Pediatric Somatic Symptom Disorder: Understanding the Condition and Diagnosis

Somatic symptom disorder is a pediatric mental health issue that refers to a condition in which a child experiences physical distress due to emotional distress. Symptoms can worsen due to excessive worry or negative thoughts and behaviors related to the physical symptoms. 

Somatic symptom disorder can affect any child but is more common in individuals assigned female at birth (AFAB) compared to those assigned male at birth (AMAB). It is also more prevalent among people who have been diagnosed with conditions such as fibromyalgia, irritable bowel syndrome, and chronic fatigue.

Different types of somatic symptom disorders include functional gastrointestinal disorder, functional neurological disorder, somatic symptom and related disorder, and functional cardiac disorder. The diagnosis may involve multiple healthcare providers, such as primary care providers, pediatricians, neurologists, gastroenterologists, cardiologists, psychiatrists, or psychologists.

Sign and Symptoms

Physical symptoms are quite common in children and may vary among children. These may include pain, fatigue, stomach-ache, nausea, vomiting, shortness of breath, rapid heartbeat, dizziness, fainting, bowel problems, movement challenges, and memory problems. Symptoms can occur in any part of the body, but pain is the most common symptom reported. Common locations for pain include the head, chest, arms, legs, joints, back, and abdomen. These symptoms are genuine and not voluntary or "fake." 

Children often experience multiple symptoms, which can range from mild to severe. They may feel extremely distressed by their symptoms, which can interfere with their daily activities, including attending school and socializing with peers. It is estimated that between 30% to 60% of people with somatic symptom disorder also experience anxiety and/or depression.

Warning signs may include:

• Sudden mood or personality changes.

• Withdrawal from social situations.

• Self-injury.

• Feelings of helplessness.

• Expressing a desire to die.

These signs should not be ignored. If a child displays indicators of suicidal tendencies connected to depression and anxiety, it is crucial immediately reach the health care provider.

Causative Factors and Contributors for Somatic Symptom Disorder

Many factors can cause somatization, like sleep habits, diet, stress, anxiety, and level of hydration. Biological and psychosocial factors contribute to the development of this childhood psychological disorder. These factors may include unresolved symptoms after an illness or injury, stress or challenges that the child cannot communicate verbally, excessive attention to bodily functions, possible signs of illness, low pain threshold, and increased anxiety about good health.

Diagnosis for Somatic Symptom Disorder

Somatic symptom disorders cannot be confirmed or explained by medical tests. Diagnosis is based on patterns of symptoms observed by a doctor. Diagnosing somatic symptom disorder may require the involvement of a team of healthcare providers. The diagnostic process may involve a physical exam, a thorough medical history, laboratory tests (e.g., blood or urine tests, imaging tests), and consultations with mental health specialists to assess children's mental health and emotional, physical, and behavioral health.

Interventional Strategies for Somatic Symptom Disorder

Somatic symptom disorder is not a lifelong condition and can be effectively managed with treatment. The primary aim is for the child to return to normal functioning, including attending school and engaging in activities they enjoy.

Psychotherapy is a vital component in the treatment of somatic symptom disorders. Children and their families may initially resist visiting a psychotherapist because they perceive their symptoms as purely physical. However, pediatric mental health and parental mental health counseling, often employing cognitive-behavioral techniques, can be highly beneficial. 

Treatment focuses on anxiety and negative thinking patterns rather than invasive interventions or high doses of pain medication. These therapeutic approaches help children and family members identify and address patterns of thought and behavior that contribute to the persistence of symptoms. Therapists may utilize techniques such as hypnosis, biofeedback, and relaxation therapy to assist in the therapeutic process.

Psychotherapy is often combined with a rehabilitation program to help children reintegrate into a normal routine. This can involve physical therapy, which serves several purposes:

1. It can address any physical effects resulting from the somatic symptom or related disorder, such as diminished mobility or muscle loss.

2. It gives children a tangible sense that concrete steps are being taken to address their condition.

3. It empowers children to participate in their own treatment and recovery actively.

In some cases, medications may be prescribed to alleviate symptoms associated with these disorders. Antidepressants known as Selective Serotonin Reuptake Inhibitors (SSRIs) can be helpful in managing pain as well as the anxiety and depression that may accompany it. Medication can be a helpful adjunct to psychotherapy and rehabilitation efforts.

The timeline for improvement varies for each child, but most children can resolve their symptoms with the appropriate treatment plan and support from parents. Treatment progress should be monitored through regular visits to healthcare providers, and adherence to the treatment plan is crucial. While improvement may not be immediate and there may be periods without symptom improvement, patience and consistency in treatment are key to preventing the condition from persisting.

The bottom line

If a child's anxiety affects their ability to enjoy their childhood, it is important to consult a pediatric psychiatric clinic for an evaluation. The provider will work with you to manage and treat the child's diagnosis. Supporting the child in adapting to new coping skills is crucial, as your encouragement and support will help them feel safe and deal with anxiety in a positive manner.