Somatic Symptom Disorders in Children
Abstract
Physical symptoms without any identifiable structural or biochemical abnormalities on detailed clinical examination and investigations, are common in children. Some children may have persistent physical discomfort which can lead to debilitating impact on their academic and social functioning. These children seek repeated medical consultations and are usually subjected to unnecessary invasive diagnostic procedures. It is extremely important to understand that emotional factors can contribute to the development as well as maintenance of impairing physical symptoms. There is scientific evidence for the association of anxiety and functional somatic symptoms in children. The diagnostic category which was previously called somatoform disorders is now included in somatic symptom disorders. The main feature of the somatic symptom disorders is the excessive concern with somatic symptoms. These children usually have high level of anxiety. Detailed clinical examination and investigations will not reveal any abnormalities to explain the symptoms. The somatic symptom disorders are common in childhood. Cognitive behavioural therapy by experts in child guidance, will relieve the somatic symptoms related to anxiety and stress. If not intervened at the earliest, the persistent physical symptoms associated with emotional stress will cause significant functional disability in childhood. Unnecessary invasive medical interventions cause more agony to the child. These children also have high risk for developing anxiety disorders and depressive disorders in young adulthood. Hence, early intervention using cognitive behavioural techniques should be provided to all children with somatic symptom disorders, which will definitely improve their quality of life.References
1. Rask CU. Functional somatic symptoms in 5-7 year old children: assessment, prevalence and co-occurrence. Dan Med J. 2012 Nov; 59(11):B4537.
2. Rask CU, Olsen EM, Elberling H, Christensen MF, Ornbøl E, Fink P, Thomsen PH, Skovgaard AM. Functional somatic symptoms and associated impairment in 5-7-year-old children: the Copenhagen Child Cohort 2000. Eur J Epidemiol. 2009;24(10):625-34.
3. Shayla L. Hart, Stacy C. Hodgkinson, Harolyn M. E. Belcher, Corine Hyman, Michele Cooley-Strickland. Somatic symptoms, peer and school stress, and family and community violence exposure among urban elementary school children. J Behav Med. 2013 Oct; 36(5): 454-465.
4. Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child / adolescent. Gastroenterol. 2006; 130: 1527-37.
5. Saps M, Seshadri R, Sztainberg M, Schaffer G, Marshall BM, Di Lorenzo C. A prospective school-based study of abdominal pain and other common somatic complaints in children. J Pediatr. 2009;154:322-326.
6. Campo JV, Comer DM, Jansen-McWilliams L, Gardner W, Kelleher KJ. Recurrent pain, emotional distress, and health service use in childhood. J Pediatr. 2002;141:76-83.
7. Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, Lee S, Irwin MR, Levenson J. Somatic symptom disorder: an important change in DSM. J Psychosom Res. 2013 Sep;75(3):223-8.
8. Kurlansik SL, Maffei MS. Somatic Symptom Disorder. Am Fam Physician. 2016 Jan 1;93(1):49-54.
9. van Dessel NC, van der Wouden JC, Dekker J, van der Horst HE. Clinical value of DSM IV and DSM 5 criteria for diagnosing the most prevalent somatoform disorders in patients with medically unexplained physical symptoms (MUPS). J Psychosom Res. 2016 Mar;82:4-10.
10. Steinbrecher N, Koerber S, Frieser D, Hiller W. The prevalence of medically unexplained symptoms in primary care. Psychosomatics. 2011;52(3):263-271.
11. Campo JV, Bridge J, Ehmann M, et al. Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics. 2004;113:817-824.
12. Rask CU, Elberling H, Skovgaard AM, Thomsen PH, Fink P. Parental-reported health anxiety symptoms in 5- to 7-year-old children: the Copenhagen Child Cohort CCC 2000. Psychosomatics. 2012 Jan-Feb;53(1):58-67.
13. Garber J, Walker LS, Zeman L. Somatization symptoms in a community sample of children and adolescents: further validation of the Children’s Somatization Inventory. Psychol Assess. 1991;3:588-595.
14. Konichezky A, Gothelf D. Somatoform disorders in children and adolescents. Harefuah. 2011 Feb;150(2):180-4, 203.
15. Ramchandani PG, Hotopf M, Sandhu B, Stein A; ALSPAC Study Team. The epidemiology of recurrent abdominal pain from 2 to 6 years of age: results of a large, population-based study. Pediatrics. 2005 Jul;116(1):46-50.
16. Chitkara DK, Rawat DJ, Talley NJ. The epidemiology of childhood recurrent abdominal pain in Western countries: a systematic review. Am J Gastroenterol. 2005 Aug;100(8):1868-75.
