Testing & Diagnosis for Somatic Symptom and Related Disorders

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When an SSD is being considered, a pediatrician and a mental health clinician should evaluate the child or adolescent from physical, psychological, social and developmental angles, both separately and in relation to each other. Having an SSD does not exclude the possibility of a physical illness, and vice versa. Both can and often coexist in the same child, so evaluation from multiple perspectives is key.

In evaluating for SSDs, clinicians will consider whether a child’s symptoms are more frequent and intense than the passing somatic symptoms we all experience, whether the child is having excessive and persistent thoughts and anxiety about existing physical symptoms, and whether the symptoms interfere with daily life, including school, home life and/or peer relationships

Medical evaluation

Medical evaluation is based on symptoms and guided by any previous tests the child or adolescent may have had. Many youth with SSDs have been subjected to a variety of medical tests already, so any medical work-up is balanced with the need to avoid unnecessary and potentially harmful tests and procedures.

Generally, in children and adolescents with SSDs, the physical examination will find that the symptoms change in different contexts, may not be consistent with any medical findings or may be more severe than what would be expected from the medical findings.

Psychological evaluation

If an SSD is suspected, a psychiatric consultation can help the child’s care team understand what may be contributing to the child’s distress and which treatments are likely to be most effective. Through careful interviews with the child and family, the team will seek to get a picture of:

  • the nature of the physical symptoms
  • the history of any past episodes of symptoms
  • how the child is functioning emotionally, socially and academically
  • how the child and family are currently coping with the symptoms
  • family life in general
The psychiatric clinician will also evaluate the child for mood and anxiety disorders. These disorders often accompany SSDs and can themselves cause physical symptoms that tend to go away when the mood/anxiety disorder is treated.
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