Somatoform Disorder in Children and Adolescent

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Somatoform Disorder in Children and Adolescents

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SomatoformDisorderinChildrenandAdolescents

Introduction 

Somatizationistherecurrentofoneormorephysicalcomplaintsinchildrenand

adolescents.Thedisordercoincideswithaphysicalillness,inwhichmedicalevaluation

revealsnopathophysiologicmechanism.Thesomatoformdisorderhascreatedanegative

effectonthelifeofadolescentsandchildren.Imean,thisdisorderhasagreatimpacton

psychologicaldistressandeducationalimpairment.Ofcourse,diagnosingsuchadisorder

becomesabigdealasitoftenappearsasmedicalconditions.Withapreviewofthefourth

editiontextrevisionDSM-IV-TR,itisevidentthatthepresenceofphysicalsymptomsmakes

mostofthesomatoformpatientsnottoseekpsychiatricassistance.Oneofthestandard

andpressingsomatoformdisorderinadolescentsandchildrenaretensionheadacheand

abdominalpain.Nevertheless,thereareplentyofdisordersinthecategory,including

conversiondisorder,somatizationdisorder,andhypochondriasis.

Originally,thisdisorderwasdiagnosedandestablishedforadults.Sincenoalternative

systemhasbeendevelopedeversincethediseasehaseruptedrapidlyaffectingchildren

adolescentsatalargepercentage.Theclinicalaspectofthisdisorderbringsrelieftoknow

thatsomeprogresshasbeenmadetocountertheproblem.Initially,childrenand

adolescentswentthroughaffectivedistressandrecurrentabdominalpains.Butthecurrent

pediatricpopulationshowsthattheprevalenceofthesomaticdisorderhasrisentohigh

levels.Thesomaticdisorderislimitedandpredominatesintwins.Thesymptomsofthis

disorderarespontaneousandvaryinextension.However,somaticcomplaintvariationisa

universalexperience.Ininfancy,thesomatoformdisorderinvolvesdiscomfortand

complaintsthat,attimes,donnotinterferewitheverydayfunctioning.Adolescents

experiencemenstrualdiscomfort,transientaches,andpains.Inchildhood,onesuffers

somaticcomplaintsbecauseoftheignoranceofavoidingnormalactivities.Asthe

adolescentstageapproaches,onegoesthroughemotionaldistress,academicdifficulties,

andsocialwithdrawal.

Somatoformdisordersareagroupofpsychiatricdisorderscharacterizedbythepresenceof

physicalsymptomsthatcannotbeexplainedbyanyknownmedicalcondition.The

symptomsmaybedistressingandcausesignificantimpairmentindailyfunctioning.The

prevalenceofsomatoformdisordersinchildrenandadolescentsisestimatedtobearound

2-3%.

Somatoformdisordersinchildrenandadolescentscanbecategorizedintodifferenttypes

basedonthepredominantsymptompresentation.Themostcommontypesofsomatoform

disordersseeninthisagegroupincludeconversiondisorder,somatizationdisorder,pain

disorder,andhypochondriasis.

Conversiondisorderischaracterizedbythepresenceofneurologicalsymptomssuchas

weakness,tremors,seizures,orparalysisthatcannotbeexplainedbyanyknownmedical

condition.Thesesymptomsmaybetriggeredbyastressfuleventoremotionalconflict.In

children,conversiondisorderismorecommonlyseeningirlsandisoftenassociatedwitha

historyofphysicalorsexualabuse.

Somatizationdisorderischaracterizedbythepresenceofmultiplephysicalsymptomssuch

aspain,gastrointestinalproblems,andfatiguethatcannotbeexplainedbyanyknown

medicalcondition.Thesesymptomsoftenpersistoveraperiodoftimeandmayresultin

frequentdoctorvisits,hospitalizations,andmedicaltests.Somatizationdisorderismore

commonlyseeningirlsandisoftenassociatedwithahistoryofabuseortrauma.

Paindisorderischaracterizedbythepresenceofpersistentpainthatcannotbeexplainedby

anyknownmedicalcondition.Thepainmaybelocalizedtoaspecificareaofthebodyor

maybediffuse.Childrenwithpaindisordermayalsoexperienceotherphysicalsymptoms

suchasheadaches,nausea,andfatigue.Paindisorderismorecommonlyseeningirlsandis

oftenassociatedwithahistoryofabuseortrauma.

Hypochondriasisischaracterizedbyexcessiveworryandfearabouthavingaseriousmedical

condition.Childrenwithhypochondriasismayfrequentlyseekmedicalattentionandmay

havemultiplemedicaltestsdonetoruleoutanyseriousillness.Theymayalsobecome

preoccupiedwiththeirbodilysensationsandmaymisinterpretnormalphysicalsensations

assignsofaseriousmedicalcondition.

Theexactcausesofsomatoformdisordersinchildrenandadolescentsarenotknown.

However,severalfactorshavebeenidentifiedthatmaycontributetothedevelopmentof

thesedisorders.Theseincludegeneticfactors,environmentalfactorssuchasexposureto

traumaorabuse,andpsychologicalfactorssuchasanxiety,depression,andstress.

Diagnosisofsomatoformdisordersinchildrenandadolescentscanbechallengingasthe

symptomsmaybevagueanddifficulttoexplain.Athoroughmedicalevaluationisnecessary

toruleoutanyunderlyingmedicalconditionsthatmaybecausingthesymptoms.Oncea

medicalcausehasbeenruledout,apsychiatricevaluationmaybedonetodeterminethe

presenceofasomatoformdisorder.

