Pediatric Somatic Symptom Disorders

Abstract

Somatic symptom disorder (SSD) is a common disorder encountered in pediatric medicine. It involves the presentation of physical symptoms that are either disproportionate or inconsistent with history, physical examination, laboratory, and other investigative findings. SSDs result in significant impairment with considerable increase in healthcare utilization, school absenteeism, and the potential for unnecessary diagnostic evaluation and treatment intervention. Patients and families often feel dismissed and may worry that a serious condition has been missed. Primary care providers are frequently frustrated due to a lack of a successful approach to patients and families impacted by SSD. The result is often a cycle of disability, frustration and missed opportunities for collaboration towards enhanced patient functionality. This review summarizes the current evidence-based understanding, as well as insights from clinician experience, on the evaluation and management of pediatric SSD.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Thomson K, Randall E, Ibeziako P, Bujoreanu S. Somatoform disorders and trauma in medically admitted children, adolescents, and young adults: prevalence rates and psychosocial characteristics. Psychosomatics. 2014;55:630–9.

    Article  PubMed  Google Scholar 

  2. 2.

    Ibeziako P, Bujoreanu S. Approach to psychosomatic illness in adolescents. Curr Opin Pediatr. 2011;23(4):384–9.

    Article  PubMed  Google Scholar 

  3. 3.

    • Rask CU, Ornbol E, Fink PK, Mette Skovgaard A. Functional somatic symptoms and consultation patterns in 5-to7- year-olds. Pediatrics. 2013;132:e459–67. Rask et al. provide a large study exploring the factors that contribute to care-seeking behavior in parents of early youth. Specifically, they identify parental behaviors and characteristics, as well as youth characteristics that are associated with increased medical consultation. This study was the first to identify these patterns in early youth and provide insight into factors that may place patients at higher risk for health utilization in the setting of somatization.

    Article  PubMed  Google Scholar 

  4. 4.

    Ibeziako P, DeMaso DR. Somatic Symptom and Related Disorders. In: Kliegman RM, Stanton B, Geme JS, Schor NF, Behrma RE, editors. Nelson textbook of pediatrics 2015. 20th ed. Philadelphia, PA: Elsevier Health Sciences; 2015. p. 135–8.

    Google Scholar 

  5. 5.

    Houtveen JH, van Broeckhuysen-Kloth S, Lintmeijer LL, Bühring ME, Geenen R. Intensive multidisciplinary treatment of severe somatoform disorder: a prospective evaluation. J Nerv Ment Dis. 2015;203(2):141–8.

    Article  PubMed  Google Scholar 

  6. 6.

    Andresen JM, Woolfolk RL, Allen LA, Fragoso MA, Youngerman NL, Patrick-Miller TJ, et al. Physical symptoms and psychosocial correlates of somatization in pediatric primary care. Clin Pediatr. 2011;50(10):904–9.

    Article  Google Scholar 

  7. 7.

    • Bujoreanu S, Randall E, Thomson K, Ibeziako P. Characteristics of medically hospitalized pediatric patients with somatoform diagnoses. Hospital pediatrics. 2014;4(5):283–90. Bujoreanu et al. provide us with an epidemiologic description of inpatient SSD care and the risk factors and practice patterns governing this care. This study influences how we proactively assess risk and manage that risk in the inpatient pediatric setting, as well as provides greater insight into current inpatient practice in SSD.

    Article  PubMed  Google Scholar 

  8. 8.

    Kelly C, Molcho M, Doyle P, Gabhainn SN. Psychosomatic symptoms among schoolchildren. Int J Adolesc Med Health. 2010;22(2):229–35.

    Article  PubMed  Google Scholar 

  9. 9.

    Dohrenwend A, Skillings JL. Diagnosis-specific management of somatoform disorders: moving beyond ‘vague complaints of pain’. J Pain. 2009;10(11):1128–37.

    Article  PubMed  Google Scholar 

  10. 10.

    Allen LA, Woolfolk RL. Cognitive behavioral therapy for somatoform disorders. Psychiatric Clinics of North America. 2010;33(3):579–93.

    Article  PubMed  Google Scholar 

  11. 11.

    Van der Leeuw G, Gerrits MJ, Terluin B, Numans ME, van der Feltz-Cornelis CM, van der Horst HE, et al. The association between somatization and disability in primary care patients. J Psychosom Res. 2015;79:117–22.

    Article  PubMed  Google Scholar 

  12. 12.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Edition. Washington DC: American Psychiatric Publishing; 2013. p. 318–21.

    Google Scholar 

  13. 13.

    Kroenke K, Sharpe M, Sykes R. Revising the classification of somatoform disorders: key questions and preliminary recommendations. Psychosomatics. 2007;48:277–85.

