SOMATIZATION IN CHILDREN AND ADOLESCENTS
Somatization is used to describe mental illnesses that cannot be explained by organic reasons, are thought to be due to psychosocial or emotional factors, and occur with physical complaints and dysfunction. Patients with somatization complain of physical symptoms, or the symptoms are exaggerated to an extent that would not be expected from physical pathology. These patients, who attribute their somatic symptoms to a physical disorder, seek medical help. These patients create difficulties in the diagnostic approach and treatment for the physician.
Somatization is more common in adult female patients. To be diagnosed with somatization disorder, there must be a history of multiple physical complaints that occur over a period of several years, result in treatment seeking, or result in impairment in social, occupational, or other important areas of functionality, and begin before the age of thirty. Although somatic symptoms are frequently seen in children and adolescents, the diagnosis of somatization disorder is rarely made before adulthood. Because diagnostic criteria developed for adults are used, and the fact that these diagnostic criteria are excessive for children and the requirement for chronicity makes it difficult to make this diagnosis. Despite this difficulty in diagnosis, studies conducted with adult patients show that the complaints of 20% of patients diagnosed with somatization disorder started before adolescence.
Unexplained pain complaints are especially common in children and adolescents. Headache ranks first among pain complaints. In community screenings, the rate of children and young people reporting that they have headaches every day or frequently is between 10-30%. Other common pain complaints are abdominal pain (10-25%), extremity pain (5-10%)and chest pain (7-15%). Apart from pain complaints, dizziness, nausea and fatigue are the most common symptoms. Abdominal pain is reported more frequently in children and headaches in young people. Somatization is usually polysymptomatic and the number of symptoms increases with age.
Somatization is The disorder usually begins in adolescence. The incidence of somatic anxiety is high even in the adolescent population who do not apply to clinics. In screening studies, it is seen that 40% of children and adolescents are frequently worried about their health, and 20% are always worried. It is stated that girls are more anxious than boys.
Various somatic complaints are most frequently seen in early adolescence. While abdominal pain is frequently found in early childhood, headaches and extremity pain become more prominent as age progresses. While the rate of somatic symptoms in childhood is equal in girls and boys, it is significantly higher in girls during adolescence.
Somatization in children and adolescents is often accompanied by other psychiatric disorders. Depression and anxiety disorders are especially observed in these patients, and separation anxiety disorder and panic disorder are the most common anxiety disorders that accompany somatization. Somatization can cause significant impairment in academic and social functioning. School loss can affect academic achievement. These children have difficulty maintaining peer relationships. They cannot overcome age-appropriate developmental issues. Excessive dependence on parents and low self-esteem are common. It seems that overachieving girls are more prone to chronic somatic complaints than boys.
There are various opinions about the reason why somatization occurs.
1- Psychodynamic explanation. :The psychodynamic explanation is that unconscious conflict, desires or needs are turned into a somatic dysfunction. The resulting symptom symbolizes an impulse or conflict related to anxiety and protects the individual from anxiety. Transforming anxiety into a dysfunction will not only alleviate the anxiety (primary gain), but will also help the individual be cared for as a patient and keep away from responsibilities for a while (secondary gain). Gains such as the patient getting rid of unpleasant emotions or internal conflicts, receiving attention and compassion from the people around him, the elimination of negative behaviors, avoiding responsibilities, and social reinforcement also improve the disease. It plays an important role in the continuation of the However, both primary and secondary gains are unconscious, and it is wrong to blame the patient for these gains and get angry with the thought that he is faking it.
2- Biological factors: It is thought that genetic factors may play a role in the etiology of somatization disorder. . Various somatic symptoms are often seen in the family of a child with somatization.
3- Learning theory: A child who has a minor accident or illness can quickly learn the benefits of the sick role and recover. It may be reluctant or recurrent. Symptoms may recur, especially if the parents' concerns and curiosity about the disease are evident and if the disease allows the patient to get rid of the responsibilities that bother them. Similarly, the presence of a disease model in family members is highly correlated with the development of somatoform disorders.
4- Family system theory: According to this theory, certain types of family functioning may initiate somatic symptoms in children or cause somatic symptoms in children. Symptoms have a special function within the family system, preserving and maintaining family functionality and perhaps preventing conflict. For example; In a family, symptoms in a child can ensure that the family stays together and does not fall apart, or that ongoing conflicts can end. It is reported that these patients have marital problems in their families.
5- Expression of emotions and communication: In people who cannot express their emotions easily, the physical symptoms are the person's body language. These symptoms are a form of communication or a call for help. Similarly, if the expression of emotions is an undesirable behavior that is prevented within the family, this attitude will cause children with problems to develop physical symptoms.
6- Social and cultural factors: Cultural factors tend to somatization. or they play an important role in the selection of somatic symptoms. In repressive, conservative and religious cultures, repression of sexual urges or inability to freely express thoughts and feelings may cause symptoms to occur. In societies where psychiatric disorders are not well received, people with anxiety or depression may experience psychological complaints. Instead, they may seek psychiatric help due to physical complaints.
TREATMENT:
In child psychiatry, patient evaluation is done by examining the child and the family together and through detailed interviews. Here, the child's behavioral characteristics, developmental level, as well as family interactions are reviewed, and treatment is planned after clarification on the basis of diagnosis, psychiatric diagnosis, medical diagnosis and family dynamics formulation. Here, a more holistic approach is used, taking into account the child's developmental level, the family environment they live in, and their compliance with the treatment. Psychodynamic, supportive cognitive and behavioral techniques and individual psychotherapy, family therapy, group therapy and play therapy can be applied individually or in combination in ways appropriate to the child and family. In therapy, the relationship between the therapist and the child is the most important therapeutic element. This relationship should be positive, friendly and helpful. It is necessary to identify and treat other psychiatric disorders that accompany somatization, such as affective disorder, anxiety disorder, psychosis, or attention deficit and hyperactivity disorders. If these disorders are accompanied, drug treatment may be required. However, in child psychiatry, drug treatment is generally symptomatic and is used to reduce maladaptive behaviors, improve adaptive behaviors in areas such as school performance, and provide greater benefit from psychotherapy. Initially, the child's psychopathology and physical condition in terms of susceptibility to side effects should be examined in detail. It is also important whether the people caring for the child will give the medicine regularly. The benefit and harm ratio of the drug should be taken into consideration and explained to the family.
If there are motor symptoms, physical therapy and exercises can be used in the treatment. This type of approach is generally easily accepted by the patient and ensures the patient's active participation in the treatment.
Somatization disorder often has a chronic course. It can cause significant impairment in patients' social and occupational functioning. Therefore, early treatment is very important.
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