Treatmentofsomatoformdisordersinchildrenandadolescentsusuallyinvolvesa

multidisciplinaryapproach.Thismayincludemedication,psychotherapy,andfamily

therapy.Medicationssuchasantidepressantsandantianxietymedicationsmaybe

prescribedtohelpalleviatesymptoms.Psychotherapysuchascognitive-behavioraltherapy

(CBT)maybeusedtohelpthechildunderstandthepsychologicalfactorsthatmaybe

contributingtothesymptomsandtodevelopcopingstrategies.Familytherapymayalsobe

beneficialinaddressinganyfamilydynamicsthatmaybecontributingtothechild's

symptoms.

Prognosisforsomatoformdisordersinchildrenandadolescentsvariesdependingonthe

severityofthesymptomsandtheunderlyingpsychologicalfactors.Somechildrenmay

experiencesignificantimprovementwithtreatment,whileothersmaycontinueto

experiencesymptomsdespitetreatment.Long-termfollow-upmaybenecessarytomonitor

thechild'sprogressandtoprovideongoingsupport.

Inconclusion,somatoformdisordersinchildrenandadolescentsareagroupofpsychiatric

disorderscharacterizedbythepresenceofphysicalsymptomsthatcannotbeexplainedby

anyknownmedicalcondition.Thesedisorderscanbechallengingtodiagnoseandtreat,but

amultidisciplinaryapproachinvolvingmedication,psychotherapy,andSomatoform

disordersareagroupofpsychiatricdisorderscharacterizedbyphysicalsymptomsthat

cannotbefullyexplainedbyanyunderlyingmedicalcondition.Inchildrenandadolescents,

thesedisorderscanbeparticularlydifficulttodiagnoseandmanage,asthesymptomsmay

bevagueanddifficulttodistinguishfromotherphysicalillnesses.

Thereareseveraldifferenttypesofsomatoformdisordersthatcanaffectchildrenand

adolescents,includingsomatizationdisorder,paindisorder,andconversiondisorder.Each

ofthesedisordershasitsownuniquesetofsymptomsanddiagnosticcriteria,buttheyall

shareacommoncharacteristicofphysicalsymptomsthatarenotfullyexplainedbya

medicalcondition.

Somatizationdisorderischaracterizedbymultiplephysicalsymptoms,suchasheadaches,

stomachaches,andjointpain,thatlastforseveralmonthsorlonger.Childrenwiththis

disordermayhaveahistoryofmultipledoctorvisits,medicaltests,andtreatments,butno

clearmedicalcausefortheirsymptomscanbefound.

Paindisorder,ontheotherhand,ischaracterizedbypersistentandseverepainthatcannot

befullyexplainedbyamedicalcondition.Thepainmaybelocalizedtoaspecificareaofthe

body,suchasthebackorneck,oritmaybemorewidespread.Childrenwithpaindisorder

mayhavedifficultyparticipatinginnormaldailyactivitiesduetotheseverityoftheirpain.

Conversiondisorder,alsoknownasfunctionalneurologicalsymptomdisorder,is

characterizedbysymptomsthatmimicthoseofaneurologicaldisorder,suchasparalysisor

seizures,butwithnoclearmedicalcause.Thesesymptomsmaybetriggeredbyatraumatic

eventorstressfullifeevent,andtheymayimproveorworsenbasedonthechild's

emotionalstate.

Inordertodiagnosesomatoformdisordersinchildrenandadolescents,healthcare

providerswilltypicallyperformathoroughphysicalexaminationandmedicalworkuptorule

outanyunderlyingmedicalconditionsthatcouldbecausingthesymptoms.Ifnomedical

causecanbefound,thechildmaybereferredtoamentalhealthprofessionalforfurther

evaluation.

Treatmentforsomatoformdisordersinchildrenandadolescentstypicallyinvolvesa

combinationofmedicalandpsychologicalinterventions.Medicationsmaybeprescribedto

helpmanagephysicalsymptoms,suchaspainoranxiety,whilepsychotherapymaybeused

tohelpthechildaddressunderlyingemotionalorpsychologicalissuesthatmaybe

contributingtotheirsymptoms.

Cognitive-behavioraltherapy(CBT)isonetypeofpsychotherapythathasbeenshowntobe

effectiveintreatingsomatoformdisordersinchildrenandadolescents.CBTinvolves

teachingthechildhowtoidentifyandchallengenegativethoughtsandbeliefsthatmaybe

contributingtotheirsymptoms,aswellasteachingcopingskillstohelpmanagephysical

symptoms.

Othertypesoftherapythatmaybeusedtotreatsomatoformdisordersinchildrenand

adolescentsincludefamilytherapy,whichcanhelpimprovecommunicationandreduce

stresswithinthefamilysystem,andplaytherapy,whichcanhelpyoungerchildrenexpress

theiremotionsandfeelingsinanonverbalway.

Inadditiontomedicalandpsychologicalinterventions,lifestylechangesmayalsobe

recommendedforchildrenandadolescentswithsomatoformdisorders.Thesemayinclude

stressreductiontechniques,suchasyogaormeditation,andchangestodietandexercise

habits.

Overall,somatoformdisordersinchildrenandadolescentscanbechallengingtodiagnose

andmanage,butwiththerighttreatmentandsupport,manychildrenareabletoimprove

theirphysicalsymptomsandleadhealthy,fulfillinglives.Ifyouareconcernedthatyourchild

maybeexperiencingsomatoformdisorderorothermentalhealthissues,itisimportantto

seekprofessionalhelpassoonaspossible.

