A nurse is reviewing the medical record of a client who has somatic symptom disorder. Which of the following would be a likely comorbidity of somatic symptom disorder?

A. "Clients who have this disorder consciously control the manifestations." Functional neurological symptom disorder (formerly conversion disorder) involves involuntary neurological symptoms, such as paralysis, blindness, or seizures, that lack a medical explanation. Clients do not consciously produce or control these symptoms.
B. "Clients who have this disorder exhibit more than one personality." Multiple personalities are characteristic of dissociative identity disorder (DID), not functional neurological symptom disorder. Clients with functional neurological symptom disorder experience physical symptoms, not identity fragmentation.
C. "Feeling outside of one's body is a primary manifestation of this disorder." Feeling detached from one's body, known as depersonalization, is a symptom of depersonalization/derealization disorder. Functional neurological symptom disorder primarily involves physical, rather than perceptual, disturbances.
D. "The manifestations of this disorder are worse during times of increased stress." Symptoms of functional neurological symptom disorder often intensify during emotional or psychological stress. Stress-related factors contribute to the onset or worsening of symptoms, making stress management a key part of treatment.

A. Encourage the client to use relaxation techniques. While relaxation techniques can help manage symptoms in somatic symptom disorder, they should not be the first response to a new symptom like chest pain. The nurse must first rule out a medical cause before assuming the pain is psychological.
B. Reassure the client that pain is an expected part of their disorder. Assuming that the pain is purely psychosomatic without assessing for a potential medical emergency could lead to a delay in necessary treatment. Each new symptom should be evaluated independently.
C. Explain to the client that the pain is not real. The pain experienced by clients with somatic symptom disorder is real to them, even if a physical cause is not found. Dismissing their symptoms can damage trust and discourage them from reporting future concerns.
D. Assess the client's vital signs. Any new report of chest pain should be taken seriously, regardless of the client’s psychiatric history. Assessing vital signs ensures that a potential cardiac event or other medical issue is not overlooked before considering psychological factors.