Dr. Jnanendra N. Sharma
(The writer can be reached at drjnanen@rediffmail.com)
Many a time, children present with physical symptoms that are either without clear medical cause or where an emotional component appears to play a significant role in the child’s illness. There is an increasing trend of this disorder among children.
Technically it is called a psychosomatic disorder. Psyche means mind and soma means body. Hence it is a disorder involving both mind and body.
Psychosomatic symptoms suggest the occurrence of one or more physical complaints for which appropriate medical evaluation does not reveal any explanation. Due to various reasons, there seems to be an increasing trend of this type of illness in children. However, it should be noted that a group of mental disorders may also present with physical signs.
Psychosomatic disorders are not uncommon in children. Changing lifestyle, family organization issues and stressful environment are important risk factors. Differentiating an organic disorder from psychosomatic symptom is important as it radically alters the approach to management.
The prevalence of psychosomatic complaints in children and adolescents has been reported to be from 10-25 per cen. The female to male ratio is 2:1.
Two groups of children can present with psychosomatic disorders: one in whom a physical disorder is already present and the psychosomatic element lies in emotional exacerbation of existing somatic symptoms. The examples of such a disease are asthma, allergic skin disease etc.
In the other group there is no identifiable predisposing physical disorder. The psychosomatic element is apparent in the transformation of emotional disturbances into somatic symptoms.
Characteristics that favour a psychosomatic basis for the symptoms include the following:
Common issues causing psychosomatic symptoms:
Psychologist Leslie LeCron has identified the following seven common issues that cause psychosomatic symptoms.
Conflict in the child’s mind pulls him/her in two directions and this creates discomfort. A conflict occurs when children are compelled to do something when they feel that they should do the opposite.
Organ language refers to use of a phrase that use a part of a body or organ in day-to-day conversation by adults. For example –“This man is a headache for me.” This may initiate a psychosomatic complaint. That is the child may start complaining of headache.
Motivation of children to have a symptom in order to solve a problem can happen. For example a child complaining of pain abdomen to avoid school.
Past experience of an emotional episode which is still affecting the child can be one of the causes of symptoms. Similarly, memory of a disturbing scene in the past may initiate a complaint like headache.
Identification of a symptom occurs when there is a strong emotional relationship to a person who has the same complain. A good example of such a complaint is backache by an adolescent girl which she might have identified with her grandmother.
Self-punishment may seem sometimes necessary to compensate a feeling of guilt. The subconscious mind dispenses this as a form of self-punishment. A typical example is complaint of pain abdomen by an adolescent child with eating disorder as a punishment response to binge eating.
Suggestion indicates a comment passed by an authoritative person. For example a comment like “the child may get giddiness after some particular activity” may actually induce giddiness as a psychosomatic complaint.
Family organization
Besides the above mentioned typical causes, family organization is an important factor to be remembered. Three important conditions for the development and maintenance of psychosomatic problems in children have been identified. They are:
Presenting symptoms
The child may present with a variety of symptoms like (i) headache (ii) sleep disorders (iii) vomiting (iv) dizziness (v) lack of appetite (vi) increased fatigue (vii) daytime sleepiness (viii) emotional liability (ix) irritability (x) impulsiveness (xi) reduced attention span (xii) poor memory (xiii) bed wetting (xiv) chest pain, pain in the limbs, back pain, generalized body ache (xv) difficulty in breathing (xvi) bloating (xvii) muscle twitching, numbness of body parts (xviii) pain during menstruation and during passing stool.
The reactions usually occur when exposed to stress. They are usually short lived. They arise after a child experiences an unpleasant circumstance.
Functional or organic?
Two types of psychosomatic disorders can occur: functional or organic.
A functional disorder is one where there is no structural damage to any organ in the body. It is connected, apparently with a single adverse circumstance or recurring difficulties in life. Here the symptoms are diverse and related to a system viz.
Organic psychosomatic diseases have a structural defect in the organs but symptoms are triggered or exaggerated by psychological factors. The examples are allergic disorders like asthma, allergic dermatitis and allergic rhinitis, peptic ulcer etc. The child present with the symptoms related to the particular disease only.
Diagnosis
Management
For the functional type, psychotherapy is the most effective method of management. A multi-model approach is found to be useful which should include cognitive family behavioural therapy among other modalities. It is found to be the mainstay. Relaxation techniques viz. yoga is useful, especially in adolescents.
However, for the organic type the child needs diagnosis and treatment of the organic cause as well as psychotherapy.