Functional somatic complaints in adolescents: Relationship to negative life events, self-concept, and family characteristics

doi:10.1016/S0022-3476(88)80660-7

The Journal of Pediatrics

Volume 113, Issue 3, September 1988, Pages 588-593

https://doi.org/10.1016/S0022-3476(88)80660-7 Get rights and content

While recurrent somatic complaints are commonly encountered in children and adolescents, occult organic disease is rarely found in patients with these complaints. Recent studies have confirmed the clinical impression that a relationship exists between functional somatic complaints and negative life events in adolescents. Our goal was to investigate additional psychosocial characteristics that may be associated with functional complaints. One hundred fifteen adolescents coming for the first time to an adolescent medicine clinic completed standard measures of negative life events, psychophysiologic symptoms, self-esteem, peer social comparison, and family functioning before an independent evaluation by a physician. Pattents with functional somatic complaints (chest pain, recurrent abdominal pain, limb pain, and hyperventilation syndrome) reported significantly more negative life events, lower self-esteen, more psychophysiologic symptoms and a lower self-evaluation than did patients coming for physical examination or routine health maintenance. Functional somatic complaints in adolescents may be associated with poor psychosocial adjustment and reaction to negative life events. In addition to ruling out organic disease, physicians dealting with these patients should evaluate other areas, including stressful life events, peer relations, and self-esteem.

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Cited by (41)

