Abstract
Functional somatic symptoms (FSS), defined as physical symptoms of unknown pathology, are common among children and adolescents and are often associated with high levels of functional impairment. Self-discrepancy theory (SDT) suggests that discrepancies between one’s ideal, ought, or undesired self-states and one’s actual self-representation may lead to emotional distress. Among families with dysfunctional patterns, such emotional distress may result in FSS. The current study examined the relationship between familial patterns and children’s levels of self-discrepancies, among children with and without FSS. Twenty-three children diagnosed with FSS and 23 children with orthopedic problems (non-FSS) and their mothers participated in the study. Mothers and children completed the Child Somatization Inventory and the Integrated Self-Discrepancies Index. Mothers also completed the general scale of the Family Assessment Device. Higher levels of symptom intensity were found in the FSS group than in the non-FSS group. Dysfunctional familial patterns were significantly higher in the FSS group, and higher levels of discrepancies were reported in the FSS group, compared with the non-FSS group. No significant relationship was found in the FSS group between level of self-state discrepancies and level of family functioning. Higher levels of dysfunctional patterns are observed among families of children with FSS. Furthermore, children with FSS and their mothers hold relatively high levels of self-state discrepancies. However, these elevated discrepancies are not significantly related to familial dysfunctional patterns. Viewing self-state discrepancies together with family maladaptive patterns might help address both inter- and intrapersonal conflicts within the family and reduce children’s symptoms.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Achenbach, T. M., & Edelbrock, C. S. (1983). Manual for the child behavior checklist and revised child behavior profile. Burlington, VT: Department of Psychiatry, University of Vermont.
Akister, J., & Stevenson-Hinde, J. (1991). Identifying families at risk: Exploring the potential of the McMaster Family Assessment Device. Journal of Family Therapy, 13, 411–421. https://doi.org/10.1046/j.1991.00437.x.
Al-Krenawi, A., Graham, J. R., & Kanat-Maymon, Y. (2009). Analysis of trauma exposure, symptomatology and functioning in Jewish Israeli and Palestinian adolescents. The British Journal of Psychiatry, 195, 427–432. https://doi.org/10.1192/bjp.bp.108.050393.
Alderfer, M. A., Fiese, B. H., Gold, J. I., Cutuli, J., Holmbeck, G. N., Goldbeck, L., & Patterson, J. (2008). Evidence-based assessment in pediatric psychology: Family measures. Journal of Pediatric Psychology, 33, 1046–1061. https://doi.org/10.1093/jpepsy/jsm083.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Washington, DC: Author.
Ani, C., Reading, R., Lynn, R., Forlee, S., & Garralda, E. (2013). Incidence and 12-month outcome of non-transient childhood conversion disorder in the U.K. and Ireland. The British Journal of Psychiatry, 202, 413–418. https://doi.org/10.1192/bjp.bp.112.116707.
Aronson, E. (1969). The theory of cognitive dissonance: A current perspective. Advances in Experimental Social Psychology, 4, 1–34. https://doi.org/10.1016/S0065-2601(08)60075-1.
Beck, J. E. (2008). A developmental perspective on functional somatic symptoms. Journal of Pediatric Psychology, 33, 547–562. https://doi.org/10.1093/jpepsy/jsm113.
Bellak, L., & Abrams, D. M. (1997). The thematic apperception test, the children’s apperception test, and the senior apperception technique in clinical use. Boston, MA: Allyn and Bacon.
Bihun, J. T., Wamboldt, M. Z., Gavin, L. A., & Wamboldt, F. S. (2002). Can the family assessment device (FAD) be used with school aged children?. Family Process, 41, 723–731. https://doi.org/10.1111/j.1545-5300.2002.00723.x.
Bronfenbrenner, U. (1979). Contexts of child rearing: Problems and prospects. American Psychologist, 34, 844–850. https://doi.org/10.1037/0003-066X.34.10.844.
Brown, R. J. (2004). Psychological mechanisms of medically unexplained symptoms: An integrative conceptual model. Psychological Bulletin, 130, 793–812. https://doi.org/10.1037/0033-2909.130.5.793.
Campo, J. V. (2012). Annual research review: Functional somatic symptoms and associated anxiety and depression—Developmental psychopathology in pediatric practice. Journal of Child Psychology and Psychiatry, 53, 575–592. https://doi.org/10.1111/j.1469-7610.2012.02535.x.
Campo, J. V., & Fritz, G. (2001). A management model for pediatric somatization. Psychosomatics, 42, 467–476. https://doi.org/10.1176/appi.psy.42.6.467.
Cramer, P., & Gaul, R. (1988). The effects of success and failure on children’s use of defense mechanisms. Journal of Personality, 56, 729–742. https://doi.org/10.1111/j.1467-6494.1988.tb00474.x.
