Somatic

Symptom and
Related
Disorders
PGI EKP
 What is Somatic Symptom?

• "Somatic symptom" refers to a physical or bodily symptom experienced by an individual.

• These symptoms are perceived as originating from the body and are often related to
sensations or functions such as pain, fatigue, weakness, or disturbances in bodily functions.

Somatic Symptom and Related Disorders

• classified on the basis of physical symptoms associated with significant distress

and impairment, with or without the presence of a diagnosed medical condition.
Somatic Illness Anxiety
Symptom Disorder
Disorder

Conversion Specified/
Disorder DSM 5 Somatic Unspecified Somatic
Symptom and Symptom Disorder
Related Disorder

Factitious Physiological Factors

Disorders affecting Other Medical
Conditions
 Epidemiology

• Between 10% and 30% of children worldwide

10 % experience physical symptoms that are seemingly
unexplained by a physical illness.

30 % • Many children with persistent complaints of abdominal

pain meet criteria for somatic symptom disorder with
predominant pain in DSM-5.
• Headaches and back, limb, and chest pain are also
frequently occurring pain symptoms in adolescents.
Somatic
Symptom
Disorder
Conversion
Disorder
Factitious
Disorder
Illness Anxiety
Disorder
Specified/
Unspecified Somatic
Symptom Disorder
 Physiological Factors
affecting Other Medical
Conditions
 Risk Factors

Individual

Coping Styles Psychiatric Comorbidity

more common in children who are conscientious, There is an association between somatization and
sensitive, insecure, and anxious, and in those who other psychiatric illness, in particular depressive
strive for high academic achievement. and anxiety disorders.

Learned Behavior Childhood Physical Illness

Somatic complaints may be reinforced through a An antecedent history (e.g., accident, viral illness)
decrease in responsibilities or expectations by may trigger onset of symptoms and lead to
others and through receiving attention and prolonged recovery or recurrence of symptoms after
sympathy. illness should have subsided
 Risk Factors

Family / Environmental

Symptom Modeling School & Family Stressors

a significant proportion of patients with SSRD had Common school stressors :

recently encountered similar symptoms in their -bullying,
local environment or live with family members -fear of academic failure
who complain of similar physical symptoms - extracurricular school activities.

Parental Responses Genetic & Biologic Vulnerabilities

Parent beliefs about the significance of symptoms Genetic and biologic vulnerabilities (e.g., increased
influence the extent of symptoms the child reports. pain sensitivity) are thought to contribute to SSRDs.
Somatic complaint may be more acceptable or
noticed in some households than the expression of
strong emotions
 Assessment

ASSESSMENT Medical
• Medical History
Patients with SSRD present • Physical Examination
• Diagnostic Tests
in pediatric setting >
mental health setting.

Diagnosis should be based

on positive symptoms and
signs rather than the absence Psychosocial
of a medical explanation. • Psychiatric History
• Stressors
• Coping mechanisms
 Management

• A multidisciplinary team meeting of pediatric and mental health clinicians

should be arranged to review all the specialty evaluations and tests and
discuss diagnostic impressions and treatment recommendations.

• An informing meeting or conference with the family should be facilitated

after the team meeting to convey the multidisciplinary team’s diagnostic
impressions and treatment recommendations to the patient and family.

• Pediatric and mental health clinicians together should communicate the

diagnosis in a way that families can understand using a comprehensive
biopsychosocial formulation.
 Treatment

• Rehabilitation model provides a useful framework for treatment that shifts the focus
away from finding a cure for symptoms, and instead emphasizes a return to normal
adaptive functioning.
- increased activities of daily living
- improved nutrition
- enhanced mobility
- return to school and socialization with peers.

• Cognitive behavioral therapy (CBT)

- is the evidence-based intervention of choice.
- CBT techniques (relaxation training, biofeedback , hypnosis)
 Treatment

• A medical home model with mental health clinicians working in collaboration with
pediatric practitioners and/or different pediatric specialists may prove to be the most
suitable approach for patients with SSRD.

• In addition to discussions with the school guidance counselor and nurse, a letter for
the school providing education and recommended approaches for the patient’s
symptoms is often beneficial

• Ongoing communication between the school and the primary care provider for
monitoring of further symptoms is recommended.
THAN
K
YOU!!