Children with somatic symptom disorder worry excessively about physical symptoms that are fairly routine — headaches, stomachaches, nausea or fatigue -- which they interpret as signs of serious illness. The disorder presents conditions in which individuals experience physical symptoms that are not fully explained by the presence of a general medical condition after standard-of-care evaluations and diagnostic tests.
Dr. Thompson joins the show to provide a brief overview of the signs and symptoms of somatic symptom disorder, how it's treated in children and adolescents, and when to refer to a specialist.
Selected Podcast
Pediatric Somatic Symptom Disorder
Featured Speaker:
Learn more about Suzanne Thompson, PhD
Suzanne Thompson, PhD
Suzanne Thompson, PhD specializes in the diagnostic evaluation and cognitive-behavioral therapy for children ages 5-21 years, with primary focus on patients with chronic medical illness and associated emotional problems. She also provides Cognitive-behavioral therapy to children and adolescents with anxiety and sleep disorders.Learn more about Suzanne Thompson, PhD
Transcription:
Melanie Cole (Host): Welcome. Our topic today is Pediatric Somatic Symptom Disorder. And my guest is Dr. Suzanne Thompson. She’s a pediatric psychologist at St. Louis Children’s Hospital. Dr. Thompson what is somatic symptom disorder?
Suzanne Thompson, PhD (Guest): There are two core features. One involves a somatic symptom that’s longstanding and causes distress. Sometimes there can be multiple symptoms but you really just need one for the diagnosis and then the second criteria is excessive thought, worrying, it’s the time and energy. A lot of focus and preoccupation related to that symptom or health concern.
Melanie: So, what should pediatricians look for? As parents, we bring our children to the pediatrician and say oh, they’ve got headaches or stomach aches or joint pain or any number of things. What do you want pediatricians to know what red flags to be looking for?
Dr. Thompson: So, among kids, exactly. The examples you just gave, the most common things to look for with somatic symptom problems in kids and teens are abdominal pain, headaches, back pain, blurry vision, fatigue and nausea. And in kids, are more likely to just have the one prominent symptom and almost always, with kids, you are looking at some difficulty with daily functioning. Problems getting to school, doing social activities because of the health complaint.
Melanie: So, what are some of the risk factors? Why are some children more susceptible to somatic symptom disorder than others?
Dr. Thompson: Right, there are many factors that can influence that. One is a family history of chronic illness, being female gender, family having fewer years of education, socioeconomic challenges, and as well as adverse experiences such as physical and sexual abuse of the child.
Melanie: When a parent brings their child in and the pediatrician recognizes some of these red flags; does bringing in a mental health professional tend to upset parents or patients? Do they right away to the pediatrician get upset by this? Speak as a health professional, a mental health professional on what you see is the reaction that parents have when you come into the picture.
Dr. Thompson: Right. Well there is certainly many things primary care physicians would do on their own in treating this. The recommendations are for the PMD to be doing the primary type of treatment for a while. Some of these problems are transient. They are short-term. They resolve with education, simple education from the PMD that the body can generate symptoms in the absence of a disease is enormously sometimes very helpful. Many parents have not really thought of that. They think you need to keep doing more tests, you need to keep finding what the cause is. So, I think certainly, sometimes mental health professionals can be part of the treatment plan; but not necessarily necessary in the early stages.
Melanie: So, speak about some of the difficulties with healthcare utilization and the associated risks for other disorders that might happen as a result.
Dr. Thompson: Exactly. So, the two most common other disorders are anxiety and depression. And that there is very clear data on that, that it increases the risk and becomes a bidirectional influence, right that anxiety and depression make it harder to deal with the headaches or the abdominal pain and loss of activity, not going to school, not having typical social experiences with your friends and family then can worsen emotional distress. In terms of the healthcare utilization, these patients are often challenging for a clinician. They often seek care from multiple clinicians, doctor shopping is common. The pediatrician may be doing a beautiful job explaining the exam results are normal, the test results are normal and that doesn’t allay the family’s concern. The continue to be sometimes very focused on finding a cause or a disease mechanism, and they press the PMD to order more diagnostic tests and there may be some overt frustration and disappointment expressed that this is going on. On the other hand, we as clinicians may feel like I’m not sure what else to do to help this patient see that for example the headache or the abdominal pain is benign, that they can pursue functioning. Sometimes families will increasingly go to the internet to find kind of unorthodox remedies. So, it really can be at time, involve some frustration and difficulty with the management.
Melanie: Speak a little bit about management. How is it treated and how can pediatricians support the functioning and coping during treatment?
Dr. Thompson: Right. So, one of the standard recommendations for that is for pediatricians to regularly schedule outpatient visits so that you don’t have to have a symptom to get clinical attention, that is sort of more on a schedule. Again, we talk a lot about education and mindset. We use a lot of metaphors when we are explaining this concept that the body can generate symptoms in the absence of a disease. There are lots of helpful ways of understanding that the brain is firing like a false alarm is sometimes what we use just like you could have a fire drill. The alarm system is going off, it’s certainly very obnoxious, very loud. It seems like there could be a fire, but we know that that’s a drill or a false alarm with a car alarm going off. No one was actually trying to steal that car. The brain and the body are reacting, and a person is perceiving pain, but there’s not necessarily a disease in terms of the first domino in that domino effect.
