Paediatric Somatic Symptom Disorder Causes And Symptoms

Introduction 

Paediatric somatic symptom disorder (SSD) (also known as psychosomatic disorder) is characterised by persistent, impairing physical symptoms influenced by emotional distress among children and adolescents, usually without medical explanation, accompanied by excessive thoughts, feelings or behaviours related to them.^1,2 Due to its wide range of causes and symptoms, such as pain, sleeping problems, gastrointestinal, neurological, cardiac and respiratory issues.³ Despite its involuntary, and biologically “real” nature, it can be hard to diagnose. 

These can exacerbate the children’s excessive worry about their physical symptoms, interfering with daily activities, schooling, and social interactions.² Thereby, a clear understanding of paediatric SSD causes and symptoms is essential for early detection, effective diagnosis and intervention to improve your children's well-being and quality of life. 

This article will provide you with some insights into its causes and symptoms, along with its prognosis and long-term outlook.  

Causes 

Regarding the medically complex nature of PSSD, its aetiology will be explained through the biopsychosocial perspectives, covering the respective occurring factors. 

Environmental factors  

Family dynamics and parenting styles 

Family is undeniably the most important to children. However, family stressors have been classified as the most frequent precipitating factor of Paediatric SSD, some common characteristics are found among children with medically unexplained symptoms.^4,5

• High achieving
• Extremely compliant
• Well-behaved 
• Families with somatic preoccupation, recurrent physical complaints  
• Family history of substance abuse, psychiatric disorders 
• Families do not easily allow (verbal) negative emotional expressions 
• Families discouraging bodily sensations or symptoms 
• Overprotective ^4,5,6

Peer relationships and social influences

The school has been the second stressor of paediatric somatic symptoms and related disorders (SSRD) patients.⁴ Not only peer relationships had been the most compelling school stressor.⁴ Negative peer relationships, such as rejection, bullying, and social isolation, can contribute to increased stress and emotional distress, thus somatic symptoms manifest as a coping strategy. 

Furthermore, social learning as a result of observations and modelling, could play a significant role. When witnessing family or peers receiving attention through somatic symptoms or physical complaints, children would more likely adopt similar behaviours for attention or support seeking.⁶   

Sociocultural expectations

Sociocultural expectations can also contribute to PSSD occurrence. PSSD is more commonly reported in people associated with female at birth (AFAB) than people associated with male at birth (AMAB) due to personality differences among genders.⁴ Stress and unhappiness among children in China would have a higher chance of manifesting into psychosomatic symptoms, due to their preservative culture.⁶  

Biological factors

Genetic predisposition

Heritability has played a significant role in medically unexplained symptoms. 

Not only does parental mental health or somatization affect both a child’s genetic inheritance and physical environment but it is also found to contribute to their kids’ somatic symptoms display.⁵ 

Traits such as “novelty-seeking” associated with the dopamine D4 receptor, behavioural inhibition, perfectionism, obsessionality, or anxiety are some of the traits more prone to somatic symptoms development.⁵ 

Neurological abnormalities

Neurological abnormalities play a significant role in paediatric somatic symptom disorder. Dysregulation in brain regions involved in pain processing, such as the anterior cingulate cortex and insula, contributes to heightened pain sensitivity.⁶ Brain-gut axis alternations and dysfunctioning hypothalamic–pituitary–adrenal axis (HPA axis) also contribute to the somatic symptoms manifestation and maintenance of affected children.^5,7

Physiological responses to stress

Physiological responses to stress can trigger somatic symptoms in children. When children face stress, their sympathetic nervous system will be activated by the release of cortisol, triggering a wide variety of physiological changes.⁷ Hence, contributes to the development and persistence of somatic symptoms. 

Psychological factors 

Anxiety and other mental health disorders

Anxiety and other mental health conditions play a significant role in PSSD. Children with anxiety may experience increased physiological arousal, with amplified bodily sensitivity, triggering somatic symptoms. Co-occurring mental illnesses, such as depression, obsessive-compulsive disorder (OCD) and other emotional disorders, can also contribute to the development and maintenance of somatic symptoms among affected children.⁵ 

Trauma or adverse childhood experiences

Trauma or adverse childhood experiences could contribute to PSSD. The defence mechanism of conversion and insecure attachment underlies the psychodynamic explanation, where somatic symptoms represent unconscious conflicts.⁶ Somatic symptoms are also found among children who experienced family bereavements and sexual abuse, loss of independence and friends.⁵ 

Cognitive and emotional factors

Cognitive and emotional factors also play a role in paediatric SSD. Poor self-concept, catastrophizing, rumination, avoidance of problem-solving, and difficulty managing emotions can contribute to the development and maintenance of somatic symptoms.⁸ Cognitive processes such as distorted beliefs about health, attention biases, and interpretive biases could further influence the perception and interpretation of bodily sensations.⁵ 

Symptoms 

Paediatric SSD is a complex medical condition, children could experience a wide range of symptoms that are unable to be fully explained by an underlying medical condition. 

Physical symptoms 

While recurrent abdominal, and musculoskeletal pains and headaches are the most common, different symptoms can coexist.  

