Transcript Psychosomatic Disorders

Psychosomatic Disorders in
CAMHS
Fernanda Garcia-Costas
Child and Adolescent Consultant
Psychiatrist
Psychosomatic Disorders
• Group of disorders characterized by physical
symptoms that cannot be fully explained by a
neurological or organic condition.
• It is common for children to report recurrent
physical symptoms with no physical cause,
and the actual diagnosis in children can be
made.
Signs and symptoms
• Headaches.
• Abdominal distress.
• Anxiety and worry, fatigue, loss of appetite, aches and pain
are frequent symptoms, more prevalent in girls than boys.
• Symptoms that mimic neurological disorders, such as
double vision, poor balance and coordination, paralysis,
seizures.
• Perceived physical deformities or defects.
• Back pain.
• Fatigue.
• Sore muscles.
• Often accompanied by academic problems, school refusal,
social withdrawal, anxiety and behavioural problems.
Demography
• Prevalence: between 1.3 to 5 %.
• Less sophisticated or less educated populations and lower SES
groups.
• Prepubertal Female=Male
• Post-puberty 2 Female=Male
• General population somatic complaints 11% girls and 4%
boys.
Aetiology
• Children react differently to stress
• Role of personality, resilience and coping strategies.
• Ability to express emotions related to developmental
stage, temperament and emotional climate of the
family and cultural customs
• Most common triggers:
• Psychosocial stressors
• Trauma (physical or sexual abuse)
• Family conflict.
Causes
• Causes are unknown.
• Psychosocial theory:
– Symptoms as social communication to express emotions or to
symbolize feelings.
• Psychoanalytic interpretation:
– Symptoms as repressed instinctual impulses.
• Biological studies :
– Individual may have a faulty perception and assessment of sensory
inputs.
• Genetic data:
– Somatoform disorders tend to run in families with an occurrence of 10
- 20% in first degree female relatives.
– Anxiety and depression are more common in the families of
somatizing children
Specific types DSM IV
Conversion Disorder
• Most common type diagnosed in children.
• Unexplained symptoms or deficits affecting voluntary
motor or sensory function that suggest a neurological
or other general medical condition.
• The symptoms resemble neurological conditions such
as blindness, seizures, gait imbalance, paralysis, tunnel
vision and numbness. Children may complain of
weakness; trouble walking, talking, or hearing.
• Trauma and abuse increase the likelihood of
Conversion Disorder, which is usually triggered by
psychological factors.
Somatization Disorder
– At least 2 years of multiple and variable physical
symptoms for which no physical explanation has
been found.
– Persistent refusal to accept the advice of several
doctors that there is no physical explanation.
– Some degree of impairment of social and family
functioning attributable to the nature of the
symptoms.
Body Dysmorphic Disorder
• The preoccupation with an imagined or
exaggerated defect in physical appearance.
Hypochondriacal disorder
• Preoccupation with the fear of having, or the
idea that one has, a serious disease based on
the person's misinterpretation of bodily
symptoms or bodily functions.
Undifferentiated Somatoform
Disorder
• Unexplained physical complaints
• Lasting at least 6 months
• Below the threshold for a diagnosis of
Somatization Disorder.
• When somatoform symptoms do not meet the
criteria for any of the specific Somatoform
Disorders, a diagnosis of Somatoform Disorder
Not Otherwise Specified is utilized.
Treatment
• Educate the child regarding the interpretation
of bodily sensations.
• Develop and reinforce coping behaviours that
reduce the gain associated with the sick role
through individual, family, group and cognitive
behavioural therapies. Relaxation techniques
useful.
• Identify and plan appropriate treatment for
co-morbid diagnoses, i.e., anxiety, depression.
• When indicated, medication management
Ania (17)
• Born in the U.S. to eastern Arabic parents.
• Wanted to attend an out-of-town college.
• Parents disapproving as in accordance with
their culture, wanted her to remain at home
while attending college.
• The disagreement was not discussed openly; it
was assumed that Ania would attend a local
college.
• She developed seizures and was admitted to a
• After psychiatric consultation:
– Seizures as related to a long-established pattern in
which Ania did not deal directly with her anxiety.
– Unable to express negative and angry feelings,
Ania reacted with her body.
– Her conflict in assertively expressing her feelings
to her parents about leaving home resulted in the
pseudo-seizures.
– Family was helped to consider the symptoms as a
manifestation of cultural style they learned new
ways to communicate their feelings, and the
symptoms remitted.
Scott (10)
• Complained over a period of more than a year of severe
stomach aches, often resulted in vomiting.
• His paediatrician conducted a series of diagnostic tests and
found no physical basis for his complaints.
• School avoidance pattern was ruled out, since Scott willingly
attended school.
• He was a good student, well-liked by his classmates and an
outstanding football player.
• He spent many after-school hours at football practice and
practiced at home, travelled with his team, took trombone
lessons, and often stayed up until midnight completing his
homework.
• Scott's parents began to think his complaints were imagined.
Psychiatric consultation
• Helped to understand that when stress builds
up without relief the body may react.
• They were advised to make life-style changes
such as limiting his football practice and
trombone lessons to reduce the pressure that
Scott was experiencing.
• The stomach aches and vomiting subsided
within a few months.