    Article  PubMed  Google Scholar 

  14. 14.

    Dell ML, Campo JV. Somatoform disorders in children and adolescents. Psychiatric Clinics of North America. 2011;34(3):643–60.

    Article  PubMed  Google Scholar 

  15. 15.

    Dimsdale J, Sharma N, Sharpe M. What do physicians think of somatoform disorders? Psychosomatics. 2011;52(2):154–9.

    Article  PubMed  Google Scholar 

  16. 16.

    Rief W, Martin A, Rauh E, Zech T, Bender A. Evaluation of general practitioners’ training: how to manage patients with unexplained physical symptoms. Psychosomatics. 2006;47(4):304–11.

    Article  PubMed  Google Scholar 

  17. 17.

    Silber TJ. Somatization disorders: diagnosis, treatment and prognosis. Pediatr Rev. 2011;32(2):56–63.

    Article  PubMed  Google Scholar 

  18. 18.

    Campo JV, Fritsch SL. Somatization in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1994;33(9):1223–35.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Van Ravesteijn H, Wittkampf K, Lucassen P, et al. Detecting somatoform disorders in primary care with the PHQ-15. Ann Fam Med. 2009;7:232–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Rocha EM, Prkachin KM, Beaumont SL, Hardy CL, Zumbo BD. Pain reactivity and somatization in kindergarten-age children. J Pediatr Psychol. 2003;28(1):47–57.

    Article  PubMed  Google Scholar 

  21. 21.

    Kozlowska K. Good children with conversion disorder: breaking the silence. Clin Child Psychol Psychiatry. 2003;8(1):73–90.

    Article  Google Scholar 

  22. 22.

    Campo J. Functional abdominal pain in childhood: lifetime and familial associations with irritable bowel syndrome and psychiatric disorders. Prim Psychiatry. 2007;14(4):64–8.

    Google Scholar 

  23. 23.

    Plioplys S, Doss J, Siddarth P, Bursch B, Falcone T, Forgey M, et al. Risk factors for comorbid psychopathology in youth with psychogenic nonepileptic seizures. Seizure. 2016;38:32–7.

    Article  PubMed  Google Scholar 

  24. 24.

    Walker LS, Beck JE, Garber J, Lambert W. Children’s somatization inventory: psychometric properties of the revised form (CSI-24). J Pediatr Psychol. 2009;34(4):430–40.

    Article  PubMed  Google Scholar 

  25. 25.

    Martel MM. Sexual selection and sex differences in the prevalence of childhood externalizing and adolescent internalizing disorders. Psychol Bull. 2013;139:1221–59.

    Article  PubMed  Google Scholar 

  26. 26.

    Kingma EM, Janssens KA, Venema M, Ormel J, de Jonge P, Rosmalen JG. Adolescents with low intelligence are at risk of functional somatic symptoms: the TRAILS study. J Adolescent Health. 2011;49(6):621–6.

    Article  Google Scholar 

  27. 27.

    Kozlowska K, Palmer DM, Brown KJ, Scher S, Chudleigh C, Davies F, et al. Conversion disorder in children and adolescents: a disorder of cognitive control. J Neuropsychol. 2015;9(1):87–108.

    Article  PubMed  Google Scholar 

  28. 28.

    Plioplys S, Doss J, Siddarth P, Bursch B, Falcone T, Forgey M, et al. A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures. Epilepsia. 2014;55(11):1739–47.

    Article  PubMed  Google Scholar 

  29. 29.

    Wilson AC, Moss A, Palermo TM, Fales JL. Parent pain and catastrophizing are associated with pain, somatic symptoms, and pain-related disability among early adolescents. J Pediatr Psychol. 2014;39(4):418–26.

    Article  PubMed  Google Scholar 

  30. 30.

    Rousseau S, Grietens H, Vanderfaeillie J, Hoppenbrouwers K, Wiersema JR, Baetens I, et al. The association between parenting behavior and somatization in adolescents explained by physiological responses in adolescents. Int J Psychophysiol. 2014;93:261–6.

    Article  PubMed  Google Scholar 

  31. 31.

    Schulte IE, Petermann F, Noeker M. Functional abdominal pain in childhood: from etiology to maladaptation. Psychother Psychosom. 2010;79(2):73–86.

    Article  PubMed  Google Scholar 

  32. 32.

    Shaw RJ, Spratt EG, Bernard RS, DeMaso DR. Somatoform Disorders. In: Shaw RJ, DeMaso DR, editors. Textbook of pediatric psychosomatic medicine: mental health consultation with physically ill children, vol. 4. Washington DC: American Psychiatric Press, Inc; 2010. p. 47–62.

    Google Scholar 

  33. 33.

