Somatic symptom, functional and dissociative disorders: the nursing approach

What it is

In somatic symptom disorder, the person's worry and behaviour about physical symptoms are so intense that they disrupt daily life; the symptoms are real and not faked. In functional neurological disorder (conversion), the nervous system does not work properly without a structural disease, causing weakness, seizures, tremor or other symptoms that the person cannot switch on or off. Dissociation is a break in how the mind handles information, with disconnection from thoughts, feelings, memories and surroundings, often linked to trauma. The nurse offers a steady, supportive relationship, avoids telling people their symptoms are «in their head», supports therapy and function, and applies trauma-informed care. Factitious disorder, in which illness is deliberately falsified, is different: the nurse documents objective observations and reports concerns to the team; when a caregiver falsifies a child's illness, it is a form of child abuse.

What it requires

• A complete medical assessment by the team to look for physical causes.
• A consistent, non-judgemental approach agreed by the whole team.
• Link with cognitive behavioural therapy and physical, speech or occupational therapy as indicated.
• Trauma-informed care for every person.

Components

• Relationship: belief, validation, consistency.
• Function: activity, rehabilitation, coping and stress reduction.
• Safety: depression, suicide risk and triggers of dissociation.
• Team reporting when deliberate falsification is suspected.

How it is applied (and why)

1. Listen to the symptoms and say that you believe the person is experiencing them — feeling dismissed damages trust and increases distress.
2. Assess and document symptoms objectively, including what you observe and how the person functions — this informs the team without judging.
3. Coordinate care through one main provider and scheduled reviews rather than urgent repeated tests — this avoids unneeded and risky procedures.
4. Encourage daily activity, rehabilitation exercises and social contact, setting small goals — function improves even before symptoms fade.
5. Teach stress-reduction and relaxation exercises and help the person notice what worsens symptoms — anxiety amplifies physical sensations.
6. Reinforce the exercises set by the physical, speech or occupational therapist — rehabilitation is part of treating functional symptoms.
7. If the person seems disconnected, slow down, explain each step, ask before touching and watch for flinching — choice and control lower the threat response.
8. If symptoms seem deliberately produced, record objective facts and tell the team; for a child, follow the child-protection route — falsified illness harms.

In nursing practice

• Screen for depression and suicidal ideation; untreated somatic symptom disorder raises both risks.
• Symptoms of functional neurological disorder may last days or years and can be disabling even though they are not life-threatening.
• Childhood trauma and ongoing stress are common in these disorders; apply trauma-informed principles.
• A clear explanation that no serious disease was found, combined with validation, can reduce anxiety.

Common mistakes

• Saying «there is nothing wrong with you».
• Ordering or requesting new tests at every complaint without a plan.
• Keeping a suspicion of falsified illness to yourself instead of reporting it to the team.
• Touching a person who seems disconnected without asking first.

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Elsewhere in DurgiPedia

• Psychological factors in physical illness

Connections

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Somatic symptom disorder (MedlinePlus, U.S. National Library of Medicine, 2025); Functional neurological disorder (MedlinePlus, U.S. National Library of Medicine, 2024); Nursing: Mental Health and Community Concepts, 15.3: Trauma-informed care (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Munchausen syndrome by proxy (MedlinePlus, U.S. National Library of Medicine, 2025).

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