17. Monnikes H, Tebbe JJ, Hildebrandt M, Arck P, Osmanoglou E, Rose M, Klapp B, Wiedenmann B, Heymann-Mönnikes I. Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity. Dig Dis. 2001;19(3):201-11.
18. Scharff L. Recurrent abdominal pain in children: a review of psychological factors and treatment. Clin Psychol Rev. 1997;17(2):145-66.
19. Helgeland H, Van Roy B, Sandvik L, Markestad T, Kristensen H. Paediatric functional abdominal pain: significance of child and maternal health. A prospective study. Acta Paediatr. 2011 Nov;100(11):1461-7.
20. Hinson VK, Haren WB. Psychogenic movement disorders. Lancet Neurol. 2006 Aug;5(8):695-700.
21. Drapier S, Vérin M. Psychogenic movement disorders. Rev Neurol (Paris). 2012 Aug-Sep;168(8-9):662-7.
22. Khundadze M, Mkheidze R, Geladze N, Bakhtadze S, Khachapuridze N. The causes and symptoms of somatoform disorders in children (Review). Georgian Med News. 2015;246:59-65.
23. Baslet G, Seshadri A, Bermeo-Ovalle A, Willment K, Myers L. Psychogenic Non-epileptic Seizures: An Updated Primer. Psychosomatics. 2016 Jan-Feb;57(1):1-17.
24. Park EG, Lee J, Lee BL, Lee M, Lee J. Paroxysmal nonepileptic events in pediatric patients. Epilepsy Behav. 2015 Jul;48:83-7.
25. Alsaadi TM, Marquez AV. Psychogenic nonepileptic seizures. Am Fam Physician. 2005 Sep 1;72(5):849-56.
26. Bodde NM, Brooks JL, Baker GA, Boon PA, Hendriksen JG, Aldenkamp AP. Psychogenic non-epileptic seizures-diagnostic issues: a critical review. Clin Neurol Neurosurg. 2009 Jan;111(1):1-9.
27. Plioplys S, Doss J, Siddarth P, Bursch B, Falcone T, Forgey M, Hinman K, LaFrance WC Jr, Laptook R, Shaw RJ, Weisbrot DM, Willis MD, Caplan R. A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures. Epilepsia. 2014 Nov;55(11):1739-47.
28. Salawu FK, Wakil MA, Danburam A. Overview of somatization-diagnosis and management. Niger J Med. 2009 Oct-Dec;18(4):349-53.
29. Thomson AB, Page LA. Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews. 2007;4:CD006520.
30. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012 Oct 1;36(5):427-440.
31. Masia Warner C, Reigada LC, Fisher PH, Saborsky AL, Benkov KJ. CBT for anxiety and associated somatic complaints in pediatric medical settings: an open pilot study. J Clin Psychol Med Settings. 2009 Jun;16(2):169-77.
32. Warner CM, Colognori D, Kim RE, Reigada LC, Klein RG, Browner-Elhanan KJ, Saborsky A, Petkova E, Reiss P, Chhabra M, McFarlane-Ferreira YB, Phoon CK, Pittman N, Benkov K. Cognitive-behavioral Treatment of Persistent Functional Somatic Complaints and Pediatric Anxiety: An Initial Controlled Trial. Depress Anxiety. 2011 Jul;28(7):551-559.
33. Weydert JA, Ball TM, Davis MF. Systematic review of treatments for recurrent abdominal pain. Pediatrics. 2003;111:e1-e11.
34. Abbott RA, Martin AE, Newlove-Delgado TV, Bethel A, Thompson-Coon J, Whear R, Logan S. Psychosocial interventions for recurrent abdominal pain in childhood. Cochrane Database Syst Rev. 2017 Jan 10;1:CD010971.
35. Perez DL, LaFrance WC Jr. Nonepileptic seizures: an updated review. CNS Spectr. 2016 Jun;21(3):239-46.
36. Sawchuk T, Buchhalter J. Psychogenic nonepileptic seizures in children - Psychological presentation, treatment, and short-term outcomes. Epilepsy Behav. 2015 Nov;52(Pt A):49-56.
37. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007;69(9):881-888.
38. olde Hartman TC, Borghuis MS, Lucassen PL, van de Laar FA, Speckens AE, van Weel C. Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review. J Psychosom Res. 2009;66(5):363-377.
