Somatoform Disorders
Somatoform disorders are a group of disorders in which an underlying psychologic problem causes distressing or disabling physical symptoms.
A child with a somatoform disorder may have a number of symptoms, including pain, difficulty breathing, and weakness, without evidence of a physical cause. Often, a child develops psychologically based physical symptoms when another family member is seriously ill. These physical symptoms are thought to develop unconsciously in response to a psychologic stress or problem (see Section 7, Chapter 99). It is clear that the symptoms are not consciously fabricated, and the child is actually experiencing the symptoms he describes.
Somatoform disorders are further classified as conversion disorder, somatization disorder, body dysmorphic disorder, and hypochondriasis (see Section 7, Chapter 99). In conversion disorder, the child may seem to have a paralyzed arm or leg, become deaf or blind, or have shaking activity resembling seizures. These symptoms begin suddenly, usually in relation to a precipitating event, and may or may not resolve abruptly. A somatization disorder is similar to conversion disorder, but the child develops numerous symptoms that are more vague, such as headaches, abdominal pain (see Section 23, Chapter 275), and nausea. These symptoms may come and go for long periods of time. In body dysmorphic disorder, the child becomes preoccupied with an imagined defect in appearance, such as the size of his nose or ears, or develops a markedly excessive concern with a minor abnormality, such as a wart. In hypochondriasis, the child has no specific, ongoing symptoms but is obsessed with bodily functions, such as heartbeat, digestion, and sweating, and is convinced that he has a serious disease when nothing is actually wrong.
Somatoform disorders are equally common among young boys and young girls, but they are more common among adolescent girls than adolescent boys.
Diagnosis
Before establishing the diagnosis of a somatoform disorder, the doctor makes sure that the child does not have a physical illness that could account for the symptoms. However, extensive laboratory tests are generally avoided because they may further convince the child that a physical problem exists and unnecessary diagnostic tests may themselves traumatize the child. If no physical illness can be found, the doctor then talks to the child and family members to try to identify underlying psychologic problems or troubled family relationships.
Treatment
A child may balk at the idea of visiting a psychotherapist because to the child his symptoms are purely physical. However, an approach combining individual and family psychotherapy and physical rehabilitation has been shown to be effective in many cases.
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