Somatoform Disorders and Chronic Pain
Children and adolescents commonly experience physical symptoms that are not readily explained by identifiable medical illness or tissue pathology. Such symptoms can be transient and benign, or they can be persistent, severe, and disabling. Whether or not
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Amanda A. Drews . Brenda Bursch
Abstract: Children and adolescents commonly experience physical symptoms that are not readily explained by identifiable medical illness or tissue pathology. Such symptoms can be transient and benign, or they can be persistent, severe, and disabling. Whether or not the symptoms are explained by a medical problem, some children have great difficulty coping with them. Among children that appear more distressed or disabled by physical symptoms than expected, a diagnosis of Somatoform Disorder can be made. There are presently seven identified Somatoform Disorders that can be applied to children, despite the lack of empirical data regarding the appropriateness of such diagnoses in this age group. A large and growing literature on pediatric chronic pain has informed the conceptualization, assessment, and treatment of childhood somatoform disorders. Most clear regarding the current understanding of chronic somatic symptoms is their multifaceted etiological nature and the necessity of interventions to address biological, psychological, and social precipitating and maintaining factors. Important areas of assessment include the nature of the physical symptoms themselves, including their location, duration, quality, variability, and intensity; the social, emotional, physical, cognitive, and academic functioning of the symptomatic child; and, family factors such as parenting style, response to child symptoms, and psychopathology. Frequently employed treatment strategies include medications, individual and/or family cognitive behavioral interventions, and bodybased therapies. Ideally, these assessment and treatment methodologies are collaboratively implemented within a biopsychosocial framework by medical and psychological professionals who are familiar with the related research evidence base.
16.1 Overview Children and adolescents often experience physical symptoms that are not readily explained by identifiable medical illness or tissue pathology (Eminson, 2007). Such symptoms can be transient and benign, or they can be persistent, severe, and disabling. Irrespective of whether or not the symptoms are explained by a medical problem, some children have great difficulty coping with them. Individuals described by the DSM-IV as having a somatoform disorder are more distressed or disabled than would be expected by one or more physical symptoms or by the misperception of a serious medical problem or deformity. Symptoms are not explained by a known medical disorder and are not intentionally produced. As with many other psychiatric diagnoses, criteria for somatoform disorders were developed for adults, and the bulk of the research has been conducted with this age group. Thus, diagnoses are applied to children without child-specific criteria. There are seven somatoform disorders in DSM-IV: Somatization Disorder, onversion Disorder, Pain Disorder, Hypochondriasis, Body Dysmorphic Disorder, Undifferentiated Somatoform Disorder, and Somatoform Disorder Not Otherwise Specified (NOS). These were J. Thomas,
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