Treatment of somatic symptom disorder in childhood: evidence-based psychotherapy interventions

Introduction: About 25-30% of patients present themselves in general practice and specialized healthcare with medically unexplained somatic symptoms. The prevalence of these symptoms is the highest among the elderly, children and adolescents. Approximately 20% of patients in primary care and 47% of them in specialized clinics are children between the age of 7-12 who seem to have somatic symptom disorder (SSD). Somatization disorder most frequently occur with symptoms of headache, stomach ache or various kinds of pain in the limbs that show high comorbidity with other mental disorders, predominantly with anxiety. SSDs are always multicausal issues where biological, social-environmental and psychological factors are interconnected in a complex manner. According to our experience, somaziting patients are often drifting in the healthcare system for years, and instead of getting adequate treatment, they only receive medication, thus their symptoms may easily become chronic. Aim, method: Our aim was to review the current literature and guidelines concerning evidence-based treatments for SSD in childhood. Furthermore, to underline the importance of psychotherapy in SSD, we present the cognitive behavior therapy of a 16-year-old adolescent with vertigo, gastrointestinal symptoms and insomnia over a 8-month period.
Discussion: The results of effectiveness studies unequivocally recommend cognitive behavioral therapy in the treatment of SSD patients, accompained by family therapy or family consultation. The therapy should focus on reducing psychosocial stressors, health anxiety and catastrophizing thinking style in the family, while developing adequate coping and communication skills as well as maintaining the patient's age-appropriate activity level.
Conclusion: Cognitive behavior therapy is the treatment of choice in SSD for children and young people. Applying the biopsychosocial approach is a key issue in the assessment of predisposing and maintaining factors, ensuring that only methods based on scientific evidence will be applied to help these children. Orv Hetil. 2020; 161(25): 1050-1058.