Somatic Symptom and Related Disorders

“The absolute worst thing is that no one wants to believe you, no one wants to take care of you.”
Julie, 14-year old girl with recurrent abdominal pain

Somatic Symptom and Related Disorders (SSDs) are a group of diseases in which youth have physical symptoms that are either very distressing or result in significant disruption of their daily functioning, as well as excessive thoughts, feelings and behaviors regarding those symptoms. The symptoms are typically more severe than would be expected for an existing medical problem or may occur in the absence of a clear medical problem.

SSDs are common in both children and adolescents, occur across cultures and can begin as early as the preschool years. Other names for them include somatoform disorders, conversion disorders, psychological factors affecting medical conditions, or psychosomatic disorders. They have also been called functional disorders (such as functional pain disorders, functional gastrointestinal disorders, or functional neurological symptom disorders).

It is not unusual for youth with SSDs to see a variety of medical specialists and undergoing multiple medical tests in search of an answer, often with little or no positive findings. Despite this, it’s important to know that SSD symptoms are real, distressing, and can cause significant impairment and disability.

The mind-body connection

While many people view the body and the brain as separate, scientific research has shown that the two are closely linked and that psychological and social factors can influence how our bodies function. The body and the mind work together to promote well-being—what’s often called the “mind-body connection.”

SSDs may develop after a stressful event or a major change in a child’s life. As with adults, children and adolescents can express their stress through physical symptoms rather than through emotions or thoughts. Some children such as those with difficulty putting feelings into words or those who associate stigma to psychiatric illness seem to be especially susceptible.

Most people experience physical (or somatic) symptoms as part of everyday life without having a medical disease. For example, many people get a headache before a stressful event, or experience stomach upset when asked to give a public speech. In youth, stresses can include things like pressure at school, being bullied, illness in the family, parents’ divorce—or any major change, good or bad. Sometimes even fun situations can be stressful to the body!

Although SSDs are connected with psychological stress, this does not mean that children are “faking” or having symptoms purposefully. In fact, they may not even perceive events in their life as stressful. It is not uncommon for children with SSDs to experience some of these events without feeling stressed in their mind, but rather their body expresses the stress in the form of physical symptoms.

Why are some children susceptible to SSDs?

While stressful situations or major life changes are the trigger for SSDs, several risk factors can make a child more vulnerable:

  • A tendency to keep feelings inside or “internalize” feelings
  • Learning difficulties that may affect how the brain identifies and understands emotions
  • Genetic factors
  • Medical illness or injury

The last factor—medical illness—may seem puzzling as a risk factor, but sometimes, a medical illness like a stomach bug or an injury can activate an “alarm” that will not stop ringing in the brain. Even after the medical condition goes away, it can still trigger the development of an SSD. In these situations, children may experience physical symptoms of the illness or injury more intensely and frequently than is typical, may recover more slowly and/or may suffer other, unrelated physical symptoms.

Additionally, family environments where family members tend to get attention and sympathy for physical symptoms as opposed emotional symptoms can influence the amount and intensity of physical symptoms in a child.