    Burns AR, Solis JM, Shadur JM, Hussong AM. Comparing psychiatric symptoms among children of substance-abusing parents with different treatment histories. Vulnerable Child Youth Stud 2013; 8(3): 10.1080/17450128.2012.738948.

  34. 34.

    Serec M, Svab I, Kolšek M, Svab V, Moesgen D, Klein M. Health-related lifestyle, physical and mental health in children of alcoholic parents. Drug Alcohol Rev. 2012;31(7):861–70.

    Article  PubMed  Google Scholar 

  35. 35.

    Little CA, Williams SE, Puzanovova M, Rudzinski ER, Walker LS. Multiple somatic symptoms linked to positive screen for depression in pediatric patient with chronic abdominal pain. J Pediatr Gastroenterol Nutr. 2007;44(1):58–62.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Campo JV. Annual research review: functional somatic symptoms and associated anxiety and depression- developmental psychopathology in pediatric practice. J Child Psychol Psychiatry. 2012;53(5):575–92.

    Article  PubMed  Google Scholar 

  37. 37.

    Atmaca M, Sirlier B, Yildirim H, Kayali A. Hippocampus and amygdalar volumes in patients with somatization disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2011;35:1699–703.

    Article  PubMed  Google Scholar 

  38. 38.

    Zhang J, Jiang M, Yao D, Dai Y, Long L, Yu M, et al. Alterations in white matter integrity in first-episode, treatment-naïve patients with somatization disorder. Neurosci Lett. 2015;599:102–8.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Stein DJ, Muller J. Cognitive-affective neuroscience of somatization disorder and functional somatic syndromes: reconceptualizing the triad of depression-anxiety-somatic symptoms. CNS Spectr. 2008;13:379–84.

    Article  PubMed  Google Scholar 

  40. 40.

    Hakala M, Vahlberg T, Niemi PM, Karlsson H. Brain glucose metabolism and temperament in relation to severe somatization. Psychiatry Clin Neurosci. 2006;60:669–75.

    Article  PubMed  Google Scholar 

  41. 41.

    Bonvanie IJ, Janssens KA, Rosmalen JG, Oldehinkel AJ. Life events and functional somatic symptoms: a population study in older adolescents. Br J Psychol. 2016.

  42. 42.

    Ibeziako P, Choi C, Randall E, Bujoreanu S. Bullying Victimization in Medically Hospitalized Pediatric Patients with Somatic Symptom and Related Disorders: Prevalence and Associated Factors. Hospital Pediatrics. 2016;6(5):290–6.

    Article  PubMed  Google Scholar 

  43. 43.

    Ani C, Reading R, Lynn R, Forlee S, Garralda E. Incidence and 12-month outcome of non-transient childhood conversion disorder in the U.K. and Ireland. Br J Psychiatry. 2013;202(6):413–8.

    Article  PubMed  Google Scholar 

  44. 44.

    Sun XY, Fan HM, Bai B, Song HT, Tao FY, Song ZX, et al. Psychosomatic conditions of the children and adolescents exposed to 5.12 Wenchuan earthquake. Int J Behav Med. 2014;21(4):730–5.

    Article  PubMed  Google Scholar 

  45. 45.

    Guerriero RM, Pier DB, de Gusmão CM, Bernson-Leung ME, Maski KP, Urion DK, et al. Increased pediatric functional neurological symptom disorders after the Boston marathon bombings: a case series. Pediatr Neurol. 2014;51(5):619–23.

    Article  PubMed  Google Scholar 

  46. 46.

    Kugler B, Bloom M, Kaercher L, Traux T, Storch E. Somatic symptoms in traumatized children and adolescents. Child Psychiatry Hum Dev. 2012;43(5):661–73.

    Article  PubMed  Google Scholar 

  47. 47.

    Waldinger RJ, Schulz MS, Barsky AJ, Ahern DK. Mapping the road from childhood trauma to adult somatization: the role of attachment. Psychosom Med. 2006;68(1):129–35.

    Article  PubMed  Google Scholar 

  48. 48.

    Grover S, Kate N. Somatic symptoms in consultation-liaison psychiatry. Int Rev Psychiatry. 2013;25(1):52–64.

    Article  PubMed  Google Scholar 

  49. 49.

    Bujoreanu S, White MT, Gerber B, Ibeziako P. Effect of timing of psychiatry consultation on length of pediatric hospitalization and hospital charges. Hospital pediatrics. 2015;5(5):269–75.

    Article  PubMed  Google Scholar 

  50. 50.

    Rask CU, Christensen MF, Borg C, et al. The Soma Assessment Interview: new parent interview on functional somatic symptoms in children. J Psychosom Res. 2009;66:455–64.

