In somatoform disorders, an underlying psychologic problem causes distressing or disabling physical symptoms.
Symptoms and treatment of somatoform disorders are very similar to those of anxiety disorders.
Children with a somatoform disorder may have a number of symptoms, including pain, difficulty breathing, and weakness, without evidence of a physical cause (see see Somatoform Disorders). Often, children develop psychologically based physical symptoms when another family member is seriously ill. These physical symptoms are thought to develop unconsciously in response to a psychologic stress or problem (see see Sidebar 1: Mind and Body). The symptoms are not consciously fabricated, and children are actually experiencing the symptoms they describe.
Somatoform disorders include the following:
Somatoform disorders are equally common among young boys and young girls but are more common among adolescent girls than adolescent boys.
Doctors ask children about their symptoms and do a physical examination and sometimes tests to make sure that children do not have a physical disorder that could account for the symptoms. However, extensive laboratory tests are generally avoided because they may further convince children that a physical problem exists and unnecessary diagnostic tests may themselves traumatize children.
If no physical problem can be identified, doctors may use standardized mental health tests to help determine whether symptoms are due to a somatoform disorder. Doctors also talk to the children and family members to try to identify underlying psychologic problems or troubled family relationships.
Children may balk at the idea of visiting a psychotherapist because they think their symptoms are purely physical. However, individual and family psychotherapy, often using cognitive-behavioral techniques, can help children and family members recognize patterns of thought and behavior that perpetuate the symptoms. Therapists may use hypnosis, biofeedback, and relaxation therapy.
Psychotherapy is usually combined with a rehabilitation program that aims to help children get back into a normal routine. It can include physical therapy, which has the following benefits:
Drugs may be used to relieve pain or the anxiety or depression that can accompany these disorders.
Last full review/revision February 2009 by Hugh F. Johnston, MD