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Pain Somatoform Disorder Clinical Presentation

  • Author: Dolores Protagoras-Lianos, MD; Chief Editor: Caroly Pataki, MD  more...
Updated: Oct 04, 2013


Obtain a history of physical symptoms from parent and child. When one pain symptom is reported, inquire about other symptoms as well.

Obtain a psychosocial history, including separate interviews with the parent and child to facilitate disclosure. Psychosocial factors implicated in pain disorder include the following[21, 22, 23, 24] :

  • Family history of anxiety, depression, and psychiatric problems
  • Family history of somatization and preoccupation with illness
  • Nontraditional family structure
  • Chronic physical illness in a parent
  • Economic stress in the family
  • History of negative life events
  • Disorganized chaotic family functioning
  • Academic difficulties experienced by the patient
  • Involvement in bullying, especially as a victim[25, 26]
  • Previous history of somatization, behavior problems, or psychiatric illness

Positive evidence of the role of psychological factors includes the following[27] :

  • Onset of pains after stressful event
  • Exacerbation linked with stressful events
  • Relief of symptoms following removal of stressor
  • Pain out of proportion to objective medical findings
  • Disability or handicap out of proportion to reported pain
  • Secondary gain


A thorough physical examination is imperative for purposes of diagnosing the symptoms and, when indicated, reassuring the family. Examining the patient with and without the parents present is advisable.



Numerous theories regarding the causes of pain disorder have been proposed; they should not be considered mutually exclusive. Theories include the following:

  • Biologic factors: Adoption studies have found somatization disorders to be 5-10 times more common in first-degree relatives of probands with somatization than in the general population.
  • Stress: Stress may induce gut motility dysfunction and mucosal dysfunction through corticotropin-releasing hormone, acetylcholine release, or both
  • Psychodynamic theory: An unconscious conflict, wish, or need is converted into a somatic symptom, thus protecting the individual from conscious awareness of it.
  • Trauma and abuse: An association between physical abuse, psychological abuse, or both and somatization has been well documented.
  • Learning theory: The child learns from role models for illness behavior within the family. The child learns about secondary gains from the modeled sick role.
  • Emotions and communication: Limited vocabulary and concrete thinking may cause a child to express distress in terms of physical symptoms.
  • Environmental and social influences: In families and cultures in which psychological problems are stigmatized, the individual may communicate distress through a somatic symptom.
  • Family systems theory: The child's sick role is encouraged because it serves to perpetuate specific family dynamic patterns. According to the model developed by Minuchin, families of somatizing children use 4 distinct transactional patterns: (1) Enmeshment, (2) overprotection, (3) rigidity, (4) lack of conflict resolution.
Contributor Information and Disclosures

Dolores Protagoras-Lianos, MD Former Director of Outpatient Department, Department of Pediatrics, Aghia Sophia Children's Hospital, Athens, Greece

Dolores Protagoras-Lianos, MD is a member of the following medical societies: American Academy of Pediatrics, Hellenic Paediatric Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Chet Johnson, MD Professor of Pediatrics, Associate Director and Developmental-Behavioral Pediatrician, KU Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies; Assistant Dean, Faculty Affairs and Development, University of Kansas School of Medicine

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

  1. APA. Diagnostic and Statistic Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.

  2. American Academy of Pediatrics. Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Versions. Elk Grove Village, IL: 1996.

  3. Soderholm JD, Perdue MH. Stress and gastrointestinal tract. II. Stress and intestinal barrier function. Am J Physiol Gastrointest Liver Physiol. 2001 Jan. 280(1):G7-G13. [Medline].

  4. McEwen BS. Understanding the potency of stressful early life experiences on brain and body function. Metabolism. 2008 Oct. 57 Suppl 2:S11-5. [Medline].

  5. Ehlert U, Straub R. Physiological and emotional response to psychological stressors in psychiatric and psychosomatic disorders. Ann N Y Acad Sci. 1998 Jun 30. 851:477-86. [Medline].

