Somatic emotional disorders in childhood and adolescence

We conducted a short-term follow-up study of severe somatic emotional disorders in 93 children and adolescents. Our aim was to investigate whether the type of physical presentation influenced the outcome in terms of symptoms and subsequent use of medical services. Three groups of patients were identified. Two groups presented with neurological symptoms and were divided into a pseudo-epilepsy group (n = 23) and other hysterias (n = 30); and a third presented with non-neurological symptoms which we termed 'other somatic presentations' (n = 40). Cases in the hysteria groups were significantly more likely to be female and post-pubertal. Polysymptomatic presentations accounted for 85% of all cases and were as common in boys as in girls at all ages. The greatest number of symptoms was found in the pseudo-epilepsy group. None of the hysterias met DSM III-R criteria for somatization disorder. Outcome in terms of residual physical symptoms and subsequent use of medical services was poorest for the pseudo-epilepsy group, and nearly 40% of these patients were judged by their general practitioner to be unchanged since discharge. By comparison, 85% of all other somatic cases were judged improved since discharge from hospital out-patients. Neither polysymtomatic presentations nor persistent physical symptoms at discharge predicted a poor outcome in any group. The general practitioners considered the psychiatric treatment to have been helpful in the majority of cases, even when the somatic outcome was rated as unchanged.