Somatoformdisordersareagroupofmentalhealthconditionsthatarecharacterizedby

physicalsymptomsthatcannotbefullyexplainedbyamedicalconditionorsubstanceuse.

Thesesymptomscancausesignificantdistressorimpairmentindailyfunctioning,andcan

beassociatedwithhighlevelsofmedicalutilizationandcosts.Somatoformdisordersare

relativelycommoninchildrenandadolescents,withestimatessuggestingthatupto20%of

childrenandadolescentsmayexperiencesomaticsymptomsthatcannotbeexplainedbya

medicalcondition.Inthisarticle,wewillexplorethedifferenttypesofsomatoform

disordersinchildrenandadolescents,aswellastheircauses,riskfactors,assessment,and

treatment.

TypesofSomatoformDisordersinChildrenandAdolescents

Thereareseveraltypesofsomatoformdisordersthatcanaffectchildrenandadolescents.

Theseinclude:

ConversionDisorder:Thisdisorderischaracterizedbythepresenceofneurological

symptomssuchasweaknessorparalysis,speechdifficulties,orseizuresthatcannotbefully

explainedbyamedicalcondition.Thesesymptomsmaybesuddeninonsetandcanbe

triggeredbyastressfulevent.Thesymptomsarenotintentionallyproducedorfeigned,and

maybeassociatedwithimpairmentindailyfunctioning.

PainDisorder:Thisdisorderischaracterizedbythepresenceofpersistentandseverepain

thatcannotbefullyexplainedbyamedicalcondition.Thepainmaybelocalizedtoaspecific

areaofthebodyormaybediffuse,andcanbeassociatedwithsignificantdistressand

impairmentindailyfunctioning.

Hypochondriasis:Thisdisorderischaracterizedbypersistentandexcessiveworryabout

havingaseriousmedicalcondition,despitemedicalreassurancetothecontrary.Children

andadolescentswithhypochondriasismayengageinrepeatedcheckingbehaviorsorseek

medicalcareexcessively,whichcanresultinsignificantmedicalutilizationandcosts.

BodyDysmorphicDisorder:Thisdisorderischaracterizedbypersistentandexcessive

preoccupationwithaperceiveddefectorflawinone'sappearance,whichisnotnoticeable

toothersorisonlyminimallynoticeable.Thispreoccupationcancausesignificantdistress

andimpairmentindailyfunctioning,andmaybeassociatedwithrepeatedchecking

behaviorsoravoidanceofsocialsituations.

SomatizationDisorder:Thisdisorderischaracterizedbythepresenceofmultiplephysical

symptomsindifferentorgansystems,whichcannotbefullyexplainedbyamedical

condition.Thesesymptomsmaybepersistentandmayresultinsignificantmedical

utilizationandcosts.Inchildrenandadolescents,somatizationdisorderisoftendiagnosed

asfunctionalabdominalpainorirritablebowelsyndrome.

CausesandRiskFactors

Theexactcausesofsomatoformdisordersinchildrenandadolescentsarenotwell

understood,butthereareseveralfactorsthatmayincreasetheriskofdevelopingthese

conditions.Theseinclude:

Genetics:Theremaybeageneticpredispositiontosomatoformdisorders,asthese

conditionstendtoruninfamilies.

PsychologicalFactors:Childrenandadolescentswhohaveexperiencedtrauma,abuse,or

neglectmaybemorelikelytodevelopsomatoformdisorders.Additionally,childrenand

adolescentswhohaveanxiety,depression,orothermentalhealthconditionsmaybemore

likelytoexperiencesomaticsymptoms.

EnvironmentalFactors:Childrenandadolescentswhohaveahighlevelofstressorwholive

instressfulenvironmentsmaybemorelikelytodevelopsomatoformdisorders.

Additionally,childrenandadolescentswhohaveahistoryofmedicalproblemsorwhohave

experiencedsignificantmedicalinterventionsmaybemorelikelytoexperiencesomatic

symptoms.

AssessmentandDiagnosis

Theassessmentanddiagnosisofsomatoformdisordersinchildrenandadolescentscanbe

challenging,astheseconditionscanbedifficulttodistinguishfrommedicalconditions.

Additionally,childrenandadolescentsmayhavedifficultyarticulatingtheirsymptoms,and

maybehesitanttoreportpsychologicaldistress.

Acomprehensiveevaluationforsomatoformdisordersshouldincludeathoroughmedical

evaluationtoruleoutanyunderlyingmedicalconditionsthatcouldbecausingthe

symptoms.Additionally,amentalhealthevaluationshouldbeconductedtoassessforany

Somatoformdisordersareagroupofpsychiatricdisorderscharacterizedbyphysical

symptomsthatcannotbeexplainedbyanyknownmedicalcondition.Thesesymptomscan

beverydistressingfortheindividualandmayleadtosignificantimpairmentindaily

functioning.Inchildrenandadolescents,somatoformdisordersarerelativelycommon,with

estimatessuggestingthattheymayaffectupto20%ofthispopulation.Thisarticlewill

provideanoverviewofsomatoformdisordersinchildrenandadolescents,includingtheir

presentation,diagnosis,andtreatment.

Presentation

Somatoformdisordersinchildrenandadolescentsarecharacterizedbyphysicalsymptoms

thatarenotcausedbyanyunderlyingmedicalcondition.Thesesymptomscaninclude

headaches,stomachaches,fatigue,andpaininvariouspartsofthebody.Theycanalso

includemoreunusualsymptomssuchasseizures,blindness,orparalysis.Inmanycases,

thesesymptomsarechronicandmaylastformonthsorevenyears.