  6. Bener A, Al-Kazaz M, Ftouni D, Al-Harthy M, Dafeeah EE. Diagnostic overlap of depressive, anxiety, stress and somatoform disorders in primary care. Asia Pac Psychiatry. 2013 Mar. 5(1):E29-38. [Medline].

  7. Busch V, Haas J, Cronlein T, et al. Sleep deprivation in chronic somatoform pain-effects on mood and pain regulation. Psychiatry Res. 2012 Feb 28. 195(3):134-43. [Medline].

  8. Goubert L, Eccleston C, Vervoort T, Jordan A, Crombez G. Parental catastrophizing about their child's pain. The parent version of the Pain Catastrophizing Scale (PCS-P): a preliminary validation. Pain. 2006 Aug. 123(3):254-63. [Medline].

  9. Vervoort T, Goubert L, Eccleston C, Bijttebier P, Crombez G. Catastrophic thinking about pain is independently associated with pain severity, disability, and somatic complaints in school children and children with chronic pain. J Pediatr Psychol. 2006 Aug. 31(7):674-83. [Medline].

  10. Logan DE, Williams SE, Carullo VP, Claar RL, Bruehl S, Berde CB. Children and adolescents with complex regional pain syndrome: more psychologically distressed than other children in pain?. Pain Res Manag. 2013 Mar-Apr. 18(2):87-93. [Medline]. [Full Text].

  11. Hermann C, Zohsel K, Hohmeister J, Flor H. Cortical correlates of an attentional bias to painful and innocuous somatic stimuli in children with recurrent abdominal pain. Pain. 2008 Jun. 136(3):397-406. [Medline].

  12. Ghandour RM, Overpeck MD, Huang ZJ, Kogan MD, Scheidt PC. Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: associations with behavioral, sociodemographic, and environmental factors. Arch Pediatr Adolesc Med. 2004 Aug. 158(8):797-803. [Medline].

  13. Campo JV, Bridge J, Ehmann M, et al. Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics. 2004 Apr. 113(4):817-24. [Medline].

  14. Santalahti P, Aromaa M, Sourander A, Helenius H, Piha J. Have there been changes in children's psychosomatic symptoms? A 10-year comparison from Finland. Pediatrics. 2005 Apr. 115(4):e434-42. [Medline].

  15. Ramchandani PG, Hotopf M, Sandhu B, Stein A. The epidemiology of recurrent abdominal pain from 2 to 6 years of age: results of a large, population-based study. Pediatrics. 2005 Jul. 116(1):46-50. [Medline].

  16. Silber TJ. Somatization disorders: diagnosis, treatment, and prognosis. Pediatr Rev. 2011 Feb. 32(2):56-63; quiz 63-4. [Medline].

  17. Vanaelst B, De Vriendt T, Ahrens W, Bammann K, Hadjigeorgiou C, Konstabel K. Prevalence of psychosomatic and emotional symptoms in European school-aged children and its relationship with childhood adversities: results from the IDEFICS study. Eur Child Adolesc Psychiatry. 2012 May. 21(5):253-65. [Medline].

  18. Tanaka H, Mollborg P, Terashima S, Borres MP. Comparison between Japanese and Swedish schoolchildren in regards to physical symptoms and psychiatric complaints. Acta Paediatr. 2005 Nov. 94(11):1661-6. [Medline].

  19. Petersen S, Brulin C, Bergstrom E. Recurrent pain symptoms in young schoolchildren are often multiple. Pain. 2006 Mar. 121(1-2):145-50. [Medline].

  20. Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1997 Oct. 36(10):1329-38. [Medline].

  21. Alfven G. The covariation of common psychosomatic symptoms among children from socio-economically differing residential areas. An epidemiological study. Acta Paediatr. 1993. 82:484 – 487.