Cruz, C., Chudleigh, C., Savage, B., & Kozlowska, K. (2014). Therapeutic use of fact sheets in family therapy with children and adolescents with functional somatic symptoms. Australian and New Zealand Journal of Family Therapy, 35, 223–243. https://doi.org/10.1002/anzf.1059.
Duval, S., & Wicklund, R. A. (1972). A theory of objective self awareness. New York, NY: Academic Press.
Dweck, C. S. (2000). Self-theories: Their role in motivation, personality, and development. Philadelphia, PA: Psychology Press.
Essau, C. A., Olaya, B., Bokszczanin, A., Gilvarry, C., & Bray, D. (2013). Somatic symptoms among children and adolescents in Poland: A confirmatory factor analytic study of the Children Somatization Inventory. Frontiers in Public Health, 1, 72. https://doi.org/10.3389/fpubh.2013.00072.
Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster family assessment device. Journal of Marital and Family Therapy, 9, 171–180. https://doi.org/10.1111/j.1752-0606.1983.tb01497.x.
Garralda, M. E. (1996). Somatisation in children. Journal of Child Psychology and Psychiatry, 37, 13–33. https://doi.org/10.1111/j.1469-7610.1996.tb01378.x.
Hardin, E. E., & Lakin, J. L. (2009). The integrated self-discrepancy index: A reliable and valid measure of self-discrepancies. Journal of Personality Assessment, 91, 245–253. https://doi.org/10.1080/00223890902794291.
Haug, T. T., Mykletun, A., & Dahl, A. A. (2004). The association between anxiety, depression, and somatic symptoms in a large population: The HUNT-II study. Psychosomatic Medicine, 66, 845–851. https://doi.org/10.1097/01.psy.0000145823.85658.0c.
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456–470. https://doi.org/10.1037/0022-3514.60.3.456.
Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94, 319–340. https://doi.org/10.1037/0033-295X.94.3.319.
Higgins, E. T., Klein, R., & Strauman, T. (1985). Self-concept discrepancy theory: A psychological model for distinguishing among different aspects of depression and anxiety. Social Cognition, 3, 51–76. https://doi.org/10.1521/soco.1985.3.1.51.
Holahan, C. J., & Moos, R. H. (1981). Social support and psychological distress: A longitudinal analysis. Journal of Abnormal Psychology, 90, 365–370. https://doi.org/10.1037/0021-843X.90.4.365.
Kabacoff, R. I., Miller, I. W., Bishop, D. S., Epstein, N. B., & Keitner, G. I. (1990). A psychometric study of the McMaster Family Assessment Device in psychiatric, medical, and nonclinical samples. Journal of Family Psychology, 3, 431–439. https://doi.org/10.1037/h0080547.
Keitner, G. I., Heru, A. M., & Glick, I. D. (2009). Clinical manual of couples and family therapy. Washington, DC: American Psychiatric Publishing.
Kozlowska, K. (2007). Intergenerational processes, attachment and unexplained medical symptoms. Australian and New Zealand Journal of Family Therapy, 28(2), 88–99. https://doi.org/10.1375/anft.28.2.88.
Kozlowska, K. (2009). Attachment relationships shape pain-signaling behavior. The Journal of Pain, 10, 1020–1028. https://doi.org/10.1016/j.jpain.2009.03.014.
Kozlowska, K. (2016). The body comes to family therapy: Utilising research to formulate treatment interventions with somatising children and their families. Australian and New Zealand Journal of Family Therapy, 37, 6–https://doi.org/10.1002/anzf.1133.
Kozlowska, K., English, M., & Savage, B. (2013). Connecting body and mind: The first interview with somatising patients and their families. Clinical Child Psychology and Psychiatry, 18, 224–245. https://doi.org/10.1177/1359104512447314.
Lewandowski, A. S., Palermo, T. M., Stinson, J., Handley, S., & Chambers, C. T. (2010). Systematic review of family functioning in families of children and adolescents with chronic pain. The Journal of Pain, 11, 1027–1038. https://doi.org/10.1016/j.jpain.2010.04.005.
Miller, I. W., Ryan, C. E., Keitner, G. I., Bishop, D. S., & Epstein, N. B. (2000). The McMaster approach to families: Theory, assessment, treatment and research. Journal of Family Therapy, 22, 168–189. https://doi.org/10.1111/1467-6427.00145.
Miller, R. B., Anderson, S., & Keals, D. K. (2004). Is Bowen theory valid? A review of basic research. Journal of Marital and Family Therapy, 30, 453–466. https://doi.org/10.1111/j.1752-0606.2004.tb01255.x.
Minuchin, S., Baker, L., Rosman, B. L., Liebman, R., Milman, L., & Todd, T. C. (1975). A conceptual model of psychosomatic illness in children: Family organization and family therapy. Archives of General Psychiatry, 32, 1031–1038. https://doi.org/10.1001/archpsyc.1975.01760260095008.