Thesymptomsofsomatoformdisordersareoftenassociatedwithanxietyanddepression.

Childrenandadolescentswithsomatoformdisordersmayhaveahistoryoftrauma,

includingphysical,sexual,oremotionalabuse.Theymayalsohaveafamilyhistoryof

anxiety,depression,orsomatoformdisorders.

Diagnosis

Thediagnosisofsomatoformdisordersinchildrenandadolescentscanbechallenging,as

thesesymptomscanbecausedbyavarietyofmedicalconditions.Therefore,itisessential

toruleoutanyunderlyingmedicalconditionsthatmaybecausingthesymptoms.Thiscan

involveathoroughmedicalevaluation,includinglaboratorytests,imagingstudies,and

consultationswithspecialists.

Oncemedicalcauseshavebeenruledout,thediagnosisofasomatoformdisordercanbe

madeiftheindividualmeetsthecriteriaoutlinedintheDiagnosticandStatisticalManualof

MentalDisorders,FifthEdition(DSM-5).Thesecriteriaincludethepresenceofoneormore

physicalsymptomsthataredistressingorimpairingdailyfunctioning,andthatcannotbe

explainedbyanyunderlyingmedicalcondition.Thesymptomsmustalsobeassociatedwith

excessivethoughts,feelings,orbehaviorsrelatedtothesymptoms,suchasexcessive

worrying,preoccupation,orseekingmedicalattention.

Treatment

Thetreatmentofsomatoformdisordersinchildrenandadolescentscanbechallenging,as

theseindividualsmayberesistanttotheideathattheirsymptomsarepsychologicalin

nature.Therefore,acollaborativeapproachthatinvolvesthechildoradolescent,their

family,andmentalhealthprofessionalsisessential.

Cognitive-behavioraltherapy(CBT)isthemosteffectivetreatmentforsomatoform

disordersinchildrenandadolescents.CBTaimstoidentifyandchallengethenegative

thoughtsandbehaviorsassociatedwiththephysicalsymptoms.Thiscaninvolveteaching

theindividualcopingskills,suchasrelaxationtechniques,tomanagetheirsymptoms.Itcan

alsoinvolveaddressinganyunderlyinganxietyordepressionthatmaybecontributingtothe

symptoms.

Insomecases,medicationmaybeusedtotreatsomatoformdisordersinchildrenand

adolescents.Antidepressantmedications,suchasselectiveserotoninreuptakeinhibitors

(SSRIs),maybehelpfulinmanaginganxietyanddepressionthatmaybecontributingtothe

physicalsymptoms.However,medicationshouldbeusedcautiouslyinthispopulation,as

someindividualsmaybeatriskfordevelopingsubstanceabuseordependence.

Familytherapymayalsobehelpfulinthetreatmentofsomatoformdisordersinchildren

andadolescents.Thiscaninvolveeducatingfamilymembersaboutthedisorderandhelping

themtounderstandtheimportanceofacollaborativeapproachtotreatment.Family

therapycanalsohelptoaddressanyfamilyfactorsthatmaybecontributingtothe

symptoms,suchasfamilyconflictordysfunction.

Prognosis

Theprognosisforsomatoformdisordersinchildrenandadolescentsisgenerallygood,

especiallywithearlyintervention.Withappropriatetreatment,manyindividualsareableto

managetheirsymptomsandreturntonormaldailyfunctioning.However,insomecases,

somatoformdisorderscanbecomechronicandmayleadtosignificantimpairmentindaily

functioning.

Prevention

PreventionofsomSomatoformdisordersareagroupofpsychiatricconditionscharacterized

byphysicalsymptomsthathavenoapparentmedicalexplanation.Thediagnosisof

somatoformdisorderinchildrenandadolescentsiscontroversialandcomplicated,asthe

symptomsareoftenvague,difficulttodescribe,andcanberelatedtoavarietyofunderlying

psychologicalfactors.Inthisessay,wewillexploresomatoformdisordersinchildrenand

adolescents,includingtheirsymptoms,causes,diagnosis,andtreatment.

SymptomsofSomatoformDisorderinChildrenandAdolescents

Somatoformdisorderscancauseawiderangeofphysicalsymptoms,includingheadaches,

stomachpain,backpain,jointpain,fatigue,dizziness,andshortnessofbreath.These

symptomsareoftenchronicandmaypersistformonthsorevenyears,leadingtosignificant

distressandimpairmentinthechild'sfunctioning.Childrenandadolescentswith

somatoformdisordersmayalsoexperienceanxiety,depression,andsocialwithdrawal,

whichcanfurtherexacerbatetheirsymptoms.

Itisimportanttonotethatthephysicalsymptomsassociatedwithsomatoformdisorders

arenotintentionallyproducedorfeigned,asisthecasewithfactitiousdisordersor

malingering.Instead,thesesymptomsarebelievedtoarisefrompsychologicaldistressor

conflict,oftenrelatedtostressorssuchasfamilyconflict,academicpressure,ortrauma.

CausesofSomatoformDisorderinChildrenandAdolescents

Theexactcausesofsomatoformdisorderinchildrenandadolescentsarenotwell

understood,butthereareseveralfactorsthatmaycontributetoitsdevelopment.These

include:

Genetics:Likemanypsychiatricconditions,somatoformdisordermayhaveagenetic

component.Childrenwithafamilyhistoryofsomatoformdisorderorothermentalhealth

conditionsmaybemorelikelytodeveloptheconditionthemselves.