    Article  PubMed  Google Scholar 

  51. 51.

    • Aiarzaguena JM, Gaminde I, Clemente I, Garrido E. Explaining medically unexplained symptoms: somatizing patients’ responses in primary care. Patient Educ Couns. 2013;93(1):63–72. Aiazaguena et al. explore the relationship of primary care provider discussion of a conceptual framework for SSD and the response of the patient in this process. This study highlights factors that both enhance and detract from the critical patient-provider relationship in this discourse and offers greater evidence to support certain explanatory strategies in discussing SSD with patients.

    Article  PubMed  Google Scholar 

  52. 52.

    Van Tilburg MA, Palsson OS, Whitehead WE. Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. J Psychosom Res. 2013;74(6):486–92.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Burton C, Weller D, Marsden W, Worth A, Sharpe M. A primary care symptoms clinic for patients with medically unexplained symptoms: pilot randomized trial. British Medical Journal Open. 2012;2:e000513. doi:10.1136/bmjopen-2011-000513.

    Google Scholar 

  54. 54.

    Weisblatt E, Hindley P, Rask C. Medically unexplained symptoms in children and adolescents. In: Creed F, Henningsen P, Fink P, editors. Medically unexplained symptoms, somatisation and bodily distress. London: Cambridge University Press; 2011. p. 158–74.

    Google Scholar 

  55. 55.

    Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007;69:881–8.

    Article  PubMed  Google Scholar 

  56. 56.

    Campo JV, Fritz G. A management model for pediatric somatization. Psychosomatics. 2001;42(6):467–76.

    CAS  Article  PubMed  Google Scholar 

  57. 57.

    Kleinstauber M, Witthoft M, Steffanowski A, van Marwijk H, Hiller W, Lambert MJ. Pharmacologic interventions for somatoform disorders in adults. Cochrane Database Syst Rev 2014; (11) doi: 10.1002/14651858.CD010628.pub2

  58. 58.

    Rytila-Manninen M, Frojd S, Haravuori H, Lindberg N, Marttunen M, Kettunen K, et al. Psychometric properties of the Symptom Checklist-90 in adoelscent psychiatric inpatients and age-and gender-matched community youth. Child Adoelsce Psychiatry Ment Health. 2016;10:23.

    Article  Google Scholar 

  59. 59.

    Wright KD, Asmundson GJ. Health anxiety in children: development and psychometric properties of the Childhood Illness Attitudes Scales. Cogn Behav Ther. 2003;32(4):194–202.

    Article  PubMed  Google Scholar 

  60. 60.

    Wisniewski JJ, Naglieri JA, Mulick JA. Psychometric properties of a Children’s Psychosomatic Symptom Checklist. J Behav Med. 1988;11(5):497–507.

    CAS  Article  PubMed  Google Scholar 

  61. 61.

    Williams RA, Hollis HM. Health beliefs and reported symptoms among a sample of incarcerated adolescent females. J Adolesc Health. 1999;24(1):21–7.

    CAS  Article  PubMed  Google Scholar 

  62. 62.

    Jellesma FC, Rieffe C, Terwogt MM. The Somatic Complaint List: validation of a self-report questionnaire assessing somatic complaints in children. J Psychosom Res. 2007;63(4):399–401.

    Article  PubMed  Google Scholar 

  63. 63.

    Weiss KE, Hahn A, Wallace DP, Biggs B, Bruce BK, Harrison TE. Acceptance of pain: associations with depression, catastrophizing, and functional disability among children and adolescents in an interdisciplinary chronic pain rehabilitation program. J Pediatr Psychol. 2013;38(7):756–65.

    Article  PubMed  Google Scholar 

  64. 64.

    Kashikar-Zuck S, Flowers SR, Claar RL, Guite JW, Logan DE, Lynch-Jordan AM, et al. Clinical utility and validity of the Functional Disability Inventory (FDI) among a multicenter sample of youth with chronic pain. Pain. 2011;152(7):1600–7.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The editors would like to thank Dr. Tami D. Benton for taking the time to review this manuscript.

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Correspondence to Nasuh Malas.

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Nasuh Malas, Roberto Ortiz-Aguayo, Lisa Giles, and Patricia Ibeziako declare that they have no conflict of interest.

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This article is part of the Topical Collection on Complex Medical-Psychiatric Issues

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Malas, N., Ortiz-Aguayo, R., Giles, L. et al. Pediatric Somatic Symptom Disorders. Curr Psychiatry Rep 19, 11 (2017). https://doi.org/10.1007/s11920-017-0760-3

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Keywords

  • Somatic symptom disorder
  • Somatization
  • Somatoform
  • Conversion
  • Functional
  • Pediatric
  • Medically unexplained symptoms