Pain Somatoform Disorder Clinical Presentation

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

History

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

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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

  • 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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