PsychologicalFactors:Psychologicalfactorssuchasstress,anxiety,depression,andtrauma

cancontributetothedevelopmentofsomatoformdisorderinchildrenandadolescents.

Thesefactorscancausephysicalsymptomsbyalteringthebody'sstressresponse,leadingto

increasedmuscletension,pain,andotherphysicalsensations.

EnvironmentalFactors:Environmentalfactorssuchasfamilyconflict,academicpressure,

andpeerrelationshipscanalsocontributetothedevelopmentofsomatoformdisorder.

Childrenandadolescentswhoexperiencechronicstressortraumamaybemorelikelyto

developtheconditionasawayofcopingwiththeiremotionaldistress.

DiagnosisofSomatoformDisorderinChildrenandAdolescents

Diagnosingsomatoformdisorderinchildrenandadolescentscanbechallenging,asthe

symptomsareoftendifficulttodistinguishfromthoseofphysicalillness.Athoroughmedical

evaluationisnecessarytoruleoutanyunderlyingmedicalconditionsthatmaybecausing

thesymptoms.Onceamedicalcausehasbeenruledout,amentalhealthevaluationis

necessarytodetermineifthesymptomsarerelatedtoasomatoformdisorder.

TheDiagnosticandStatisticalManualofMentalDisorders(DSM-5)outlinesseveralcriteria

forthediagnosisofsomaticsymptomdisorder(SSD)inchildrenandadolescents,which

include:

Oneormoresomaticsymptomsthataredistressingordisruptivetothechild'sdailylife.

Excessivethoughts,feelings,orbehaviorsrelatedtothesomaticsymptoms,suchas

worryingaboutthesymptomsorseekingmedicalattention.

Symptomsthatpersistforatleast6months,despitemedicalevaluationandreassurance.

Thesymptomscannotbefullyexplainedbyamedicalcondition,substanceuse,orother

mentalhealthdisorder.

ItisimportanttonotethattheDSM-5alsoincludesadiagnosisofillnessanxietydisorder

(IAD),whichischaracterizedbyexcessiveworryaboutthepossibilityofhavingor

developingaseriousillness,despitemedicalreassurancethatnosuchillnessispresent.IAD

iscloselyrelatedtoSSDandmaybediagnosedinchildrenandadolescentswhoexhibit

excessivehealth-relatedfearsoranxiety,butdonothavesignificantsomaticsymptoms.

TreatmentofSomatoformDisorder

Somatoformdisordersrefertoagroupofpsychiatricdisordersinwhichphysicalsymptoms

occurwithoutanunderlyingmedicalcause.Thesedisorderscanaffectpeopleofanyage,

includingchildrenandadolescents.Inthisarticle,wewilldiscusssomatoformdisordersin

childrenandadolescents,includingtheirsymptoms,causes,andtreatmentoptions.

SymptomsofSomatoformDisordersinChildrenandAdolescents

Thesymptomsofsomatoformdisordersinchildrenandadolescentscanvarygreatly,

dependingonthespecificdisorder.However,someofthemostcommonsymptomsinclude:

Physicalcomplaints:Childrenandadolescentswithsomatoformdisordersoftenhave

physicalcomplaintsthatcannotbeexplainedbyamedicalcondition.Thesecomplaintsmay

includeheadaches,stomachaches,ormusclepain.

Excessiveworryaboutphysicalhealth:Childrenandadolescentswithsomatoformdisorders

maybeoverlyconcernedabouttheirphysicalhealth,evenifthereisnoreasontobe

concerned.

Frequentvisitstodoctors:Childrenandadolescentswithsomatoformdisordersmayvisit

doctorsfrequently,seekingmedicalattentionfortheirphysicalcomplaints.

Schoolabsenteeism:Childrenandadolescentswithsomatoformdisordersmaymissschool

frequentlyduetotheirphysicalcomplaints.

Anxietyanddepression:Childrenandadolescentswithsomatoformdisordersmayalso

experienceanxietyanddepression,whichcanexacerbatetheirphysicalsymptoms.

TypesofSomatoformDisordersinChildrenandAdolescents

Thereareseveraltypesofsomatoformdisordersthatcanoccurinchildrenandadolescents.

Theseinclude:

Conversiondisorder:Conversiondisorderisaconditioninwhichachildoradolescent

experiencesphysicalsymptoms,suchasparalysisorblindness,thatcannotbeexplainedby

amedicalcondition.

Hypochondriasis:Hypochondriasisisaconditioninwhichachildoradolescentisoverly

concernedabouttheirhealth,despitetheabsenceofanymedicalcondition.

Somatizationdisorder:Somatizationdisorderisaconditioninwhichachildoradolescent

experiencesmultiplephysicalsymptomsthatcannotbeexplainedbyamedicalcondition.

Paindisorder:Paindisorderisaconditioninwhichachildoradolescentexperienceschronic

painthatcannotbeexplainedbyamedicalcondition.

CausesofSomatoformDisordersinChildrenandAdolescents

Theexactcausesofsomatoformdisordersinchildrenandadolescentsarenotwell

understood.However,thereareseveralfactorsthatmaycontributetothedevelopmentof

thesedisorders,including:

Genetics:Theremaybeageneticcomponenttosomatoformdisorders,astheytendtorun

infamilies.

Psychologicalfactors:Psychologicalfactors,suchasanxiety,depression,orahistoryof

trauma,maycontributetothedevelopmentofsomatoformdisorders.