Can the bodily distress syndrome (BDS) concept be used to assess functional somatic symptoms in adolescence?
2022, Journal of Psychosomatic Research
Citation Excerpt :
Functional somatic symptoms, which cannot be attributed to a well-defined somatic disease, are common in childhood and adolescence, and typically include abdominal pain, headaches, muscular soreness or fatigue [1–4]. Most symptoms are mild, short-lasting and without considerable adverse impact on daily functioning, but in some cases they develop into persistent symptomatology, which is associated with negative long-term consequences, such as school absenteeism, diminished school performance or psychosocial functioning, and a heavier reliance on health care services [5–10]. Severe, persistent functional somatic symptoms occur in various medical domains where they are conceptualized and diagnosed according to different medical specializations' classification systems [11,12], such as chronic primary pain syndromes like irritable bowel syndrome or fibromyalgia in somatic health care (ICD-11) [13,14], or bodily distress disorder (BDD) (ICD-11) or somatic symptom disorder (SSD) (DSM-5) in psychiatric settings [13,15].
Bodily Distress Syndrome (BDS) represents a new research concept for adult patients with various functional somatic syndromes. We evaluated the utility of the BDS research concept and the associated BDS-25-checklist as a screening tool for diverse functional somatic symptoms (FSS) in adolescence by investigating: 1) the psychometric and factorial structures of the checklist, 2) symptom cluster patterns and 3) illness classification and associations with emotional psychopathology and sociodemographic factors.
This cross-sectional study obtained data from the 16/17-year follow-up (N = 2542) of the general population Copenhagen Child Cohort 2000 (CCC2000). We used self-reported questionnaires to assess physical symptoms (the BDS-25 checklist), overall health (KidScreen), emotional psychopathology (Spence Children's Anxiety Scale; The Mood and Feelings Questionnaire), and illness worry (Whiteley-6 Index), and utilized data from Danish national registers to assess sociodemographic factors.
The BDS-25 checklist items displayed satisfactory psychometric data quality. Factor analyses revealed a similar four-factor model as reported in adults (factor loadings λ ≥0.5), representing distinct BDS symptom clusters: cardio-pulmonary, gastro-intestinal, musculoskeletal and general symptoms. Latent class analyses revealed a model with three latent classes, i.e. probable no to mild BDS, probable moderate, single-organ BDS and probable severe, multi-organ BDS, displaying acceptable class quality (Entropy = 0.904). Trend analyses revealed sociodemographic group differences across latent classes. Increased emotional psychopathology was associated with more pronounced BDS symptoms.
Our findings support the BDS concept with four symptom clusters and three illness severity groups (no BDS, single- organ and multi-organ BDS) to screen for FSS in adolescence.
Individual variation in temporal relationships between stress and functional somatic symptoms
2014, Journal of Psychosomatic Research
Citation Excerpt :
Among clinicians, psychosocial stress is widely believed to be a precipitating or perpetuating factor in FSSs, but is this notion supported by evidence? Epidemiological research shows that people who suffer from FSSs report more stressful life events [9–12] and daily hassles [13–15] than controls. However, these findings are almost exclusively based on cross-sectional studies.
Medically unexplained or functional somatic symptoms (FSSs) constitute a major health problem because of their high prevalence and the suffering and disability they cause. Psychosocial stress is widely believed to be a precipitating or perpetuating factor, yet there is little empirical evidence to support this notion. Prior studies mainly focused on comparing groups, which has resulted in the obscuring of temporal complexity and individual differences. The aim of this study is to elucidate the relationship between stress and FSSs over time within individual patients.
Twenty patients (17 females, ages 29–59) with multiple, persistent FSSs were included in the study. They used electronic diaries to report stress and FSSs twice daily over the course of 12 weeks. For each individual data set, Vector autoregressive (VAR) modelling was used to investigate possible associations between daily average stress and FSSs scores.
In six subjects (30%), an increase in stress was followed by an increase in one or more FSSs. In three subjects (15%), an increase in FSSs was followed by an increase in stress. Additionally, negative and mixed associations were found. Only two subjects (10%) showed no cross-lagged association between stress and FSSs in either direction. We did not find specific types of symptoms to be more stress-related than others.
Although stress does not seem to be a universal predictor of FSSs, an increase in stress precedes an increase in symptoms in some individuals. Identifying these individuals using time-series analysis might contribute to a more patient-tailored treatment.
Cortical correlates of an attentional bias to painful and innocuous somatic stimuli in children with recurrent abdominal pain
2008, Pain
Citation Excerpt :
The attentional bias to innocuous stimulation was specific for somatic stimuli, since the P3 component of the AEP to the target tones was not altered in the RAP group. Such a heightened and automatic focus on somatic sensations might underlie the increased levels of self-reported somatic (both visceral and non-visceral) symptoms in children with RAP [41,70,81]. Interestingly, children with RAP were found to be particularly prone to enhanced gastrointestinal symptom reporting in a water-load symptom provocation test when their parents were instructed to keep the child’s attention focused on the bodily sensations [84].
Recurrent abdominal pain (RAP) is a common gastrointestinal problem during childhood. It is not only a pediatric health problem, but may represent a risk factor for chronic pain, psychosomatic symptoms, and psychopathological problems later in life. Alterations in central pain processing and an attentional bias to potentially aversive somatic sensations could contribute to the unfavorable outcome of RAP during childhood. Fourteen children with RAP and 15 control children (age: 10–15 year) participated in an attentional task. Children had to respond to rare targets (tones) and ignore frequent either painful (pain threshold) or non-painful mechanical stimuli delivered at the hand. Event-related cortical potentials in response to the somatic stimuli and the tones were measured and stimulus intensity ratings, reaction time and number of errors were obtained. Painful as compared to non-painful stimuli elicited significantly larger N1, P2 and P3 components of the somatosensory-evoked potential (SEP) in all children. The RAP children responded with a significantly larger P3 to both painful and non-painful stimuli. No group differences were found for the auditory-evoked potentials. Perceived stimulus and pain intensity, reaction time and number of errors did not differ between groups. Similar to findings in adults with functional gastrointestinal disorders (FGIDs), children with RAP did not show somatic hyperalgesia as revealed by unaltered pain thresholds and middle latency pain-evoked SEPs. However, they displayed an attentional bias to painful and non-painful (innocuous) somatic stimuli as indicated by an enhanced P3. This may represent an important mechanism not only for the maintenance of RAP, but also for the development of psychosomatic symptoms.
Family-focused pediatrics: A primary care family systems approach to psychosocial problems
2002, Current Problems in Pediatric and Adolescent Health Care
Every child comes with a family—the single greatest, most enduring influence on a child. Forces within the family—their socioeconomic status, parental medical and mental health, parenting practices, nature of the spousal/partner relationship, behavior, cultural beliefs, and communication style—powerfully affect children's physical and mental health, self-image, behavior, educational attainment, and overall well-being. It follows logically that the family is the domain of the pediatrician and other primary providers.
Pediatricians are trained with the biomedical model, but they increasingly encounter problems for which they should consider incorporating a biopsychosocial-family systems-model: (1) psychosocial problems that prove resistant to traditional child-centered, or symptom-centered interventions, (2) problems that are affected by and/or impact the family context, and (3) families who actively seek help for behavioral and interactive-emotional problems.
This article has described (1) the family systems model and techniques (with an illustrative case study of a common pediatric problem); (2) the rationale for adopting (and adapting) this model to better address psychosocial problems that are increasing in America; (3) the unique qualifications and position of primary care pediatricians in the health care system to address these problems; (4) the impact of family relationships and other family-social factors on children's behavior, development, and emotions; and finally, (5) a variety of clinical strategies and interviewing techniques for pediatricians (and other primary care providers) who want to enhance their skills in working with children and adolescents within the context of their families. This article concludes with recommendations (from the AAP Task Force on the Family) for future pediatric training, education, and policymaking.
The family is the pediatrician's greatest resource, and the family is the best expert on their children. Using an admixture of the family's strengths and values and the pediatrician's knowledge, skills, and guidance, pediatricians and families can coconstruct solutions to ensure the best outcome for children and their families.98., 204.
Psychiatric issues in pulmonary disease
2002, Psychiatric Clinics of North America
Stress, stressors and coping among high school students
2000, Children and Youth Services Review
A sample of 333 tenth and eleventh grade students in the Los Angeles area were surveyed to determine the degree of stress experienced, the stressors encountered most frequently, and the frequency with which specific coping strategies were employed along with their perceived effectiveness. The respondents scored above the norms for their age on the State Trait Anxiety Inventory, and up to one third of the sample reported high levels of daily stress. The stressors highest in frequency reflected concerns about one's future goals followed by several school-related items. No gender differences were found in degree of stress or most frequent stressors. White students reported experiencing personal and school-related stressors more often than African American or Latino students. Latino students experienced family stressors more often than their cohorts in other ethnic groups. The frequency with which coping strategies were employed was low, with no ethnic differences and females employing adaptive coping strategies more often than males. Gender and ethnic differences were found with respect to specific adaptive coping strategies. Comparisons with regard to stressors and coping strategies were also made between students reporting high levels of stress and those reporting moderate to low levels of stress.

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SupplementFunctional somatic complaints in adolescents: Relationship to negative life events, self-concept, and family characteristics

Pediatr Clin North Am

The child with abdominal pains

Recurrent abdominal pain, headache, and limb pain in children and adolescents

Pediatrics

Chest pain in children: a prospective study

Pediatrics

Changing stress and recurrent somatic symptoms in adolescents

Psychiatr J Univ Ottawa

Quality of life events in relation to psychoatric symptoms

Arch Gen Phychiatry

Recurrent abdominal pain in children: a retrospective survey of 119 patients

Clinic (Philadelphia)

Children with psychogenic abdominal pain and their families

Clin Pediatr (Phila)

Stressful life events and somatic complaints in adolescents

Pediatrics

Assessing life stress in older children and adolescents: preliminary findings with the life events checklist

Supplement
Functional somatic complaints in adolescents: Relationship to negative life events, self-concept, and family characteristics