In somatoform disorders, an underlying psychologic problem causes distressing or disabling physical symptoms.

• There are several types of somatoform disorders.
• Symptoms may resemble those of a neurologic disorder (such as paralysis or loss of vision) or be vague (such as headache and nausea), or children may be obsessed with an imagined defect or be convinced that they have a serious disease.
• After doing tests to exclude physical disorders that could cause the symptoms, doctors base the diagnosis on symptoms.
• Individual and family psychotherapy, often using cognitive-behavioral techniques, can help.

Symptoms and treatment of somatoform disorders are very similar to those of anxiety disorders.

Children with a somatoform disorder may have a number of symptoms, including pain, difficulty breathing, and weakness, without evidence of a physical cause (see Somatoform Disorders). Often, children develop 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 Somatoform Disorders: Mind and Body). The symptoms are not consciously fabricated, and children are actually experiencing the symptoms they describe.

Somatoform disorders include the following:

• Conversion disorder: Symptoms resemble those of a neurologic disorder. Children may seem to have a paralyzed arm or leg, become deaf or blind, or have shaking that may resemble seizures. These symptoms begin suddenly, usually after a distressing event, and may or may not resolve abruptly.
• Somatization disorder: Children develop numerous vague symptoms, such as headaches, abdominal pain (see Digestive Disorders: Chronic and Recurring Abdominal Pain), and nausea. Any part of the body may be affected. These symptoms may come and go for long periods of time.
• Body dysmorphic disorder: Children become preoccupied with an imagined defect in appearance, such as the size of their nose or ears, or become excessively concerned with a slight abnormality, such as a wart.
• Hypochondriasis: Children have no specific, ongoing symptoms but are obsessed with bodily functions, such as heartbeat, digestion, and sweating, and are convinced that they have a serious disease when nothing is wrong. They may also feel anxious and depressed.

Somatoform disorders are equally common among young boys and young girls but are more common among adolescent girls than adolescent boys.

Diagnosis

Doctors ask children about their symptoms and do a physical examination and sometimes tests to make sure that children do not have a physical disorder that could account for the symptoms. However, extensive laboratory tests are generally avoided because they may further convince children that a physical problem exists and unnecessary diagnostic tests may themselves traumatize children.

If no physical problem can be identified, doctors may use standardized mental health tests to help determine whether symptoms are due to a somatoform disorder. Doctors also talk to the children and family members to try to identify underlying psychologic problems or troubled family relationships.

Treatment

Children may balk at the idea of visiting a psychotherapist because they think their symptoms are purely physical. However, individual and family psychotherapy, often using cognitive-behavioral techniques, can help children and family members recognize patterns of thought and behavior that perpetuate the symptoms. Therapists may use hypnosis, biofeedback, and relaxation therapy.

Psychotherapy is usually combined with a rehabilitation program that aims to help children get back into a normal routine. It can include physical therapy, which has the following benefits:

• It may treat actual physical effects, such as reduced mobility or loss of muscle, caused by a somatoform disorder.
• It makes children feel as if something concrete is being done to treat them.
• It enables children to participate actively in their treatment.

Drugs may be used to relieve pain or the anxiety or depression that can accompany these disorders.

Last full review/revision February 2009 by Hugh F. Johnston, MD