A study of projective test responses and intervention strategies in children with unexplained pain symptoms

Abstract

Psychiatric morbidity is high in children with unexplained chronic pain and thus needs to be assessed and treated. Unexplained pain symbolizes emotional distress and conflicts in children. The most common somatic symptoms are headache, abdominal pain, and musculoskeletal symptoms. Aim: The aim of this case series is to qualitatively analyze the responses obtained on projective tests and intervention strategies employed in children with unexplained pain symptoms. Materials and Methods: Our cases included a total of 12 children and adolescents who were referred to us from the pediatric department for complaints of unexplained pain symptoms for a period of at least 6 months. The investigations done for these children were reportedly normal. After the initial rapport and initial intake, the children underwent projective testing. The projective tests used were Children apperception test, Thematic Apperception Test and Sentence Completion test. Results: The findings observed were conflict with primary caregivers, over-involvement and overly critical parents, sibling rivalry and intrapersonal conflicts. Intervention strategies primarily focused on psychoeducation, addressing secondary gain, parents session to address their relationship with the child and cognitive behavioral strategies as applicable to the case. Conclusion: Children with unexplained pain symptoms require detailed history taking and psychological evaluation. Projective tests facilitate conflict identification and early intervention to address psychological factors. Keywords: Projective test, Uexplained pain symptoms, Management.