Persistent pain

Children with SSD frequently complain of persistent pain, such as headaches, muscle aches, back pain and abdominal pain.^3,9 While these pains can be localised or generalised, varied in intensity.¹⁰ They are often worse during the day, with resolve at night and school holidays, leading to distress and interfering with daily activities.¹¹

Neurological issues 

Children may experience unexplained neurological symptoms. While weaknesses and fatigue can be chronic, even after adequate rest. They might complain of physical or mental exhaustion that is disproportionate to their efforts, sleeping problems, poor concentration, posing difficulties in participating in regular activities.^3,10,11 Psychogenic nonepileptic seizures that are inconsistent with that of an abnormal EEG can also occur.¹⁰  

Gastrointestinal issues

Among Pediatric SSD, children may present with gastrointestinal symptoms, such as nausea, bloating, constipation, or diarrhoea. They can be chronic, and misdiagnosed as irritable bowel syndrome (IBS) yet, may not be linked to any specific gastrointestinal medical conditions.^3,11  

Cardiac and respiratory issues

Paediatric SSD can elicit cardiac and respiratory issues. Children may feel pain and tightness in their chest, palpitations, as well as breathlessness, which not only hinders their daily functioning, meanwhile heightens their distress to their physical symptoms.^{3, 11}  

Emotional and behavioural symptoms 

Paediatric SSD can manifest through various emotional and behavioural symptoms, impacting a child’s daily life and well-being. 

Anxiety and worry

Children with SSD often experience excessive anxiety and worry regarding their physical health. They may frequently be concerned about their symptoms and fear the worst-case scenarios, leading to heightened stress and anxiety levels, in turn exacerbating their bodily symptoms.^12,13

Depression and irritability

The chronic and persistent somatic symptoms can trigger feelings of sadness and hopelessness among the affected children. They may also become easily frustrated, and irritable, with emotional instability due to their physical discomfort.¹³ 

School avoidance and academic difficulties

SSD can significantly interfere with a child's ability to attend school regularly. Fear of symptoms or concerns about being judged by peers can lead to school avoidance. Consequently, academic performance may suffer, leading to difficulties keeping up with coursework.^12,13  

Social withdrawal and isolation

Children with SSD may withdraw from social interactions and isolate themselves from family and friends, due to their self-consciousness and embarrassment to their symptoms. This could lead to decreased social participation and a sense of isolation and detachment from others.^12,13 

Cognitive symptoms 

Excessive attention to bodily sensations

Children with SSD often exhibit heightened awareness and focus on bodily sensations. They may excessively monitor and interpret normal bodily functions, such as heart rate or breathing, as indicative of severe medical conditions, leading to increased distress and anxiety.¹⁴ 

Preoccupation with illness or disease

These children may have persistent thoughts and concerns about being sick and developing serious medical conditions. They might research symptoms online frequently, consult medical resources, and seek constant reassurance from caregivers and healthcare professionals throughout extensive medical checkups.¹³  

Fear of having a serious medical condition

Children with SSD often experience irrationally intense fear, worry and exaggerated responses to symptoms of severe illness development, despite medical evaluations indicating otherwise. They tend to interpret minor physical as evidence of life-threatening conditions, leading to constant stress and hypervigilance.¹³  

Prognosis and long-term outlook 

The prognosis of Paediatric SSD can vary based on symptom duration, severities, and presence of co-occurring disorders. Though some can still experience residual symptoms or occasional relapses, with early CBT, family therapy, and medication interventions, children with SSD can still have significant symptom improvement and enhanced overall well-being in general. 

By creating a supportive environment involving the collaboration of healthcare providers, parents, and educators, healthy coping can be promoted, thus preventing long-term functional impairment. 

Ongoing monitoring, and follow-up care, are essential for optimising the long-term outcomes of paediatric SSD, facilitating your child's return to their schooling and enjoyable activities engagements.³  

Summary 

Paediatric somatic symptom disorder is the disproportionated physical symptoms to any underlying medical condition. The causes and symptoms are wide-ranged from biological, psychological, and social factors, and vary from pain, fatigue, gastrointestinal, and neurological issues. Due to the high variability, yet significant emotional distress and functional impairment it imposes. Careful differentiation between genuine medical conditions and SSD is essential for appropriate care. Please don’t hesitate to consult a healthcare professional if any physical symptoms or emotional distress are discovered in your children. Early identification for comprehensive assessment, and healthcare collaborations are crucial in optimising your child's daily functioning and overall well-being.

FAQs 

When should I see my healthcare provider?

Bring your child to a healthcare provider if signs of suicidal behaviours related to depression and anxiety are shown. Warning signs could include:

• Sudden changes to their mood or personality
• Withdrawing from social situations
• Self-injury
• Feeling helpless
• Talking about wanting to die

What is the difference between illness anxiety disorder and somatic symptom disorder?

Illness anxiety disorder is the preoccupation and excessive worry of having an illness; however, unlike SSD, they don’t usually experience physical symptoms. 

What’s the difference between conversion disorder and somatic symptom disorder?

Conversion disorder involves nervous system dysfunctioning without evidence of physical or neurological causes, which primarily affects perception, sensation, or mobility. Excessive physical symptoms are not the main part of conversion disorder.