Pain Somatoform Disorder Clinical Presentation

  • Author: Dolores Protagoras-Lianos, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Nov 21, 2011
 

History

  • Obtain a history of physical symptoms from the 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:
    • Family history of anxiety, depression, and psychiatric problems
    • Family history of somatization and preoccupation with illness
    • 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
    • Harassment by classmates (particularly frequent)
    • 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
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Physical

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.

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Causes

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.[5]
  • 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 the following 4 distinct transactional patterns:
    • Enmeshment
    • Overprotection
    • Rigidity
    • Lack of conflict resolution
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Contributor Information and Disclosures
Author

Dolores Protagoras-Lianos, MD  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

Disclosure: Nothing to disclose.

Specialty Editor Board

Chet Johnson  MD, Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies, University of Kansas; Professor and Chair of Pediatrics, University of Kansas Medical Center

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

Disclosure: Nothing to disclose.

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.

Carrie Sylvester, MD, MPH  Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

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

Disclosure: Nothing to disclose.

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