Familydynamics:Childrenandadolescentswhogrowupinfamilieswherethereisahigh

levelofconflictorstressmaybemorelikelytodevelopsomatoformdisorders.

Culturalfactors:Insomecultures,physicalcomplaintsmaybemoreacceptablethan

emotionalcomplaints,leadingchildrenandadolescentstoexpresstheiremotionaldistress

throughphysicalsymptoms.

TreatmentofSomatoformDisordersinChildrenandAdolescents

Thetreatmentofsomatoformdisordersinchildrenandadolescentstypicallyinvolvesa

combinationofpsychotherapyandmedication.Someofthemosteffectivetreatments

include:

Cognitive-behavioraltherapy(CBT):CBTisaformofpsychotherapythatfocuseson

identifyingandchangingnegativethoughtpatternsandbehaviors.Itcanbeaneffective

treatmentforsomatoformdisordersinchildrenandadolescents.

Familytherapy:Familytherapycanbehelpfulforchildrenandadolescentswithsomatoform

disorders,asitcanaddressfamilydynamicsthatmaybecontributingtothechild's

symptoms.

Antidepressantmedication:Antidepressantmedicationmaybeprescribedtochildrenand

adolescentswithsomatoformdisorders,asthesemedicationscanhelptoreducesymptoms

ofanxietyanddepression.

Supportgroups:Supportgroupscanprovidechildren

Somatoformdisordersrefertoagroupofpsychologicaldisorderscharacterizedbyphysical

symptomsthatcannotbeattributedtoanyunderlyingmedicalconditionorsubstance

abuse.Instead,thesymptomsarebelievedtobecausedbypsychologicalfactors,suchas

stress,anxiety,ordepression.Somatoformdisordersarerelativelycommoninchildrenand

adolescentsandcanhaveasignificantimpactontheirphysicalandemotionalwell-being.

Thisarticlewillprovideanoverviewofsomatoformdisordersinchildrenandadolescents,

includingtheirsymptoms,causes,diagnosis,andtreatment.

TypesofSomatoformDisorders

Thereareseveraltypesofsomatoformdisordersthatcanoccurinchildrenandadolescents,

including:

Conversiondisorder:Thisdisorderischaracterizedbythepresenceofphysicalsymptoms,

suchasparalysis,blindness,orseizures,thatcannotbeexplainedbyamedicalcondition.

Thesymptomsoftenoccurafterastressfulevent,suchasatraumaticexperienceora

significantloss.

Hypochondriasis:Thisdisorderischaracterizedbyexcessiveworryabouthavingaserious

medicalcondition,despitehavingnoormildsymptoms.Childrenandadolescentswith

hypochondriasisoftenvisitdoctorsfrequentlyandmayundergounnecessarymedical

procedures.

Somatizationdisorder:Thisdisorderischaracterizedbythepresenceofmultiplephysical

symptomsthatcannotbeattributedtoanyunderlyingmedicalcondition.Thesymptoms

oftenincludepain,gastrointestinalproblems,andfatigueandcanbepersistentand

recurrent.

Paindisorder:Thisdisorderischaracterizedbypersistentpainthatcannotbeattributedto

anyunderlyingmedicalcondition.Thepainmaybelocalizedorwidespreadandcanhavea

significantimpactonthechild'sabilitytofunctionindailylife.

SymptomsofSomatoformDisorders

Thesymptomsofsomatoformdisorderscanvarydependingonthetypeofdisorderandthe

individualchildoradolescent.However,somecommonsymptomsmayinclude:

Physicalsymptomsthatcannotbeattributedtoanyunderlyingmedicalcondition

Persistentandrecurrentpain

Excessiveworryabouthavingaseriousmedicalcondition

Frequentdoctorvisitsandmedicalprocedures

Difficultyfunctioningindailylife

Anxiety,depression,orotherpsychologicalsymptoms

CausesofSomatoformDisorders

Theexactcausesofsomatoformdisordersinchildrenandadolescentsarenotwell

understood.However,severalfactorsmaycontributetotheirdevelopment,including:

Genetics:Somestudieshavesuggestedthattheremaybeageneticcomponentto

somatoformdisorders,astheytendtoruninfamilies.

Psychologicalfactors:Stress,anxiety,anddepressioncanallcontributetothedevelopment

ofsomatoformdisorders.Childrenandadolescentswhoexperiencetraumaorsignificant

lifechangesmaybemoresusceptibletodevelopingthesedisorders.

Environmentalfactors:Environmentalfactors,suchasexposuretotoxinsorinfectious

agents,mayalsoplayaroleinthedevelopmentofsomatoformdisorders.

DiagnosisofSomatoformDisorders

Thediagnosisofsomatoformdisordersinchildrenandadolescentscanbechallenging,as

thesymptomscanmimicthoseofothermedicalconditions.However,athoroughmedical

evaluationistypicallyperformedtoruleoutanyunderlyingmedicalconditions.Ifno

medicalconditionisfound,apsychologicalevaluationmaybeperformedtodetermineifthe

symptomsareduetoasomatoformdisorder.

TheDiagnosticandStatisticalManualofMentalDisorders,FifthEdition(DSM-5)provides

diagnosticcriteriaforsomaticsymptomdisorder,whichincludessomaticsymptomsthatare

distressingorsignificantlydisruptdailylife,andexcessivethoughts,feelings,andbehaviors

relatedtothesymptoms.

