Pain Somatoform Disorder Clinical Presentation
- Author: Dolores Protagoras-Lianos, MD; Chief Editor: Caroly Pataki, MD more...
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 :
- 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.
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