This group of disorders occurs in various organs and systems, whereby emotions are expressed by affecting body organs.

1. CONCEPTS AND PRINCIPLES RELATED TO PSYCHOLOGICAL FACTORS AFFECTING PHYSICAL CONDITIONS:
1. Majority of organs involved are usually under control of autonomic nervous system.
2. Defense mechanisms
1. Repression or suppression of unpleasant emotional experiences.
2. Introjection—illness seen as punishment.
3. Projection—others blamed for illness.
4. Conversion—physical symptoms rather than underlying emotional stresses are emphasized.
3. Clients often exhibit the following underlying needs in excess:
1. Dependency.
2. Attention.
3. Love.
4. Success.
5. Recognition.
6. Security.
4. Need to distinguish between:
1. Factitious disorders—deliberate, conscious exhibit of physical or psychological illness to avoid an uncomfortable situation.
2. Conversion disorder—affecting sensory and skeletal-muscular systems that are usually under voluntary control; generally non–life-threatening; symptoms are symbolic solution to anxiety; no demonstrable organic pathology.
3. Psychological factors affecting physical condition (e.g., psychophysiological disorders); under autonomic nervous system control; structural organic changes; may be life threatening.
5. A decrease in emotional security tends to produce an increase in symptoms.
6. When treatment is confined to physical symptoms, emotional problems are not usually relieved.
2. ASSESSMENT OF PHYSIOLOGICAL FACTORS:
1. Persistent psychological factors may produce structural organic changes resulting in chronic diseases, which may be life-threatening if untreated.
2. All body systems are affected:
1. Skin (e.g., pruritus, acne, dermatitis, herpes, psoriasis).
2. Musculoskeletal (e.g., backache, muscle cramps).
3. Respiratory (e.g., asthma, hiccups, hay fever).
4. Gastrointestinal (e.g., obesity, ulcers, ulcerative colitis, irritable bowel syndrome, gastroesophageal reflux disease, constipation, diarrhea, nausea and vomiting).
5. Cardiovascular (e.g., cardiospasm, angina, paroxysmal tachycardia, migraines, palpitations, hypertension, coronary heart disease).
6. Genitourinary (e.g., impotence, enuresis, amenorrhea, dysuria, dysmenorrhea).
7. Endocrine (e.g., hypoglycemia, hyperglycemia, hyperthyroidism).
8. Nervous system (e.g., general fatigue, anorexia, exhaustion).
9. Cancer.
10. Autoimmune disease (e.g., multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis).
3. ANALYSIS/NURSING DIAGNOSIS: ineffective individual coping related to inappropriate needgratification through illness (actual illness used as means of meeting needs for attention and affection). Absence of life experiences that gratify needs for attention and affection.
4. NURSING CARE PLAN/IMPLEMENTATION in disorders in which psychological factors affect physical conditions:
1. Long-term goal: release of feelings through verbalization.
2. Short-term goals:
1. Take care of physical problems during acute phase.
2. Remove client from anxiety-producing stimuli.
3. Prompt attention in meeting clients' basic needs, to gratify appropriate needs for dependency, attention, and security.
4. Maintain an attitude of respect and concern; clients' pains and worries are very real and upsetting to them; do not belittle the symptoms. Do not say, "There is nothing wrong with you" because emotions do in fact cause somatic disabilities.
5. Treat organic problems as necessary, but without undue emphasis (i.e., do not reinforce preoccupation with bodily complaints).
6. Help clients express their feelings, especially anger, hostility, guilt, resentment, or humiliation, which may be related to such issues as sexual difficulties, family problems, religious conflicts, and job difficulties. Help clients recognize that, when stress and anxiety are not released through some channel such as verbal expression, the body will release the tension through "organ language."
7. Provide outlets for release of tensions and diversions from preoccupation with physical complaints.
1. Provide social and recreational activities to decrease time for preoccupation with illness.
2. Encourage clients to use physical and intellectual capabilities in constructive ways.
8. Protect clients from any disturbing stimuli; help the healing process in the acute phase of illnesses (e.g., myocardial infarct).
9. Help clients feel in control of situations and be as independent as possible.
10. Be supportive; assist clients to bear painful feelings through a helping relationship.
11. Health teaching:
1. Teach how to express feelings.
2. Teach more effective ways of responding to stressful life situations.
3. Teach the family supportive relationships.
5. EVALUATION/OUTCOME CRITERIA: can verbalize feelings more fully.