39. Creed F, Barsky A. A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res. 2004;56(4):391-408.
40. Græsholt-Knudsen T, Skovgaard AM, Jensen JS, Rask CU. Impact of functional somatic symptoms on 5-7-year-olds' healthcare use and costs. Arch Dis Child. 2017 Jan 30. [Epub ahead of print]
41. Shanahan L, Zucker N, Copeland WE, Bondy CL, Egger HL, Costello EJ. Childhood somatic complaints predict generalized anxiety and depressive disorders during young adulthood in a community sample. Psychol Med. 2015 Jun;45(8):1721-30.
42. Croicu C, Chwastiak L, Katon W. Approach to the patient with multiple somatic symptoms. Med Clin North Am. 2014;98(5):1079-1095.
43. Mullick MS. Somatoform disorders in children and adolescents. Bangladesh Med Res Counc Bull. 2002 Dec;28(3):112-22.
2. Rask CU, Olsen EM, Elberling H, Christensen MF, Ornbøl E, Fink P, Thomsen PH, Skovgaard AM. Functional somatic symptoms and associated impairment in 5-7-year-old children: the Copenhagen Child Cohort 2000. Eur J Epidemiol. 2009;24(10):625-34.
3. Shayla L. Hart, Stacy C. Hodgkinson, Harolyn M. E. Belcher, Corine Hyman, Michele Cooley-Strickland. Somatic symptoms, peer and school stress, and family and community violence exposure among urban elementary school children. J Behav Med. 2013 Oct; 36(5): 454-465.
4. Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child / adolescent. Gastroenterol. 2006; 130: 1527-37.
5. Saps M, Seshadri R, Sztainberg M, Schaffer G, Marshall BM, Di Lorenzo C. A prospective school-based study of abdominal pain and other common somatic complaints in children. J Pediatr. 2009;154:322-326.
6. Campo JV, Comer DM, Jansen-McWilliams L, Gardner W, Kelleher KJ. Recurrent pain, emotional distress, and health service use in childhood. J Pediatr. 2002;141:76-83.
7. Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, Lee S, Irwin MR, Levenson J. Somatic symptom disorder: an important change in DSM. J Psychosom Res. 2013 Sep;75(3):223-8.
8. Kurlansik SL, Maffei MS. Somatic Symptom Disorder. Am Fam Physician. 2016 Jan 1;93(1):49-54.
9. van Dessel NC, van der Wouden JC, Dekker J, van der Horst HE. Clinical value of DSM IV and DSM 5 criteria for diagnosing the most prevalent somatoform disorders in patients with medically unexplained physical symptoms (MUPS). J Psychosom Res. 2016 Mar;82:4-10.
10. Steinbrecher N, Koerber S, Frieser D, Hiller W. The prevalence of medically unexplained symptoms in primary care. Psychosomatics. 2011;52(3):263-271.
11. Campo JV, Bridge J, Ehmann M, et al. Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics. 2004;113:817-824.
12. Rask CU, Elberling H, Skovgaard AM, Thomsen PH, Fink P. Parental-reported health anxiety symptoms in 5- to 7-year-old children: the Copenhagen Child Cohort CCC 2000. Psychosomatics. 2012 Jan-Feb;53(1):58-67.
13. Garber J, Walker LS, Zeman L. Somatization symptoms in a community sample of children and adolescents: further validation of the Children’s Somatization Inventory. Psychol Assess. 1991;3:588-595.
14. Konichezky A, Gothelf D. Somatoform disorders in children and adolescents. Harefuah. 2011 Feb;150(2):180-4, 203.
15. Ramchandani PG, Hotopf M, Sandhu B, Stein A; ALSPAC Study Team. The epidemiology of recurrent abdominal pain from 2 to 6 years of age: results of a large, population-based study. Pediatrics. 2005 Jul;116(1):46-50.
16. Chitkara DK, Rawat DJ, Talley NJ. The epidemiology of childhood recurrent abdominal pain in Western countries: a systematic review. Am J Gastroenterol. 2005 Aug;100(8):1868-75.
17. Monnikes H, Tebbe JJ, Hildebrandt M, Arck P, Osmanoglou E, Rose M, Klapp B, Wiedenmann B, Heymann-Mönnikes I. Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity. Dig Dis. 2001;19(3):201-11.
18. Scharff L. Recurrent abdominal pain in children: a review of psychological factors and treatment. Clin Psychol Rev. 1997;17(2):145-66.
19. Helgeland H, Van Roy B, Sandvik L, Markestad T, Kristensen H. Paediatric functional abdominal pain: significance of child and maternal health. A prospective study. Acta Paediatr. 2011 Nov;100(11):1461-7.
