People have normal concerns about their appearance, but when excessive time is consumed by their preoccupation with their appearance and social and occupational functioning is impaired, it is referred to as Body Dysmorphic Disorder or “Dysmorphophobia.” For those who are depressed or have an anxiety disorder, 5% to 40% suffer from this disorder as well. These individuals experience their preoccupation with their “deformity” as intensely painful. Work and social interaction are avoided. They will spend many hours of the day thinking about their “defect” to the point that it dominates their lives. Their days are characterized by obsessive checking of their perceived defect and weak attempts to block such thoughts. Since a work related amputation is a sudden event for which an individual is not prepared, “Dysmorphophobia” is often acute and time limited. It simply takes a few months to accept that the event has occurred and that the change ...
It occurs far too often and is distressing and confusing for most people to conceive of someone causing serious or even minor injury to him or herself. The goal of such self-abusive, self-destructive and self-mutilating acts are most often twofold: 1. To remain in the role of a patient wherein 2. They are rewarded, gain attention, play the victim and escape responsibility In psychological evaluation, they most often over-endorse their limitations and vulnerabilities and frequently offer that others suspect they are being self-destructive and how insulted they are by that attribution. There are several things that must be done: a. The history and progression of their initial injury must be meticulously outlined to insure whether it is following a standard clinical course b. Attempts need to be made to determine what has happened developmentally with this patient and ...
Just prior to Thanksgiving, a patient “turns sour.” He is doing very poorly, calling repeatedly with uncertain and nonspecific needs. This is unlikely to be manipulation. Covering financial bases during a holiday season can be extremely problematics. It is important to know how past Christmas Holidays or how this Thanksgiving, Memorial, Fourth of July, etc differs from past? Likely, in past years, he got together with family and was a productive participant. This year he may be overwhelmed by his pain, have an uncertain future, knows he will not meet the financial needs. This may be an “adjustment disorder with anxiety and depressed mood” and tied situationally to the holiday season. (There are also those patients who suffer from seasonal affective disorder (S.A.D.) for whom decreased daylight hours triggers a depressive disorder. This is the time when some injured workers need cash advances, need brief psychological support, ...
Monday, December 3, 2001 When a nurse case manager, feels as though the patient is witholding data or altering information, the frustration and resentment can lead to burn out. If you feel your efforts are futile and that you no longer derive any satisfaction from your work and that your work is under appreciated, then perhaps burn-out does apply. However, perhaps the following will better help you understand what is occurring with the patients and that your work is not in vain: As a nurse case manager (or adjustor, surgeon or attorney), the patients feel that there are specific data you are seeking and other data of which you would have little interest. Often, the patient does not even recognize the importance of unspoken facts. Do patients lie? Of course they do. Do patients lie for the sake of money? Yes, that is part of any compensated disability process. However, if we define lying as deliberate withholding or distorting ...
Whether a patient is being mean and inappreciative or irritable due to depression is an important differentiation. · What if their “meanness” is a combination of disappointment and/or rage? · What if they wait for hours in waiting rooms and see a difference in the way they, versus private patients, are treated? · What if the accident itself was the result of under-trained co-worker(s) whom they believe should never have been performing the job? · Or, worse, as in a patient this week reported, they have ample confirmation that their “accident” was really sabotage at the hands of an envious or retaliatory co-worker. · What if the accident resulted from faulty equipment or safety standards that they have reported numerous times and which are implemented as soon as they are injured. · What if their spouse left, their children’s needs cannot be met, ...
Recent Comments
