Psychosomatic Disorders: The Approach

Abstract

Pediatricians frequently encounter patients in their daily clinical practice who present having chronic or recurrent symptoms that do not suggest a physical disorder. In fact, social, emotional, or behavioral problems can constitute up to 25% of visits in a pediatric practice, and it has been estimated that as many as 68% of children who present for medical treatment have psychological factors associated with somatic complaints. These clusters of symptoms typically are referred to as a psychosomatic illness and usually require more time to treat than an acute infection such as otitis media. Additionally, the approach, diagnostic evaluation, and treatment plan require careful construction, which places an increased burden on the pediatrician to "cure" the patient and relieve parent, environment, and other associated stressors in a limited time.

Research suggests that as much as 10% of a pediatric practice is comprised of patients who have a psychosomatic diagnosis. Studies have suggested that psychosomatic symptoms peak during certain ages (age 7 for boys and at ages 6 and 16 for girls) or by diagnosis (psychogenic pain found more commonly among girls and afflicts children ages 4 to 12 years more frequently). Among children, these chronic and vague somatic symptoms frequently include recurrent abdominal pain, headache, and musculoskeletal pain.