Somatic Symptom Disorder in Children & Adolescents

Overview

What is a somatic symptom disorder?

Physical symptoms are very common in children, with as many as 10 percent of children reporting a pain or worry per day. When these physical symptoms are not able to be confirmed by medical testing, nor have a medical explanation due to illness or disease, it may be due to a somatic symptom disorder.

A somatic symptom disorder is when emotional distress is felt as physical distress. These symptoms are biological in nature and are not voluntary or “fake.” Your child may feel extremely distressed about his or her health symptoms and it may be interfering with daily life such as missing school, not wanting to be with peers, or avoiding typically enjoyed activities.

How common are somatic symptom disorders?

Somatic symptom disorder ranges from 5 to 7 percent in the general population (adults and children), which makes it one of the most commonly reported disorders in the primary care setting.

Who is affected by somatic symptom disorders?

Females are ten times more likely to be diagnosed with somatic disorders than males.

Symptoms and Causes

What causes a somatic symptom disorder?

Researchers believe there are biological and psychosocial factors (learned ways of thinking in the context of a person’s social environment) involved in the development of somatic symptom disorder, which may include:

  • Continuing, unresolved symptoms after an illness or injury
  • Stress or struggles that a child has not been able to communicate verbally
  • Indications/signs of emotional distress including excessive attention to bodily processes and possible signs of illness; low pain threshold; increased anxiety about good health

What are the symptoms of a somatic symptom disorder?

Somatic symptom disorder symptoms include:

  • Pain. This is the most commonly reported symptom. Areas of reported pain can include head, chest, arms, legs, joints, back, abdomen and other areas.
  • Feeling tired/low energy level
  • Stomach ache, nausea, vomiting
  • Shortness of breath, trouble breathing
  • Rapid heart beat
  • Dizziness
  • Fainting
  • Bowel problems (diarrhea, constipation, bloating, gas)
  • Movement disorders, weakness, paralysis, seizure-like episodes, memory problems

Usually, patients report experiencing more than one symptom. Symptoms can range from mild to severe. In the adult literature, approximately 30 to 60 percent of patients with somatic symptom disorder also have anxiety and/or depression.

Diagnosis and Tests

How is a somatic symptom disorder diagnosed?

Your child will likely be seen by a multidisciplinary team consisting of various professionals, including: primary care provider, pediatric subspecialist (neurology, gastroenterology, etc.), and psychiatry/psychology.

The evaluation typically includes:

  • A physical exam with any medical tests (lab work, imaging)
  • Meeting with psychiatry/psychology to assess emotional, physical, and behavioral functioning.

Management and Treatment

How is a somatic symptom disorder treated?

The goal of treating a somatic symptom disorder is to manage symptoms using both behavioral therapy and sometimes psychopharmacology. Cognitive behavioral therapy (CBT) is a type of psychotherapy (talk therapy) that helps children learn ways to change their patterns of thinking or behavior in order to change the way they feel. CBT helps children better cope with situations, and anxiety and stress, and respond to situations more effectively.

Outlook / Prognosis

What is the outlook for patients who have somatic symptom disorder?

With CBT treatment, children with a somatic symptom disorder have a good prognosis. Somatic symptom disorder is not a disease and does not have to be a life-long disorder. The primary goal of treatment is for your child to return to typical functioning, including attending school and engaging in typically enjoyed activities.

Last reviewed by a Cleveland Clinic medical professional on 10/02/2018.

References

  • American Academy of Child & Adolescent Psychiatry. Accessed 10/2/2018.Physical Symptoms of Emotional Distress: Somatic Symptoms and Related Disorders. (https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Physical_Symptoms_of_Emotional_Distress-Somatic_Symptoms_and_Related_Disorders.aspx)
  • American Psychiatric Association DSM Library. Accessed 10/2/18.Somatic Symptom and Related Disorders. (https://doi.org/10.1176/appi.books.9780890425596.dsm09)
  • American Academy of Family Physicians. Accessed 10/2/18.Somatic Symptom Disorder. (https://www.aafp.org/afp/2016/0101/p49.html)
  • Merck Manual Professional Version. Accessed 10/2/18.Somatic symptom disorder. (https://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/somatic-symptom-disorder)
  • American Psychiatric Association. Accessed 10/2/18.Somatic Symptom Disorder. (https://www.psychiatry.org/patients-families/somatic-symptom-disorder/what-is-somatic-symptom-disorder)

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