Somatization in everyday life
Somatization is the expression of distress and emotions through physical symptoms and results from the mind-body connection. Everyone experiences somatization. For example, after a tough day, you may experience muscle tension, a headache or tiredness. If you feel anxious, for instance, before giving a presentation, you may have nausea or an upset stomach. If you are annoyed or upset, your muscles may tense up. These are all examples of how people can express their emotions through physical symptoms.
Disorders related to somatization
When somatization causes distress, impairs a person's quality of life and becomes a focus of medical attention, it is diagnosed as a somatic symptom and related disorder (SSRD). The term SSRD is used to refer to a category of diagnoses that are related to somatization. The different types of SSRDs describe the physical symptoms a person experiences or the area of their body that is most impacted. Some examples of SSRDs include somatic symptom disorder (SSD) and functional neurological disorder (FND)—also known as conversion disorder or psychogenic non-epileptic seizures. A person who seeks medical attention for somatization might be described as having functional symptoms.
Some people may have an SSRD alongside a medical condition. Other people with medical conditions may have an element of somatization that partly explains their symptoms. In this case, they may be diagnosed with psychological factors affecting other medical conditions.
Health-care providers consider the role of somatization when a child has physical symptoms that:
- are more severe, and have a greater impact on daily life, than would be expected based on their medical condition
- cannot be entirely explained by the medical condition.
Somatic symptom disorder
When a person has SSD, a lot of thoughts, feelings and behaviours become connected to their physical symptoms. A child may have a medical condition, but their symptoms impair their daily routine and cause them more distress than would be expected from the medical condition on its own.
Examples of somatic symptoms may include:
- pain
- fatigue
- shortness of breath
- heart palpitations
- fainting
- dizziness
- nausea, vomiting, stomach ache or diarrhea
- needing to urinate often.
Functional neurological disorder
When a person has FND (also known as conversion disorder or psychogenic non-epileptic seizures), they experience distressing neurological symptoms that cannot be explained by a physical examination, including neurological examination, or tests.
FND symptoms typically affect a person's movement or senses. Examples include:
- sensory loss, including numbness or vision problems
- weakness or paralysis
- abnormal movements
- seizure-like episodes
- problems with swallowing
- problems with speech.
Prevalence
Somatization is more common in children and teens with pre-existing medical problems or injuries.
What are some underlying causes of somatization?
Response to illness or injury
Often, children who experience somatization may have had an illness or injury but then have a longer-than-expected recovery. The illness or injury may have caused them to be more aware of their body's sensations, including pain.
When illness or injury affects children who are perfectionists or high-achievers who are used to excelling at school or elsewhere, it can disrupt their routines, sense of identity and connection to their peers. You can think of the analogy of a car driving on a highway, where the car symbolizes the child’s ability to engage in life, while the highway reflects the fast-paced lives of others. Children with somatization may feel like they are no longer speeding along the fast lane of the highway but instead are stalling at the side of the road. They might feel overwhelmed about 'starting the car', never mind getting back to their previous fast pace, as the effort to recover or adapt can seem daunting. They might compare themselves to their friends and peers who continue to move forward without interruption, which may cause frustration and isolation. This may make recovery more stressful and challenging.
Response to stress and uncomfortable emotions
Some children may have experienced stressful situations such as managing a chronic health condition or stress related to the onset of a new illness or physical symptoms; time away from school; a drop in marks; a conflict with a friend or teacher; family stress; death of a loved one or a traumatic event.
These situations may have led to uncomfortable emotions such as anxiety, sadness, fear, shame, embarrassment or anger. The child may avoid thinking about stressful situations, minimize how those situations affect them, or push down any difficult emotions. If there is any stigma with expressing emotions, family members may pay more attention to and offer sympathy for a child endorsing physical symptoms versus a child expressing difficult emotions. In addition, some children find it difficult to label their feelings and communicate about their emotions.
Stressful situations affect children in different ways. When children are under stress, they may become sad, scared or mad. Their behaviour may also be affected, and they may become withdrawn or act younger than their age. They may get into arguments or fights. When children experience stress, it activates the fight, flight or freeze response and can increase the chance of distress showing up through somatic (physical) symptoms. In this way, somatic symptoms are the body's way of talking when a child cannot express what is troubling them.
Does somatic symptom disorder or functional neurological disorder occur with other mental health conditions?
Children and teens with an SSRD may have other mental health conditions such as depression, anxiety, attention deficit hyperactivity disorder (ADHD) or a learning disability. In addition, youth with medical conditions are at greater risk of having co-occurring mental health conditions.
A number of mental health conditions, such as depression and anxiety disorders, may also have a component of somatization. For instance, children and teens with depression may often have fatigue and headaches. Those with anxiety disorders often have headaches, muscle tension and nausea.
How is somatization assessed?
If your child has significant physical symptoms that cause them to miss school or activities, it is important that they see a health-care provider. Health-care providers should be seeking to understand the underlying biological, psychological and social factors that are causing your child distress, not just looking to treat the physical symptoms.
A detailed assessment using a biopsychosocial approach can help identify the various factors contributing to your child’s physical symptoms. This approach looks at how biological, psychological, and social influences may have caused the symptoms, as well as what might trigger them to return, worsen, or improve.
- Biological factors are the physical causes of symptoms, such as an illness, a health condition or an injury.
- Psychological factors include any ways of negative thinking, stress and/or uncomfortable emotions.
- Social factors could be any stressors or other features in a child's environment, whether at home, at school or with friends.
A biopsychosocial approach can explore not only the symptoms, but also their context and their impact. These can all highlight opportunities for treatment.
A child who is assessed for somatization should also be checked for other mental health concerns such as:
- depression
- anxiety
- eating disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder and avoidant/restrictive food intake disorder (ARFID)
- ADHD
- learning difficulties.
Health-care professionals involved in assessment
Depending on your child's symptoms and their impact on your child's life, your child may be assessed by a range of health-care professionals. These include:
- pediatric specialists, such as neurologists and gastroenterologists
- a dietitian
- rehabilitation specialists, such as occupational therapists, physiotherapists and speech and language therapists
- mental health professionals such as psychologists, psychiatrists and social workers
- a behavioural analyst, if your child's behaviour seems to be regressing (behaving in a less mature manner).
A case manager for your child can work to make sure there are adequate resources and good communication between the health-care professionals if many people are involved in assessing your child at the hospital and in the community.
References
Adams JS, Chien AT, Wisk LE. Mental illness among youth with chronic physical conditions. Pediatrics. 2019; 144(1). Retrieved from: https://publications.aap.org/pediatrics/article-abstract/144/1/e20181819/37113/Mental-Illness-Among-Youth-With-Chronic-Physical?redirectedFrom=PDF.