TreatmentofSomatoformDisorders

Thetreatmentofsomatoformdisordersinchildrenandadolescentstypicallyinvolvesa

combinationofpsychologicalandmedicalinterventions.Thespecifictreatmentapproach

willdependonthetypeandseverityofthedisorder,aswellastheindividualchildor

adolescent.

Psychologicaltreatmentsmayinclude:

Cognitive-behavioraltherapy(CBT):Thistypeoftherapyfocusesonchangingnegative

thoughtsandbehaviorsthatcontributetothedevelopment

Somatoformdisordersareagroupofpsychiatricconditionscharacterizedbythepresence

ofphysicalsymptomsthatcannotbefullyexplainedbyanyknownmedicalcondition.These

disordersoftenresultinsignificantimpairmentindailyfunctioningandqualityoflife,aswell

assubstantialhealthcareutilizationandcosts.Somatoformdisorderscanoccurinchildren

andadolescents,andcanpresentuniquechallengesintermsofdiagnosisandmanagement.

Somatoformdisordersinchildrenandadolescentsarerelativelycommon,withestimated

prevalenceratesrangingfrom0.2%to2.0%.Thesedisordersaremorecommonlydiagnosed

ingirlsthanboys,withafemale-to-maleratioofapproximately2:1.Theonsetof

somatoformdisordersinchildrenandadolescentstypicallyoccursduringearlyadolescence,

althoughtheycanoccuratanyage.

Thereareseveraltypesofsomatoformdisordersthatcanoccurinchildrenandadolescents.

Theseinclude:

Somatizationdisorder:Thisdisorderischaracterizedbythepresenceofmultiple,recurrent,

andmedicallyunexplainedphysicalsymptoms.Thesesymptomsmusthavebeenpresentfor

atleast2years,andmusthavecausedsignificantimpairmentindailyfunctioning.

Conversiondisorder:Thisdisorderischaracterizedbythepresenceofneurological

symptomsthatcannotbefullyexplainedbyanyknownmedicalcondition.Thesesymptoms

mayincludeweakness,paralysis,tremors,orseizures.Thesymptomsmustbesignificant

enoughtocauseimpairmentindailyfunctioning,andmustnotbeintentionallyproducedor

feigned.

Hypochondriasis:Thisdisorderischaracterizedbythepersistentbeliefthatonehasa

seriousmedicalcondition,despitemedicalreassurancetothecontrary.Thisbeliefisnot

basedonanyobjectiveevidence,andcanresultinsignificantdistressandimpairmentin

dailyfunctioning.

Paindisorder:Thisdisorderischaracterizedbythepresenceofchronicpainthatcannotbe

fullyexplainedbyanyknownmedicalcondition.Thepainmusthavebeenpresentforat

least6months,andmusthavecausedsignificantimpairmentindailyfunctioning.

Bodydysmorphicdisorder:Thisdisorderischaracterizedbythepreoccupationwitha

perceiveddefectorflawinone'sphysicalappearance.Thispreoccupationmustcause

significantdistressandimpairmentindailyfunctioning.

Diagnosingsomatoformdisordersinchildrenandadolescentscanbechallenging,asthese

disorderscanmimicawiderangeofmedicalconditions.Medicalevaluationistypicallythe

firststepindiagnosis,asitisimportanttoruleoutanyunderlyingmedicalconditionsthat

maybecausingthephysicalsymptoms.Oncemedicalcauseshavebeenruledout,a

thoroughpsychiatricevaluationisnecessarytoassessforthepresenceofasomatoform

disorder.

Inadditiontomedicalandpsychiatricevaluations,acomprehensiveassessmentofthechild

oradolescent'spsychosocialfunctioningisnecessary.Thismayincludeassessmentsof

familydynamics,schoolfunctioning,andoverallsocialsupport.Understandingthechildor

adolescent'spsychosocialfunctioningisimportantindeterminingappropriatetreatment

interventions.

Treatmentforsomatoformdisordersinchildrenandadolescentstypicallyinvolvesa

combinationofpsychologicalandpharmacologicalinterventions.Cognitive-behavioral

therapy(CBT)isoftenthefirst-linepsychologicaltreatment,andhasbeenshowntobe

effectiveinreducingphysicalsymptomsandimprovingdailyfunctioning.CBTfocuseson

identifyingandchangingmaladaptivethoughtpatternsandbehaviorsthatmaybe

contributingtothephysicalsymptoms.

Pharmacologicalinterventionsmayalsobenecessary,particularlyforthetreatmentof

comorbidpsychiatricconditionssuchasanxietyordepression.Antidepressantmedications,

inparticular,havebeenshowntobeeffectiveinreducingphysicalsymptomsinsomatoform

disorders.

Inadditiontothesetraditionaltreatmentmodalities,alternativeandcomplementary

therapiesmayalsobehelpfulinthetreatmentofsomatoformdisordersinchildrenand

adolescents.Thesemayincludeyoga,meditation,acupuncture,andmassagetherapy.

However,itisimportanttonotethatthesetherapiesshouldnotbeusedasasubstitutefor

evidence-basedpsychologicalandpharmacologicaltreatments.

Inconclusion,

Somatoformdisordersareagroupofmentalhealthconditionsthatarecharacterizedby

physicalsymptomsthatcannotbeexplainedbyanymedicalconditionorotherunderlying

physiologicalcause.Instead,thesymptomsarebelievedtobetheresultofpsychological

factors,suchasstress,anxiety,ortrauma.Somatoformdisorderscanaffectpeopleofall

ages,buttheyareparticularlycommoninchildrenandadolescents.

