Somatoform Disorder in Children and Teenagers

Somatization is the occurrence of one or more physical complaints for which appropriate medical evaluation reveals no explanatory physical pathology or pathophysiologic mechanism. In somatoform disorder (also known as somatic symptom disorder), children/teenagers have an exceptionally intense response to physical symptoms they have, think excessively about the symptoms, overuse medical care, and allow health concerns to become the focus of their life (Merck Manual, 2019). Whilst somatic symptom disorders (SSD) are equally common among young boys and girls, in adolescence, it is more common in teenage girls than boys.

There are several types of disorders that fall under the somatic symptom and related disorders umbrella:

  • Body dysmorphic disorder
  • Conversion disorder
  • Pain disorder
  • Illness anxiety disorder (hypochondriasis)
  • Somatoform disorder not otherwise specified
  • Undifferentiated somatoform disorder
  • Somatic symptom disorder

Somatic Symptom Disorder

In SSD, the headaches, fatigue and stomach aches a child/teen commonly experience in everyday life become a source of great distress and anxiety. The child/teen spends a disproportionate amount of time and energy worrying that he/she has a serious or life-threatening illness e.g. a headache is really a brain tumour; a bruised knee is really haemophilia. The child/teen many have many symptoms or one specific symptom, typically pain. The pain may be specific such as abdominal or vague e.g. pain all over.

It is important to note that these symptoms are not imaginary, but the intense worry and anxiety generated by actual physical symptoms that are in reality quite mild and inconsequential are misinterpreted by the child. SSD symptoms are commonly triggered by mental health issues such as trauma, conflict or other stressors.

Common Symptoms of SSD:

  • Headaches
  • Nausea
  • Fatigue
  • Abdominal pain
  • Pain

When a child/teenager has SSD, he/she may either refuse to go to a physician/hospital because of fear of being told that the illness is severe or life threatening or frequently visits the doctor, school nurse, ER Department. Sadly, living with SSD can severely impact the child/teens home life, performance in school, friendships, and social development. Imagine what it must be like believing you are seriously ill and may die, and everyone tells you that there is nothing wrong.

SSD Risk Factors

  • Genetic factors
  • Stress (traumatic event, stressful life event, ACEs)
  • Adversity
  • Pre-existing medical condition, mental/neurodegenerative disorder e.g. ADHD, depression, anxiety disorder, eating disorders, learning disability
  • Recent illness/injury e.g. car accident, flu virus.
  • Internalizes emotions and feelings

Diagnosis

Diagnosis of SSD is very challenging and may include a physical assessment, review of medical history, psychological evaluation, and review of multiple test results (which are negative). To assist the physician, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) lists three criteria that help confirm the diagnosis of somatic symptom disorder:

  • One or more somatic symptoms that cause problems in daily life
  • Excessive and persistent thoughts about the seriousness of the symptoms and a persistently high level of anxiety about the symptoms OR constant preoccupation with symptoms/health concerns which impact day to day life
  • Symptoms continue for more that six months

Treatment of SSD

  • Individual psychotherapy e.g. CBT (cognitive behavioural therapy) has been found to be very effective
  • Exercise and breathing techniques
  • Talk therapy
  • Relaxation therapy
  • Family therapy
  • Medications such as antidepressants (SSRIs) may be helpful to relieve symptoms of extreme anxiety and/or depression

CBT helps the child/teen identify the thoughts that fuel intense reactions. The goal is to stop the behaviors that worsen the fear e.g. learn that his/her thoughts are just thoughts and not proof of any physical illness. If CBT is successful, the child/teen may then undergo ERPT (exposure and response prevention therapy) which exposes him/her to the fearful thoughts and stressors in a safe environment. Over time, this therapy aims to gradually diminish the thoughts ‘power’ until the child/teen feels in control and no longer reacts to symptoms

How Can Parent(s) Help?

  • Be patient, supportive and understanding, do not criticize or belittle, your child is not lying or faking the symptoms and truly believes he/she is very ill
  • Encourage your child/teen to talk about his/her feelings, thoughts, how he/she feels
  • Acknowledge the symptoms are real and are directly impacting your child/teen’s behaviour, daily life, schoolwork, etc.
  • Enlist help of all family and adopt stress management and relaxation techniques daily
  • Work with child/teenager to understand what makes symptoms better/worse
  • Talk with school e.g. develop an IEP or school-based symptom management plan
  • Spend one on one time with child/teen, enjoy fun activity, listen to concerns, be kind, be there, show love
  • Ensure medications are taken, appointments and therapy sessions are attended
  • As a family, implement and follow through with counselling management strategies and care plan
  • Celebrate small successes
  • Spend time together as a family, do fun things
  • Maintain daily routine e.g. bedtime, healthy diet, chores, exercise, socialization, return to school
  • Encourage child/teen to express feelings and emotions in art, drawing, poetry, music, journaling
  • With assistance of medical team and child/teen develop a somatic symptom action plan
  • If physical symptoms make an activity difficult, encourage your child/teen to use ‘graded activity’ to return to routine. Consider enlisting help of physiotherapist, occupational therapist. NB it may take months before child/teen is back to full activity
  • Ensure time for self and self care
  • Consider joining support group, individual therapy
  • Breathe….it will get better

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