[Somatoform disorders in children and adolescents]

Somatoform disorders among children and adolescents may cause impairment in educational and social functioning and generate a great deal of psychosocial distress. The diagnosis of such disorders is complex due to the fact that they may appear as medical conditions. Hence, most of somatoform patients do not seek psychiatric assistance. The common feature of somatoform disorders as described in DSM-IV-TR is the presence of physical symptoms suggesting an underlying medical condition that is either not found or does not account for the level of functional impairment. The diagnostic criteria for the somatoform disorders were established for adults and are applied to children for lack of child-specific research base and a developmentally appropriate alternative system. The most common somatoform disorders in children and adolescents are recurrent abdominal pain and tension headache. Other disorders in the category include: somatization disorder, undifferentiated somatoform disorder, conversion disorder, hypochondriasis and body dysmorphic disorder Treatment is applied through a combination of pharmacotherapy and psychotherapy. SSRI'S are effective in somatoform disorders that have co-morbidity with anxiety and depression as well as in body dysmorphic disorder and hypochondriasis. Conversion disorder is usually treated with benzodiazepines and pain disorder with light analgesics, tricyclics and tegretol. In terms of psychotherapy, treatments most effective for somatoform disorders have been found to be cognitive-behavioral therapy, hypnosis and biofeedback.