Melanie: One of the more important factors I would suspect Dr. Thompson, is when pediatricians are referring patients. How can they set realistic expectations for referral to a specialist with their patients? What do you want them to be telling their patients about what they can expect?
Dr. Thompson: Right. So, we definitely want to avoid using language like we are going to find out what’s going on. Because the sort of reinforces the mistaken idea that there’s something serious going on, sort of like some of the television shows like House, right, if we just get the right doctor, we’ll figure out what’s going on, there will be a simple straightforward explanation and a simple straightforward treatment plan, and this problem will be fixed. So, we definitely don’t want that. Again, you want to continue talking about realistic expectations. One of the things that we know that is a developmental factor that puts certain kids and teens at risk is some real perceptional distortions about good health, that paying a lot of attention to what are generally benign bodily processes, interpreting things as catastrophic, this is a sign, health anxiety, this is a sign. This headache means, this bodily pain, the fact that I’m tired, it means that there’s something wrong. Missed attributions that these kinds of benign experiences are a reflection of serious illness. So, setting up that the specialist is going to help us come up with new strategies for management, help us talk about options for coping and really always using that language about increasing functioning. That is really key with this population. The goal is to - for us to all work together with the specialist to help you tolerate some of this discomfort while we are also looking for options to help with management at the same time.
Melanie: As a wrap up Dr. Thompson, what else does a referring physician need to know about somatic symptom disorder and when referral to a specialist is really indicated?
Dr. Thompson: Right. So, physical symptoms may be a way of talking with the body, it may be a way of expressing distress. With some patients, who have trouble expressing emotions in words. So, I think being sensitive, do the typical thorough evaluation and ongoing monitoring that our pediatricians do and then don’t be afraid to call a mental health clinician to discuss the case. We are certainly happy to do that and also to use your kind of benign generally good health interventions such as physical therapy, other ways to support physical activity and exercise and always coming back to that encouragement with families that they don’t need to sit back and wait until they are in perfect health. They can go out there and take the small steps that will build up over time to improve quality of life and overall health.
Melanie: Thank you so much Dr. Thompson for being on with us today and sharing your expertise in this very interesting situation that some parents and children find themselves in. Dr. Thompson will be presenting Pediatric Somatic Symptom Disorders in more detail during the October 26th and 27th Fall Clinical Pediatric Update for CME credits. To register, or for physician referral, please call the Children’s Direct Physician Access Line at 1-800-678-HELP, that’s 1-800-678-4357. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis children’s Hospital you can go to www.stlouischildrens.org, that’s www.stlouischildrens.org. This is Melanie Cole. Thanks for listening.
Melanie Cole (Host): Welcome. Our topic today is Pediatric Somatic Symptom Disorder. And my guest is Dr. Suzanne Thompson. She’s a pediatric psychologist at St. Louis Children’s Hospital. Dr. Thompson what is somatic symptom disorder?
Suzanne Thompson, PhD (Guest): There are two core features. One involves a somatic symptom that’s longstanding and causes distress. Sometimes there can be multiple symptoms but you really just need one for the diagnosis and then the second criteria is excessive thought, worrying, it’s the time and energy. A lot of focus and preoccupation related to that symptom or health concern.
Melanie: So, what should pediatricians look for? As parents, we bring our children to the pediatrician and say oh, they’ve got headaches or stomach aches or joint pain or any number of things. What do you want pediatricians to know what red flags to be looking for?
Dr. Thompson: So, among kids, exactly. The examples you just gave, the most common things to look for with somatic symptom problems in kids and teens are abdominal pain, headaches, back pain, blurry vision, fatigue and nausea. And in kids, are more likely to just have the one prominent symptom and almost always, with kids, you are looking at some difficulty with daily functioning. Problems getting to school, doing social activities because of the health complaint.
Melanie: So, what are some of the risk factors? Why are some children more susceptible to somatic symptom disorder than others?
Dr. Thompson: Right, there are many factors that can influence that. One is a family history of chronic illness, being female gender, family having fewer years of education, socioeconomic challenges, and as well as adverse experiences such as physical and sexual abuse of the child.
Melanie: When a parent brings their child in and the pediatrician recognizes some of these red flags; does bringing in a mental health professional tend to upset parents or patients? Do they right away to the pediatrician get upset by this? Speak as a health professional, a mental health professional on what you see is the reaction that parents have when you come into the picture.
