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Somatic Symptom and Related Disorders in Children

By

Josephine Elia

, MD, Sidney Kimmel Medical College of Thomas Jefferson University

Last full review/revision Apr 2021| Content last modified Apr 2021
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Somatic symptom disorder and related disorders are characterized by persistent physical symptoms that are associated with excessive or maladaptive thoughts, feelings, and behaviors in response to these symptoms and associated health concerns. These disorders are distressing and often impair functioning.

Somatic symptom and related disorders include the following:

Somatic symptom and related disorders are equally common among young boys and young girls but are more common among adolescent girls than adolescent boys.

Symptoms and treatment of somatic symptom and related disorders are very similar to those of anxiety disorders Overview of Anxiety Disorders in Children and Adolescents Anxiety disorders are characterized by fear, worry, or dread that greatly impairs the ability to function normally and that is disproportionate to the circumstances at hand. Anxiety may result... read more . The symptoms are not consciously fabricated, and children are actually experiencing the symptoms they describe.

Diagnosis of Somatic Symptom and Related Disorders

  • Usually clinical criteria

  • Sometimes tests to rule out other disorders

Diagnosis of somatic symptom or a related disorder is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Generally, for one of these disorders to be diagnosed, symptoms must cause significant distress and/or interfere with daily functioning, and children must be excessively concerned about their health and/or symptoms in thoughts and actions.

At first presentation, physicians take an extensive history (sometimes conferring with family members) and do a thorough examination and often testing to determine whether a physical disorder is the cause. Because children with somatic symptom disorder may also develop physical disorders, appropriate examinations and tests should be done whenever symptoms change significantly or when objective signs develop. 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 somatic symptom or a related disorder. Doctors also talk to the children and family members to try to identify underlying psychologic problems or troubled family relationships.

Treatment of Somatic Symptom and Related Disorders

  • Psychotherapy

  • Sometimes drugs to relieve symptoms

Children, even when there is a satisfactory relationship with a primary physician, are commonly referred to a psychotherapist. 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 Hypnotherapy Hypnotherapy, a type of mind-body medicine, is derived from western psychotherapeutic practice. Patients are put into an advanced state of relaxation and focused concentration to help them change... read more , biofeedback Biofeedback For biofeedback, a type of mind-body medicine, electronic devices are used to provide information to patients about biologic functions (eg, heart rate, BP, muscle activity, skin temperature... read more , and relaxation therapy Relaxation Techniques Relaxation techniques, a type of mind-body medicine, are practices specifically designed to relieve tension and strain. The specific technique may be aimed at Reducing activity of the sympathetic... read more .

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:

  • It may treat actual physical effects, such as reduced mobility or loss of muscle, caused by somatic symptom or a related disorder.

  • It makes children feel as if something concrete is being done to treat them.

  • It enables children to participate actively in their treatment.

Drugs to treat concurrent mental disorders (eg, depression, anxiety) may help; however, the primary intervention is psychotherapy.

Children also benefit from having a supportive relationship with a primary care physician, who coordinates all of their health care, offers symptomatic relief, sees them regularly, and protects them from unnecessary tests and procedures.

Key Points

  • Children are preoccupied with and excessively worried about their health, physical symptoms, or the possibility of having or acquiring a serious illness.

  • Children may have multiple symptoms (eg, impaired coordination or balance, weakness, paralysis or loss of sensation, seizures, blindness, double vision, deafness) or one severe symptom, typically pain.

  • Do appropriate examinations and tests initially to rule out a physical disorder as the cause of symptoms and, if symptoms change significantly or objective signs develop, to check for a new physical disorder.

  • Treatment may involve psychotherapy, usually combined with a rehabilitation program that aims to help children get back into a normal routine.

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