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Key Features

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Essentials of Diagnosis
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  • A symptom suggesting physical dysfunction

  • No physical disorder accounting for the symptom

  • Symptoms causing distress, dysfunction, or both

  • Symptoms not voluntarily created or maintained, as in malingering

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General Considerations
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  • Includes body dysmorphic disorder, conversion disorder, hypochondriasis, somatization disorder, and somatoform pain disorder

  • Body dysmorphic disorder: Manifests as preoccupation with an imagined defect in personal appearance

  • Conversion disorder: Defined as symptom onset follows psychologically stressful event; symptoms express unconscious feelings and result in secondary gain

  • Hypochondriasis: Characterized by preoccupation with worry that physical symptoms manifest unrecognized and threatening condition; medical assurance does not provide relief from worry

  • Somatization disorder: Defined as long-standing preoccupation with multiple somatic symptoms

  • Somatoform pain disorder: Manifests as preoccupation with pain that results in distress or impairment beyond what would be expected from physical findings

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Clinical Findings

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  • Most common symptoms include neurologic and gastrointestinal complaints

  • In conversion disorder

    • Symptoms include unusual sensory phenomena, paralysis, vomiting, abdominal pain, intractable headaches, and movement or seizure-like disorders

    • Symptoms and examination findings are not consistent with the clinical manifestations of any organic disease process

    • Physical symptoms often begin within the context of a family experiencing stress, such as serious illness, a death, or family discord

    • On closer examination, the child's symptoms are often found to resemble symptoms present in other family members

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Diagnosis

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  • Clinical

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Treatment

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  • In most cases, conversion symptoms resolve quickly when the child and family are reassured that the symptom is a way of reacting to stress

  • The child is encouraged to continue with normal daily activities, knowing that the symptom will abate when the stress is resolved

  • If the symptom does not resolve with reassurance, further investigation by a mental health professional is indicated.

  • Comorbid diagnoses such as depression and anxiety disorders should be addressed, and treatment with pharmacologic agents may be helpful

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Outcome

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Prognosis
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  • Patients with somatoform disorders are often resistant to mental health treatment, in part fearing that any distraction from their vigilance will put them at greater risk of succumbing to a medical illness

  • Psychiatric consultation is often helpful

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References

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Andresen  JM  et al: Physical symptoms and psychosocial correlates of somatization in pediatric primary care. Clin Pediatr (Phila) 2011 Oct;50(10):904–909
[PubMed: 21576182] .
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Campo  JV  et al: Physical and emotional health of mothers of youth with functional abdominal pain. Arch Pediatr Adolesc Med 2007 Feb;161(2):131–137
[PubMed: 17283297] .
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Ginsburg  GS, Riddle  MA, Davies  M: Somatic symptoms in children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 2006 Oct;45(10):1179–1187
[PubMed: 17003663] .
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Goldbeck  L, Bundschuh  S: Illness perception in pediatric somatization and asthma: complaints and health locus of control beliefs. ...

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