Minuchin, S., Rosman, B. L., Baker, L., & Minuchin, S. (2009). Psychosomatic families: Anorexia nervosa in context. Cambridge, MA: Harvard University Press.
Miranda, M. C., Affuso, G., Esposito, C., & Bacchini, D. (2016). Parental acceptance–rejection and adolescent maladjustment: mothers’ and fathers’ combined roles. Journal of Child and Family Studies, 25, 1352–1362. https://doi.org/10.1007/s10826-015-0305-5.
Naz, F. (2012). Parental rejection and comorbid disorders in adolescents with somatization disorder. Journal of Behavioural Sciences, 22(1), 125–142.
Ogilvie, D. M. (1987). The undesired self: A neglected variable in personality research. Journal of Personality and Social Psychology, 52, 379–385. https://doi.org/10.1037/0022-3514.52.2.379.
Palermo, T. M., & Chambers, C. T. (2005). Parent and family factors in pediatric chronic pain and disability: An integrative approach. Pain, 119(1–3), 1–4. https://doi.org/10.1016/j.pain.2005.10.027.
Palermo, T. M., Valrie, C. R., & Karlson, C. W. (2014). Family and parent influences on pediatric chronic pain: A developmental perspective. American Psychologist, 69, 142–152. https://doi.org/10.1037/a0035216.
Rickles, W. H. (1986). Self psychology and somatization: An integration with alexithymia. Progress in Self Psychology, 2, 212–226.
Rohner, R. P. (2004). The parental “acceptance–rejection syndrome”: Universal correlates of perceived rejection. American Psychologist, 59, 827–840. https://doi.org/10.1037/0003-066X.59.8.830.
Silberg, T., Brezner, A., Gilad, G., Ahonniska-Assa, J., & Levav, M. (2016). The role of maternal distress on the report of behavioral and emotional problems among children with chronic disabilities. Israel Journal of Psychiatry and Related Sciences, 53, 17–24.
Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York, NY: Norton.
Turner, R. H. (1956). Role-taking, role standpoint, and reference-group behavior. American Journal of Sociology, 61, 316–328. https://doi.org/10.1086/221763.
Van, As,N., & Janssens, J. (2002). Relationships between child behavior problems and family functioning: A literature review. International Journal of Child and Family Welfare, 5(1/2), 40–51.
Vetere, A. (2001). Structural family therapy. Child and Adolescent Mental Health, 6, 133–139. https://doi.org/10.1111/1475-3588.00336.
Walker, L. S., Beck, J. E., Garber, J., & Lambert, W. (2009). Children’s somatization inventory: Psychometric properties of the revised form (CSI-24). Journal of Pediatric Psychology, 34, 430–440. https://doi.org/10.1093/jpepsy/jsn093.
Waller, E., & Scheidt, C. E. (2006). Somatoform disorders as disorders of affect regulation: A development perspective. International Review of Psychiatry, 18, 13–24. https://doi.org/10.1080/09540260500466774.
Winnicott, D. (1966). Psycho-somatic illness in its positive and negative aspects. The International Journal of Psychoanalysis, 47, 510–516.
Yahav, R., & Sharlin, S. (2000). The symptom-caring child as a preserver of the family unit. Child & Family Social Work, 5, 353–364. https://doi.org/10.1046/j.1365-2206.2000.00175.x.
Zentner, M., & Renaud, O. (2007). Origins of adolescents’ ideal self: an intergenerational perspective. Journal of Personality and Social Psychology, 92(3), 557. https://doi.org/10.1037/0022-3514.92.3.557.
Zilber, N., Auerbach, J., & Lerner, Y. (1994). Israeli norms for the Achenbach child behavior checklist: Comparison of clinically and non-referred children. The Israel Journal of Psychiatry & Related Sciences, 31, 5–12.
Acknowledgements
The present work is part of Hilla Drucker’s MA thesis done under the supervision of Ety Berant (PhD) and Tamar Silberg (PhD). We wish to thank the children and their mothers who agreed to participate in this study. We thank Amos Schindler (MD) and Ronit Regev (MA) for their assistance in recruiting the study participants.
Author Contributions
T. S. designed the study, assisted with the data analyses, and wrote the paper. H. D. collected data and assisted with the design and writing of the study. M. G. reviewed and critically revised the article for content and approved the final version. T. K. analyzed the data and wrote part of the results. E. B. collaborated in the conception and design of the paper and approved the final version. A. B. and J. L. collaborated in the writing and editing of the final manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no competing interests.
Ethical Approval
All procedures performed in the study involving human participants were in accordance with the ethical standards of the Sheba Medical Center research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The article does not contain any studies with animals performed by any of the authors.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Silberg, T., Drucker-Bezalel, H., Gerner, M. et al. Linking Family Functioning and Self-Discrepancies among Children with Functional Somatic Symptoms. J Child Fam Stud 27, 1473–1481 (2018). https://doi.org/10.1007/s10826-017-0985-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-017-0985-0