Somatoform disorders in children:
Indeling
Holistic approach (see also ID-model)
physical disorder -> psychological repercussions
psychological problems -> physical repercussions
Terminology:
psycho-somatic disorders
somatoform disorders
Psycho-somatic disorders
physical disorders where physical and psychological factors are strongly intertwined
inflammatory bowel disease
asthma
migraine
Somatoform disorders
Physical complaints
No demonstrable physical problems
chronic pains
conversion disorder: pseudo-paralysis...
Somatoform complaints mimicking another disorder: a-typical abdominal pain...
Somatization disorder
Pain disorder
(body dismorphic disorder)
(hypochondric disorder)
Conversion disorder
Somatoform disorder NOS
Kenmerken
Child characteristics:
sensitive
insecure, anxious,
dutiful , obsessional
limited social relationships
poor individuation
Family characteristics
frequent health problems
somatic attribution style
reinforcement of somatic complaints
poor coping & problem solving
enmeshment; conflict avoidance
no tradition of verbalizing important things
increased sensitivity ?
 emotional bias
Oorzaak
Biological factors:
specific (genetic) liabilities leading to lower thresholds for physical sensations and signs
e.g. different sensitivity for / production of stress hormones ?
Different sensitivity for CO² levels, inducing vicious circle of anxiety ?
Stressors:
School
Home
Peers
Specific trauma’s : abuse...
STRESS
Psychosocial evaluation
Emotional reaction
(anxiety, anger…)
Physical reaction
Solution
Somatic complaints
Pseudo-solution
stress <
Different theories:
Stress-theory
present
past
Emotional bias
reinforcement
home
medical environment
Assessment:
Two paths from the start:
Physician:
medical attention
physical explanation
treatment….
somatic
Psychological
Beware of taking one path: it’s difficult to come back on your steps !
Treatment:
Joining:
accepting the reference scheme of the family: there’s something physical
accepting symptoms, but not necessarily their technical explanation
Indirect, non-confrontational techniques:
metaphors (physiotherapy often offers good ones)
as-if questioning, circular questioning
Quietly shifting and broadening the family’s reference system
Rehabilitation:
= walking on two paths
Reduce gain
Eg. Ordeal therapy
Stress-reduction
especially if unusual stressors
Improving coping strategies, empowerment