eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Somatoform Disorder: Pain: Differential Diagnoses & Workup

Author: Dolores Protagoras-Lianos, MD, Director of Outpatient Department, Department of Pediatrics, Aghia Sophia Children's Hospital, Athens, Greece
Contributor Information and Disclosures

Updated: Sep 10, 2008

Differential Diagnoses

Anxiety Disorder: Generalized Anxiety
Child Abuse & Neglect: Sexual Abuse
Somatoform Disorder: Body Dysmorphic
Somatoform Disorder: Conversion

Other Problems to Be Considered

  • Malingering or factitious disorder
  • Pain disorder associated with a general medical condition: A general medical condition has a major role in the onset, severity, exacerbation, or maintenance of the pain. If psychological factors are present, they are not judged to have a major role.
  • Pain secondary to undiagnosed medical condition
  • Associated disorders (ie, anxiety, depression, attention deficit hyperactivity disorder, conduct disorder)

Workup

Laboratory Studies

  • The primary physician orders laboratory studies based on clinical suggestion of a specific medical condition.

Imaging Studies

  • The primary physician orders imaging studies based on clinical suggestion of a specific medical condition.

Other Tests

  • The following are prerequisite conditions for successful referral by a medical practitioner to a mental health professional:
    • Timely, thorough medical evaluation
    • Interview and observation of family for psychosocial problems
    • Early mention of possibility that symptoms are stress-related
    • Discussion of negative medical workup results
    • Rationale provided for mental health referral
    • Assurance of ongoing medical follow-up care and collaboration with mental health specialist
  • Mental health evaluation involves the following:
    • Quantifying the pain
    • Observation scales used with preschool-aged children
    • Direct scaling techniques that ask that young children pick out from a graded series the drawings of faces that match the way they feel
    • Pain questionnaires for older children and adolescents
    • Screening instruments, such as the Child Behavior Checklist, to identify children with somatic symptoms and possible somatoform disorders
    • Comprehensive structured interviews, such as the Diagnostic Interview for Children and Adolescents (DICA), that contain questions on somatization
    • The Personality Inventory for Children (PIC), which has been used in the diagnosis of somatoform disorders in children
    • Projective tests that may help clarify underlying psychological issues and add to the evidence for a somatoform diagnosis, including the Thematic Apperception test (TAT), the Children's Apperception Test (CAT), the Rorschach, and sentence completion
  • Psychoeducational evaluation is recommended for patients with academic difficulties and prolonged school absence.

More on Somatoform Disorder: Pain

Overview: Somatoform Disorder: Pain
Differential Diagnoses & Workup: Somatoform Disorder: Pain
Treatment & Medication: Somatoform Disorder: Pain
Follow-up: Somatoform Disorder: Pain
References
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References

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Further Reading

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Keywords

somatoform disorder, pain disorder, recurrent abdominal pain, headache, limb pain, chest pain, anxiety, depression, psychosomatic pain, suicide, gut dysmotility

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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.

Medical Editor

Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center
Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck 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, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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