Somatization and somatoform disorders

Medically unexplained somatic symptoms are common in children and adolescents. They can be an expression of somatization (i.e. psychological difficulty/distress manifested through somatic symptoms which 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 - known as '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 co-morbidity is common, especially emotional disorder. Risk factors in the child include certain personality features (ie 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, 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.