Pediatric Gastrointestinal Disorders Biopsychosocial Assessment and
A child presents with weight loss, fatigue, and stomach pain. Is the diagnosis psychological, as in an eating disorder? Might it be medical, as in a GI disorder? Could it be both? A young adolescent is assessed to have a gastrointestinal disorder. Do you
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Pediatric Gastrointestinal Disorders Biopsychosocial Assessment and Treatment
Carin L. Cunningham Rainbow Babies and Children’s Hospital Case School of Medicine Cleveland, Ohio
and
Gerard A. Banez The Cleveland Clinic Cleveland, Ohio
Carin L. Cunningham, Ph.D. Department of Pediatrics Division of Behavioral Pediatrics Rainbow Babies and Children’s Hospital Case School of Medicine Cleveland, Ohio 44106
Gerard A. Banez, Ph.D. Division of Pediatrics/A120 The Cleveland Clinic Foundation Cleveland, Ohio 44195
Cover illustration: Painting “Fantasy Intestines #4,” © Seth Chwast Trust, photographed by Jane Critchlow and reproduced by permission of the artist. Library of Congress Control Number: 2005924428 ISBN-10: 0-387-25611-3 ISBN-13: 978-0387-25611-5
e-ISBN 0-387-25612-1
Printed on acid-free paper. © 2006 Springer Science+Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed in the United States of America. 9 8 7 6 5 4 3 2 1 springer.com
(SPI/EB)
To the memory of Gerald Lamont (1912–2003), a wonderful father and supporter of my work C.L.C.
Preface
As a postdoctoral fellow in pediatric psychology at a large tertiary medical center, Rainbow Babies and Children’s Hospital, in Cleveland, Ohio, I was assigned to the pediatric gastroenterology clinic for a rotation. My responsibilities included direct patient care with pediatric and adolescent patients, consultation with pediatric gastroentrologists, and the planning and implementation of a group for parents of children and adolescents with inflammatory bowel disease (IBD). The collaboration was a positive experience for the physicians and myself. I learned about the physical symptoms and the treatment of various gastrointestinal (GI) disorders that present in childhood and adolescents, a critical factor to ensure avoidance of the misattribution of psychological etiologies for physical symptoms. The pediatric gastroenterologists learned to identify behaviors that might be indicative of psychosocial issues. When the three pediatric gastrolenterologists left that medical center for another hospital, they asked me to join their practice. For ten years I was a member of this practice whose strength was comprehensive, collaborative care provided to patients in a “user-friendly” manner. Thus, patients who might have been hesitant to consult a psychologist accepted the recommen
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