Somatization and somatoform disorders

Abstract

Medically unexplained somatic symptoms are common in children and adolescents. They can be an expression of somatization (psychological difficulty or distress manifested through somatic symptoms that are attributed to physical illness) and/or of a somatoform disorder. The most common somatoform disorders in children are persistent somatoform pain disorder and dissociative/conversion disorder. Chronic fatigue syndrome, called ‘neurasthenia’ in ICD-10, shares the key features of somatoform disorders. This chapter outlines the main clinical characteristics of recurrent, medical, unexplained, somatic symptoms and somatoform disorders in children. Onset is often insidious, but some problems are brought on by a medical condition or injury. Psychiatric comorbidity is common, especially emotional disorder. Risk factors in the child include certain personality features (sensitivity, anxiety proneness, and conscientiousness). Risk factors in the family involve a history of both physical and psychological problems, and symptom reinforcement. Treatment involves taking the symptoms seriously and clarification of medical investigations and exclusions, psycho-education, and reducing attention to the symptoms, whilst relieving stresses and increasing supports for the child in school and at home as appropriate. It may involve family behavioural/cognitive work. Many children improve.