiple, vague or exaggerated physical complaints of several years' duration without identifiable physical cause; clients constantly seek medical attention, undergo numerous tests; at risk for unnecessary surgery or drug abuse.

1. Assessment:
1. Onset and occurrence—teen years, more common in women.
2. Reports illness most of life.
1. Neuromuscular symptoms—fainting, seizures, dysphagia, difficulty walking, back pain, urinary retention.
2. Gastrointestinal symptoms—nausea, vomiting, flatus, food intolerance, constipation or diarrhea.
3. Female reproductive symptoms—dysmenorrhea, hyperemesis gravidarum.
4. Psychosexual symptoms—sexual indifference, dyspareunia.
5. Cardiopulmonary symptoms—palpitations, shortness of breath, chest pain.
6. Rule out: multiple sclerosis, systemic lupus erythematosus (SLE), porphyria, hyperparathyroidism.
3. Appears anxious and depressed.
2. Analysis/nursing diagnosis:
1. Anxiety (severe) related to threat to security, unmet dependency needs, and inability to meet role expectations.
2. Self-care deficit related to development of physical symptoms to escape stressful situations.
3. Impaired social interaction related to inability to accept that physical symptoms lack a physiological basis; preoccupation with self and physical symptoms, chronic pain; rejection by others.
4. Body-image disturbance and altered role performance related to passive acceptance of disabling symptoms.