Somatization in everyday life
Everyone experiences somatization. For example, after a tough day, you may experience muscle tension, a headache or tiredness. If you feel anxious, for instance before giving a presentation, you may have nausea or an upset stomach. If you are annoyed or upset, your muscles may tense up. These are all examples of how people can express their emotions through physical symptoms.
Disorders related to somatization
When somatization causes distress, impairs a person's quality of life and becomes a focus of medical attention, it is diagnosed as somatic symptom disorder or conversion disorder. A person who seeks medical attention for somatization might be described as having functional symptoms.
Some children may have somatic symptom disorder and/or conversion disorder alongside a medical condition. Other children with medical conditions may have an element of somatization to partly explain the symptoms. In this case, they may be diagnosed with Psychological Factors Affecting their Medical Condition.
Doctors consider somatization when a child or teen has physical symptoms that:
- are more severe, and have a greater impact on daily life, than would be expected based on their medical condition
- cannot be entirely explained by the medical condition.
Somatic symptom disorder
When a person has somatic symptom disorder, a lot of thoughts, feelings and behaviours become connected to their physical symptoms. A child may have a medical condition, but their symptoms impair their routine and cause them more distress than would be expected from the medical condition on its own.
Examples of somatic symptoms may include:
- pain
- fatigue
- shortness of breath or coughing
- heart palpitations
- fainting
- dizziness
- nausea, vomiting, stomach ache or diarrhea
- needing to urinate often.
Conversion disorder
When a person has conversion disorder (also known as functional neurological symptom disorder), they experience distressing neurological symptoms that cannot be explained by a physical examination, including neurological examination, or tests.
Conversion disorder symptoms typically affect a person's movement or senses. Examples include:
- sensory loss, including numbness or vision problems
- weakness or paralysis
- abnormal movements
- seizure-like episodes
- problems with swallowing
- problems with speech.
Somatization is more common in children and teens with pre-existing medical problems or injuries.
What are some underlying causes of somatization?
Response to illness or injury
Often, children and teens who experience somatization may have had an illness or injury but then have a longer-than-expected recovery. The illness or injury may have caused them to be more aware of their body's sensations, including pain.
When illness or injury affects children and teens who are perfectionists or over-achievers who are used to excelling at school or elsewhere, they may feel like they are no longer speeding along the fast lane of the highway but instead are stalling at the side of the road. They might feel overwhelmed about 'starting the car', never mind getting back to their previous fast pace. They might compare themselves to their friends and peers, which can make recovery more difficult.
Response to stress and uncomfortable emotions
Some children and teens may have experienced stressful situations such as time away from school, a drop in marks, a conflict with a friend or teacher, stress in the family, death of a loved one or a traumatic event.
These situations may have led to uncomfortable emotions such as anxiety, sadness, fear, shame, embarrassment or anger. The child or teen may avoid thinking about stressful situations, minimize how they affect them or push down any difficult emotions. If there is any stigma with expressing emotions, the family may pay more attention to and offer sympathy for physical symptoms than for the child expressing difficult emotions. In addition, some children and teens find it difficult to label their feelings.
Stressful situations affect children and teens in different ways. When children are under stress, they may become sad, scared or mad. Their behaviour may also be affected, and they may become withdrawn or act younger than their age. They may get into arguments or fights. When children and teens find it hard to talk about what has been stressful, it can activate the fight, flight or freeze response and increase the chance of distress showing up through somatic (physical) symptoms. In this way, somatic symptoms are the body's way of talking when a child or teen cannot express what is troubling them.
Does somatic symptom disorder or conversion disorder occur with other mental health conditions?
Children and teens with somatic symptom disorder and/or conversion disorder may have other mental health conditions such as depression, anxiety, ADHD or a learning disability. In addition, up to 40 per cent of children and teens with medical conditions have mental health conditions.
A number of mental health conditions, such as depression and anxiety disorders, may also have a component of somatization. For instance, children and teens with depression may often have fatigue and headaches. Those with anxiety disorders often have headaches, muscle tension and nausea.
How is somatization assessed?
If your child has significant physical symptoms that cause them to miss school or activities, it is important to see a family doctor or paediatrician. Just as doctors try to find the cause of a fever, and not just treat the fever, they need to understand what causes distressing and impairing physical symptoms.
A detailed assessment using a biopsychosocial, or holistic, approach can help to explore the possible causes for your child's physical symptoms and their impaired routine. A biopsychosocial approach involves considering the biological, psychological and social factors that might have started the physical symptoms, as well as those that trigger the return of symptoms or make them worse or better.
- Biological factors are the physical causes of symptoms, such as an illness, a health condition or an injury.
- Psychological factors include any ways of thinking, stress and/or uncomfortable emotions.
- Social factors could be any stressors or other features in a child's or teen's environment, whether at home, at school or with friends.
A biopsychosocial approach can explore not only the symptoms but also their context and their impact. These can all highlight opportunities for treatment.
A child or teen who is assessed for somatization should also be checked for other mental health concerns such as:
- depression
- anxiety
- eating disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder and ARFID
- ADHD
- learning difficulties.
Health-care professionals involved in assessment
Depending on your child's symptoms and their impact on your child's life, your child may be assessed by a range of health-care professionals. They include:
- paediatric specialists such as neurologists and gastroenterologists
- a dietitian
- rehabilitation specialists such as occupational therapists, physiotherapists and speech and language therapists
- mental health professionals such as psychologists, psychiatrists and social workers
- a behavioural analyst, if your child's behaviour seems to be regressing (returning to a less developed stage).
A case manager for your child can work to make sure there are adequate resources and good communication between the health-care professionals if many people are involved in assessing your child at the hospital and in the community.