Somatoformdisordersinchildrenandadolescentsarechallengingtodiagnoseandtreat,

andtheycanhaveasignificantimpactonachild'sphysicalandemotionalwell-being.This

articlewillexploresomatoformdisordersinchildrenandadolescents,includingtheir

symptoms,causes,diagnosis,andtreatmentoptions.

SymptomsofSomatoformDisordersinChildrenandAdolescents

Thesymptomsofsomatoformdisordersinchildrenandadolescentscanvarywidely,

dependingonthespecificdisorderandtheindividualchild.However,somecommon

symptomsinclude:

Physicalcomplaints:Childrenandadolescentswithsomatoformdisordersoftenreporta

widerangeofphysicalsymptoms,suchasheadaches,stomachaches,fatigue,andmuscle

aches.Thesesymptomsareoftenchronicanddonotrespondtomedicaltreatment.

Excessiveworryaboutphysicalhealth:Childrenandadolescentswithsomatoformdisorders

maybecomepreoccupiedwiththeirphysicalhealth,oftenobsessingoverminorsymptoms

andfearingthattheyhaveaseriousillness.

Absencesfromschoolorotheractivities:Childrenandadolescentswithsomatoform

disordersmaymissschoolorotheractivitiesduetotheirphysicalsymptoms.Theymayalso

avoidactivitiesthattheyfearcouldcausethemharm.

Anxietyanddepression:Childrenandadolescentswithsomatoformdisordersmay

experienceanxietyanddepressionasaresultoftheirphysicalsymptomsandtheimpact

thattheyhaveontheirdailylives.

Avoidanceofmedicalcare:Somechildrenandadolescentswithsomatoformdisordersmay

avoidmedicalcare,fearingthattheywillbediagnosedwithaseriousillnessorthatmedical

procedureswillcausethemharm.

CausesofSomatoformDisordersinChildrenandAdolescents

Theexactcausesofsomatoformdisordersinchildrenandadolescentsarenotfully

understood.However,thereareseveralfactorsthatarebelievedtocontributetothe

developmentoftheseconditions,including:

Genetics:Thereisevidencetosuggestthatsomatoformdisordersmayruninfamilies,

indicatingthatgeneticsmayplayaroleintheirdevelopment.

Environmentalfactors:Childrenandadolescentswhoexperiencehighlevelsofstressor

traumamaybemorelikelytodevelopsomatoformdisorders.

Learnedbehaviors:Childrenandadolescentsmaylearntoexpresstheiremotionsthrough

physicalsymptoms,particularlyiftheyarenotencouragedtoexpresstheirfeelingsverbally.

Attention-seekingbehaviors:Somechildrenandadolescentsmayusephysicalsymptomsas

awaytogainattentionfromothers.

Culturalfactors:Someculturesmayviewphysicalsymptomsasamoreacceptablewayof

expressingemotionaldistress,whichcouldcontributetothedevelopmentofsomatoform

disorders.

DiagnosisofSomatoformDisordersinChildrenandAdolescents

Diagnosingsomatoformdisordersinchildrenandadolescentscanbechallenging,asthe

symptomscanbedifficulttodistinguishfromthoseofamedicalcondition.Inordertomake

adiagnosis,healthcareprofessionalswilltypicallyconductathoroughphysicalexamination

andmedicalhistory,lookingforanysignsofanunderlyingmedicalcondition.

Ifnomedicalconditionisfound,thehealthcareprofessionalmayreferthechildor

adolescenttoamentalhealthspecialist,whocanconductapsychologicalevaluation.This

evaluationwilltypicallyinvolveadetailedassessmentofthechild'ssymptoms,aswellas

theiremotionalandsocialfunctioning.Thespecialistmayalsousestandardized

psychologicalteststoassessthechild'scognitiveandemotionaldevelopment.

Insomecases,thespecialistmayalsoconductafamilyassessment,lookingforanyfactors

thatmaybecontributingtothechild'ssymptoms.Thisassessmentmayinvolveinterviewing

familymembers,observingfamilyinteractions,andreviewingfamilyhistory.

Management of Somatic Disorder

    The fact is that it is hard to identify somatization disorder to deliver ultimate help to

families and patients. But wait, this shouldn’t be a problem as awareness, and successful

communication of the disorder is being conducted globally to create a conducive environment

for the infected and affected. Conversely, families that are reluctant to accept the explanation

should be given quality assurance with pediatricians on their availability to help at a time of

diagnosis. Those patients who reject the diagnosis of somatization disorder are given close

attention and explanation. Essentially, pediatricians should acknowledge that the pain felt by

patients is real upon diagnosis. Finally, to help families and patients to become more open to

somatization disorder, pediatricians should recognize the link between bodily processes and

emotions.

                               References

Fritz, G. K., Fritsch, S., & Hagino, O. (1997). Somatoform disorders in children and

adolescents: a review of the past 10 years.Journal of the American Academy of Child &

Adolescent Psychiatry,36(10), 1329-1338.

Pehlivantürk, B., & Unal, F. (2002). Conversion disorder in children and adolescents: a 4-

year follow-up study.Journal of psychosomatic research,52(4), 187-191.

Campo, J. V., & Fritsch, S. L. (1994). Somatization in children and adolescents.Journal of

the American Academy of Child & Adolescent Psychiatry,33(9), 1223-1235.

Schulte, I. E., & Petermann, F. (2011). Somatoform disorders: 30 years of debate about

criteria!: What about children and adolescents?.Journal of psychosomatic research,70(3),

218-228.

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