20. Hinson VK, Haren WB. Psychogenic movement disorders. Lancet Neurol. 2006 Aug;5(8):695-700.
21. Drapier S, Vérin M. Psychogenic movement disorders. Rev Neurol (Paris). 2012 Aug-Sep;168(8-9):662-7.
22. Khundadze M, Mkheidze R, Geladze N, Bakhtadze S, Khachapuridze N. The causes and symptoms of somatoform disorders in children (Review). Georgian Med News. 2015;246:59-65.
23. Baslet G, Seshadri A, Bermeo-Ovalle A, Willment K, Myers L. Psychogenic Non-epileptic Seizures: An Updated Primer. Psychosomatics. 2016 Jan-Feb;57(1):1-17.
24. Park EG, Lee J, Lee BL, Lee M, Lee J. Paroxysmal nonepileptic events in pediatric patients. Epilepsy Behav. 2015 Jul;48:83-7.
25. Alsaadi TM, Marquez AV. Psychogenic nonepileptic seizures. Am Fam Physician. 2005 Sep 1;72(5):849-56.
26. Bodde NM, Brooks JL, Baker GA, Boon PA, Hendriksen JG, Aldenkamp AP. Psychogenic non-epileptic seizures-diagnostic issues: a critical review. Clin Neurol Neurosurg. 2009 Jan;111(1):1-9.
27. Plioplys S, Doss J, Siddarth P, Bursch B, Falcone T, Forgey M, Hinman K, LaFrance WC Jr, Laptook R, Shaw RJ, Weisbrot DM, Willis MD, Caplan R. A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures. Epilepsia. 2014 Nov;55(11):1739-47.
28. Salawu FK, Wakil MA, Danburam A. Overview of somatization-diagnosis and management. Niger J Med. 2009 Oct-Dec;18(4):349-53.
29. Thomson AB, Page LA. Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews. 2007;4:CD006520.
30. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012 Oct 1;36(5):427-440.
31. Masia Warner C, Reigada LC, Fisher PH, Saborsky AL, Benkov KJ. CBT for anxiety and associated somatic complaints in pediatric medical settings: an open pilot study. J Clin Psychol Med Settings. 2009 Jun;16(2):169-77.
32. Warner CM, Colognori D, Kim RE, Reigada LC, Klein RG, Browner-Elhanan KJ, Saborsky A, Petkova E, Reiss P, Chhabra M, McFarlane-Ferreira YB, Phoon CK, Pittman N, Benkov K. Cognitive-behavioral Treatment of Persistent Functional Somatic Complaints and Pediatric Anxiety: An Initial Controlled Trial. Depress Anxiety. 2011 Jul;28(7):551-559.
33. Weydert JA, Ball TM, Davis MF. Systematic review of treatments for recurrent abdominal pain. Pediatrics. 2003;111:e1-e11.
34. Abbott RA, Martin AE, Newlove-Delgado TV, Bethel A, Thompson-Coon J, Whear R, Logan S. Psychosocial interventions for recurrent abdominal pain in childhood. Cochrane Database Syst Rev. 2017 Jan 10;1:CD010971.
35. Perez DL, LaFrance WC Jr. Nonepileptic seizures: an updated review. CNS Spectr. 2016 Jun;21(3):239-46.
36. Sawchuk T, Buchhalter J. Psychogenic nonepileptic seizures in children - Psychological presentation, treatment, and short-term outcomes. Epilepsy Behav. 2015 Nov;52(Pt A):49-56.
37. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007;69(9):881-888.
38. olde Hartman TC, Borghuis MS, Lucassen PL, van de Laar FA, Speckens AE, van Weel C. Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review. J Psychosom Res. 2009;66(5):363-377.
39. Creed F, Barsky A. A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res. 2004;56(4):391-408.
40. Græsholt-Knudsen T, Skovgaard AM, Jensen JS, Rask CU. Impact of functional somatic symptoms on 5-7-year-olds' healthcare use and costs. Arch Dis Child. 2017 Jan 30. [Epub ahead of print]
41. Shanahan L, Zucker N, Copeland WE, Bondy CL, Egger HL, Costello EJ. Childhood somatic complaints predict generalized anxiety and depressive disorders during young adulthood in a community sample. Psychol Med. 2015 Jun;45(8):1721-30.
42. Croicu C, Chwastiak L, Katon W. Approach to the patient with multiple somatic symptoms. Med Clin North Am. 2014;98(5):1079-1095.
43. Mullick MS. Somatoform disorders in children and adolescents. Bangladesh Med Res Counc Bull. 2002 Dec;28(3):112-22.
