Somatic Symptom Disorder Basics

Children with somatic symptom disorder worry excessively about physical symptoms that are fairly routine — headaches, stomachaches, nausea or fatigue — which they interpret as signs of serious illness. Here's a brief overview of the signs and symptoms of somatic symptom disorder, and how it's treated in children and adolescents.

Somatic Symptom Disorder: What Is It?

Children with somatic symptom disorder worry a great deal about having an illness. They are not plagued by imaginary symptoms, but by the intense worry generated by actual physical symptoms that are usually mild and inconsequential but have been misinterpreted by the child. The headaches, stomach aches, rashes, fatigue and nausea experienced in everyday life prompt them to spend disproportionate time and energy worrying about the possibility that they have a serious, life-threatening illness.

Sometimes a child who has a concurrent medical illness is diagnosed with somatic symptom disorder as well, when her fears and preoccupation with the illness causes more impairment than would be expected from the physical illness alone.

Somatic Symptom Disorder: What to Look For

Kids with somatic symptom disorder misinterpret the mild aches, pains and other symptoms associated with daily living as indications that they have a serious illness—a headache might mean a brain tumor, or a bruised knee might “guarantee” hemophilia. They may fear that physical activity will damage their bodies. Some children will resist going to see the doctor, either because they are afraid of receiving confirmation or because they believe their illness is already a hopeless case. Others will frequently visit the doctor and the nurse’s office at school, and may even engage in “doctor shopping” when their physician won’t diagnose their feared illness. These kids may have unnecessary medical procedures, spend time researching diseases on the Internet, and constantly seek reassurance from their parents. Children with the disorder are not faking their fear. Somatic symptom disorder causes acute anxiety, and interferes with a child’s performance in school, as well as  with relationships with family and friends.

Somatic Symptom Disorder: Risk Factors

Risk factors for somatic symptom disorder include adversity, stressful life events, and other psychiatric conditions like depression or anxiety.  Girls are more likely to have this condition than boys.

Somatic Symptom Disorder: Diagnosis

To be diagnosed with somatic symptom disorder a child must display a severe preoccupation with having a physical illness. She must interpret physical symptoms—like headaches or stomach aches—as indications of something far more serious, and be so anxious and distracted that it interferes with school, home life, and social development. Before concluding that it’s a disorder a doctor will do a physical examination and appropriate laboratory work to make sure that the child is not actually ill.

Somatic Symptom Disorder: Treatment

Therapists frequently employ cognitive behavioral therapy (CBT) to help children identify the thoughts that fuel their anxiety reactions, with the goal of stopping behaviors that worsen their fear. Through CBT kids with somatic symptom disorder can learn to accept that their thoughts are just thoughts, and not proof of any physical illness.

After a child has some success with CBT, she may undergo exposure and response prevention therapy, which exposes kids to feared thoughts and stressors in a therapeutic setting, to gradually diminish their power and train the child not to react. For example, a boy who frequently monitors his vital signs might be asked to refrain from checking his pulse for a set period of time. A child afraid of going to the doctor might be asked to call the doctor’s office and make an appointment. Similarly, parents can be trained to be less reactive through exposure therapy. The therapist can also help families establish guidelines about when to call the pediatrician.

Pharmacological: Antidepressant medications such as SSRIs are sometimes prescribed to help relieve symptoms of anxiety.

Somatic Symptom Disorder: Risk For Other Disorders

Somatic symptom disorder often occurs alongside anxiety or depression, or a concurrent medical illness.