Pediatric Somatic Symptom Disorder

What is somatic symptom disorder?

Somatic symptom disorder is a condition that occurs when your child feels emotional distress as physical distress. Several things can contribute to somatization, including sleep patterns, nutritional intake, stress, anxiety, hydration and others. Symptoms may worsen due to excessive worry or negative thoughts and behaviors related to their physical symptoms.

Physical symptoms are very common in children, with as many as 10% of children reporting pain or worry per day. These symptoms are biological and aren’t voluntary or “fake.” Your child may feel extremely distressed about their symptoms and it may interfere with their daily activities and prevent them from going to school or spending time with their peers.

Is somatic symptom disorder the same as illness anxiety disorder?

No. Somatic symptom disorder is different from hypochondria and illness anxiety disorder.

Somatic symptom disorder is emotional distress that causes a child to feel physical symptoms like pain. Medical testing can’t confirm or explain these symptoms in your child but they aren’t fake symptoms. A diagnosis is made by a doctor based on patterns of symptoms.

Illness anxiety disorder causes your child to have a fear that they have or are at a high risk of getting a serious medical condition. Children misinterpret normal body functions as signs of an illness. Children with illness anxiety disorder can be care-seeking, where they want to spend a lot of time in a healthcare setting, or are care-avoidant, where they don’t trust doctors or healthcare providers.

Who does somatic symptom disorder affect?

Somatic symptom disorder can affect any child. It’s most common among children assigned female at birth (AFAB) versus children assigned male at birth (AMAB). Somatic symptom disorder has a higher occurrence among people also diagnosed with:

• Fibromyalgia.
• Irritable bowel syndrome.
• Chronic fatigue.

How common is somatic symptom disorder?

Somatic symptom disorder affects an estimated 5% to 7% of the United States population, which includes both children and adults. It’s one of the most common conditions reported in a primary care setting.

What are the symptoms of somatic symptom disorder?

Symptoms of somatic symptom disorder vary for each child and could include:

• Pain.
• Feeling tired or having a low energy level.
• Stomach ache, nausea or vomiting.
• Shortness of breath or trouble breathing.
• Rapid heartbeat.
• Dizziness.
• Fainting.
• Bowel problems (diarrhea, constipation, bloating, gas).
• Movement challenges like weakness, paralysis, seizure-like episodes.
• Memory problems.

Usually, children experience more than one symptom. Symptoms can range from mild to severe. Approximately 30% to 60% of people (both children and adults) with somatic symptom disorder also have anxiety and/or depression.

Where will my child experience symptoms of somatic symptom disorder?

Symptoms of somatic symptom disorder can affect any part of your child’s body. The most common symptom is pain. Healthcare providers report that the most common locations on the body where your child might experience pain could include their:

• Head.
• Chest.
• Arms.
• Legs.
• Joints.
• Back.
• Abdomen.

What causes somatic symptom disorder?

Biological and psychosocial factors, which are learned ways of thinking in the context of a person’s environment, contribute to the cause of somatic symptom disorder. These factors may include:

• Continuing, unresolved symptoms after an illness or an injury.
• Stress or challenges that a child hasn’t been able to communicate verbally.
• Excessive attention to bodily functions.
• Possible signs of an illness.
• Low pain threshold.
• Increased anxiety about good health.

How is somatic symptom disorder diagnosed?

It may take a team of different healthcare providers to diagnose somatic symptom disorder in your child. The diagnostic process may include:

• A physical exam to learn more about your child’s symptoms.
• A complete medical history.
• Laboratory tests like a blood or urine test or imaging tests like an X-ray.
• Meeting with mental health specialists to assess emotional, physical and behavioral health.

What types of somatic symptom disorders are there?

1. Functional gastrointestinal disorder.
2. Functional neurological disorder.
3. Somatic symptom and related disorder.
4. Functional cardiac disorder.

Who diagnoses somatic symptom disorder?

A somatic symptom disorder diagnosis might require a coordinated team of healthcare providers. These providers could include:

• A primary care provider.
• A pediatrician.
• A neurologist.
• A gastroenterologist.
• A cardiologist.
• A psychiatrist or a psychologist.

How is somatic symptom disorder treated?

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

Your child’s providers will focus on treating anxiety and negative patterns of thinking rather than invasive treatment methods like surgery or prescribing high doses of pain medication.

How soon after treatment will my child feel better?

Most children, with parental support of the diagnosis and treatment plan, can resolve symptoms. Somatic symptom disorder isn’t a disease and isn’t lifelong with appropriate treatment. Your child’s healthcare team will work together to help them cope with their anxieties to reduce the amount of physical discomfort they feel over time.

How can I prevent somatic symptom disorder?

If your child begins to show signs of anxiety or depression that affect their way of life and their ability to thrive, meet with their healthcare provider and/or a mental health professional. Your child’s symptoms won’t go away immediately. Stick with your child’s treatment plan and regularly visit their healthcare providers to monitor their treatment progress. While they may go through periods where they don’t show improvement of symptoms, patience and consistency of treatment are key to their success in preventing the condition from continuing.

What can I expect if I have somatic symptom disorder?

With CBT treatment, children with a somatic symptom disorder have a good outlook (prognosis). Somatic symptom disorder isn’t necessarily a chronic condition, but treatment is available to help your child manage their emotional distress related to their physical health. The primary goal of treatment is for your child to return to typical functioning, including attending school and engaging in typically enjoyed activities.

When should I see my healthcare provider?

Visit your child’s healthcare provider if they show signs of suicidal behaviors that can relate to depression and anxiety. Warning signs could include:

• Sudden changes to their mood or personality.
• Withdrawing from social situations.
• Self-injury.
• Feeling helpless.
• Talking about wanting to die.

These signs are serious and should not be ignored. Immediately contact your child’s healthcare provider if these signs are present.

What questions should I ask my child’s doctor?

• How do I support my child?
• Are there side effects to the medication you prescribed?
• How often should I schedule follow-up appointments?
• When will my child will feel better?
• How do I support my child’s functioning when they are ill?
• How can I help keep my child engaged in school and activities?

A note from Cleveland Clinic

It’s normal to worry about your health, but if your child’s anxiety affects their ability to enjoy their childhood, speak with your provider for an evaluation. Your child’s healthcare provider will work with you to help you manage and treat their diagnosis. Be there for your child if they’re struggling to adapt their new coping skills. Your encouragement and support let your child know they’re safe and dealing with their anxiety in a positive way.