  22. Hjern A, Alfven G, Ostberg V. School stressors, psychological complaints and psychosomatic pain. Acta Paediatr. 2008 Jan. 97(1):112-7. [Medline].

  23. Liakopoulou-Kairis M, Alifieraki T, Protagora D, et al. Recurrent abdominal pain and headache--psychopathology, life events and family functioning. Eur Child Adolesc Psychiatry. 2002 Jun. 11(3):115-22. [Medline].

  24. Gini G, Pozzoli T. Association between bullying and psychosomatic problems: a meta-analysis. Pediatrics. 2009 Mar. 123(3):1059-65. [Medline].

  25. Sourander A, Brunstein Klomek A, Ikonen M, Lindroos J, Luntamo T, Koskelainen M. Psychosocial risk factors associated with cyberbullying among adolescents: a population-based study. Arch Gen Psychiatry. 2010 Jul. 67(7):720-8. [Medline].

  26. Ramchandani PG, Stein A, Hotopf M, Wiles NJ. Early parental and child predictors of recurrent abdominal pain at school age: results of a large population-based study. J Am Acad Child Adolesc Psychiatry. 2006 Jun. 45(6):729-36. [Medline].

  27. Stein MT, Crow J, Abbott M, Tanner JL. Organic or psychosomatic? Facilitating inquiry with children and parents. J Dev Behav Pediatr. 2004 Oct. 25(5 Suppl):S97-101. [Medline].

  28. Otti A, Guendel H, Henningsen P, Zimmer C, Wohlschlaeger AM, Noll-Hussong M. Functional network connectivity of pain-related resting state networks in somatoform pain disorder: an exploratory fMRI study. J Psychiatry Neurosci. 2013 Jan. 38(1):57-65. [Medline]. [Full Text].

  29. Thabrewa H, de Sylvac S, Romansa E. Evaluating Childhood AdversityAdv Psychosom Med. Basel, Karger. J Pediatr Psychol. 2012. 32:35–57.

  30. Sharma MP, Manjula M. Behavioural and psychological management of somatic symptom disorders: an overview. Int Rev Psychiatry. 2013 Feb. 25(1):116-24. [Medline].

  31. Gottsegen D. Hypnosis for functional abdominal pain. Am J Clin Hypn. 2011 Jul. 54(1):56-69. [Medline].

  32. Somashekar B, Jainer A, Wuntakal B. Psychopharmacotherapy of somatic symptoms disorders. Int Rev Psychiatry. 2013 Feb. 25(1):107-15. [Medline].

  33. Sanders D. Counseling for Psychosomatic Problems. London, England: Sage Publications; 1995.

  34. Alfven G, Lindstrom A. A new method for the treatment of recurrent abdominal pain of prolonged negative stress origin. Acta Paediatr. 2007 Jan. 96(1):76-81. [Medline].

  35. Kozlowska K, Rose D, Khan R, Kram S, Lane L, Collins J. A conceptual model and practice framework for managing chronic pain in children and adolescents. Harv Rev Psychiatry. 2008. 16(2):136-50. [Medline].

  36. Campo JV, Di Lorenzo C, Chiappetta L, et al. Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it?. Pediatrics. 2001 Jul. 108(1):E1. [Medline].

  37. Cohen P, Pine DS, Must A, Kasen S, Brook J. Prospective associations between somatic illness and mental illness from childhood to adulthood. Am J Epidemiol. 1998 Feb 1. 147(3):232-9. [Medline].

  38. Roth-Isigkeit A, Thyen U, Stoven H, Schwarzenberger J, Schmucker P. Pain among children and adolescents: restrictions in daily living and triggering factors. Pediatrics. 2005 Feb. 115(2):e152-62. [Medline].

  39. Walker LS, Smith CA, Garber J, Claar RL. Appraisal and coping with daily stressors by pediatric patients with chronic abdominal pain. J Pediatr Psychol. 2007 Mar. 32(2):206-16. [Medline]. [Full Text].

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