Dr. Thompson: Right. Well there is certainly many things primary care physicians would do on their own in treating this. The recommendations are for the PMD to be doing the primary type of treatment for a while. Some of these problems are transient. They are short-term. They resolve with education, simple education from the PMD that the body can generate symptoms in the absence of a disease is enormously sometimes very helpful. Many parents have not really thought of that. They think you need to keep doing more tests, you need to keep finding what the cause is. So, I think certainly, sometimes mental health professionals can be part of the treatment plan; but not necessarily necessary in the early stages.
Melanie: So, speak about some of the difficulties with healthcare utilization and the associated risks for other disorders that might happen as a result.
Dr. Thompson: Exactly. So, the two most common other disorders are anxiety and depression. And that there is very clear data on that, that it increases the risk and becomes a bidirectional influence, right that anxiety and depression make it harder to deal with the headaches or the abdominal pain and loss of activity, not going to school, not having typical social experiences with your friends and family then can worsen emotional distress. In terms of the healthcare utilization, these patients are often challenging for a clinician. They often seek care from multiple clinicians, doctor shopping is common. The pediatrician may be doing a beautiful job explaining the exam results are normal, the test results are normal and that doesn’t allay the family’s concern. The continue to be sometimes very focused on finding a cause or a disease mechanism, and they press the PMD to order more diagnostic tests and there may be some overt frustration and disappointment expressed that this is going on. On the other hand, we as clinicians may feel like I’m not sure what else to do to help this patient see that for example the headache or the abdominal pain is benign, that they can pursue functioning. Sometimes families will increasingly go to the internet to find kind of unorthodox remedies. So, it really can be at time, involve some frustration and difficulty with the management.
Melanie: Speak a little bit about management. How is it treated and how can pediatricians support the functioning and coping during treatment?
Dr. Thompson: Right. So, one of the standard recommendations for that is for pediatricians to regularly schedule outpatient visits so that you don’t have to have a symptom to get clinical attention, that is sort of more on a schedule. Again, we talk a lot about education and mindset. We use a lot of metaphors when we are explaining this concept that the body can generate symptoms in the absence of a disease. There are lots of helpful ways of understanding that the brain is firing like a false alarm is sometimes what we use just like you could have a fire drill. The alarm system is going off, it’s certainly very obnoxious, very loud. It seems like there could be a fire, but we know that that’s a drill or a false alarm with a car alarm going off. No one was actually trying to steal that car. The brain and the body are reacting, and a person is perceiving pain, but there’s not necessarily a disease in terms of the first domino in that domino effect.
Melanie: One of the more important factors I would suspect Dr. Thompson, is when pediatricians are referring patients. How can they set realistic expectations for referral to a specialist with their patients? What do you want them to be telling their patients about what they can expect?
Dr. Thompson: Right. So, we definitely want to avoid using language like we are going to find out what’s going on. Because the sort of reinforces the mistaken idea that there’s something serious going on, sort of like some of the television shows like House, right, if we just get the right doctor, we’ll figure out what’s going on, there will be a simple straightforward explanation and a simple straightforward treatment plan, and this problem will be fixed. So, we definitely don’t want that. Again, you want to continue talking about realistic expectations. One of the things that we know that is a developmental factor that puts certain kids and teens at risk is some real perceptional distortions about good health, that paying a lot of attention to what are generally benign bodily processes, interpreting things as catastrophic, this is a sign, health anxiety, this is a sign. This headache means, this bodily pain, the fact that I’m tired, it means that there’s something wrong. Missed attributions that these kinds of benign experiences are a reflection of serious illness. So, setting up that the specialist is going to help us come up with new strategies for management, help us talk about options for coping and really always using that language about increasing functioning. That is really key with this population. The goal is to - for us to all work together with the specialist to help you tolerate some of this discomfort while we are also looking for options to help with management at the same time.
Melanie: As a wrap up Dr. Thompson, what else does a referring physician need to know about somatic symptom disorder and when referral to a specialist is really indicated?
Dr. Thompson: Right. So, physical symptoms may be a way of talking with the body, it may be a way of expressing distress. With some patients, who have trouble expressing emotions in words. So, I think being sensitive, do the typical thorough evaluation and ongoing monitoring that our pediatricians do and then don’t be afraid to call a mental health clinician to discuss the case. We are certainly happy to do that and also to use your kind of benign generally good health interventions such as physical therapy, other ways to support physical activity and exercise and always coming back to that encouragement with families that they don’t need to sit back and wait until they are in perfect health. They can go out there and take the small steps that will build up over time to improve quality of life and overall health.
Melanie: Thank you so much Dr. Thompson for being on with us today and sharing your expertise in this very interesting situation that some parents and children find themselves in. Dr. Thompson will be presenting Pediatric Somatic Symptom Disorders in more detail during the October 26th and 27th Fall Clinical Pediatric Update for CME credits. To register, or for physician referral, please call the Children’s Direct Physician Access Line at 1-800-678-HELP, that’s 1-800-678-4357. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis children’s Hospital you can go to www.stlouischildrens.org, that’s www.stlouischildrens.org. This is Melanie Cole. Thanks for listening.