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# Somatic symptom, functional and dissociative disorders: the nursing approach

- Safe practice

Believe that the symptoms are real, keep one steady care team, focus on function and coping, approach dissociation gently and report suspected falsification.

Updated Nov 13, 2026

## Key points

- The symptoms are real: never say they are imaginary or «all in the head».
- One main care provider and regular, scheduled reviews avoid unneeded, sometimes harmful tests.
- Focus on function: staying active and social and coping with symptoms, even if they continue.
- Treatment may involve neurologists, mental-health professionals and physical, speech or occupational therapists.
- Touch and surprises can trigger dissociation: explain what you will do, ask before touching and stop if the person shows discomfort.
- Watch for depression and suicide risk, which are raised in somatic symptom disorder.

## 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)

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

## Test yourself

Think of the answer, then tap the question to see it.

## Are the symptoms of somatic symptom disorder faked?

No. The symptoms are real; the main problem is the extreme reaction and behaviour about them. Do not tell the person they are imaginary.

## What is dissociation?

A break in how the mind handles information, causing disconnection from thoughts, feelings, memories and surroundings.

## What should the nurse do if a caregiver seems to be falsifying a child's illness?

Record objective observations and report to the team, following the child-protection route: it is a form of child abuse.

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## Elsewhere in DurgiPedia

- [Psychological factors in physical illness](https://durgical.com/en/behavioral-science/psychological-factors-in-physical-illness/)

## Connections

## Related 2

- [The nurse–patient therapeutic relationship: phases, boundaries, self-awareness and transference](https://durgical.com/en/nursing/the-nurse-patient-therapeutic-relationship-phases-boundaries-self-awareness-and/)
- [Trauma-informed care and nursing for PTSD and acute stress](https://durgical.com/en/nursing/trauma-informed-care-and-nursing-for-ptsd-and-acute-stress/)

## Related conditions 4

- [Somatic symptom and illness anxiety disorders](https://durgical.com/en/conditions/somatic-symptom-and-illness-anxiety-disorders/)
- [Functional neurological symptom disorder (conversion disorder)](https://durgical.com/en/conditions/functional-neurological-symptom-disorder/)
- [Dissociative disorders](https://durgical.com/en/conditions/dissociative-disorders/)
- [Factitious disorder and malingering](https://durgical.com/en/conditions/factitious-disorder-and-malingering/)

[← All of nursing](https://durgical.com/en/nursing/)

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](https://medlineplus.gov/ency/article/000955.htm) (MedlinePlus, U.S. National Library of Medicine, 2025); [Functional neurological disorder](https://medlineplus.gov/ency/article/000954.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [Nursing: Mental Health and Community Concepts, 15.3: Trauma-informed care](https://med.libretexts.org/Bookshelves/Nursing/Nursing%3A_Mental_Health_and_Community_Concepts_(OpenRN)/15%3A_Trauma_Abuse_and_Violence/15.03%3A_Trauma-Informed_Care) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); [Munchausen syndrome by proxy](https://medlineplus.gov/ency/article/001555.htm) (MedlinePlus, U.S. National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/somatic-symptom-functional-and-dissociative-disorders-the-nursing-approach/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/somatic-symptom-functional-and-dissociative-disorders-the-nursing-approach/