172 Chapter 21
links are the focus of Chapter 29, which describes the common psycholog-
ical complications of children and adolescents’ brain disorders.
Some general principles
Stress and anxiety can initiate and amplify
somatic symptoms
Most readers will know from personal experience or direct observation
that stress can induce a variety of somatic symptoms, including headaches,
nausea, abdominal pains, diarrhoea and urinary frequency. It is also
common knowledge that an anxious focus on a symptom often makes the
symptom seem worse, resulting in increased anxiety, even greater fixation
on the symptom, and so on. In addition, a child or adolescent’s anxiety
and distress can make the parents feel helpless and panic-stricken. If the
parents are unable to hide this, this further fuels their child’s anxiety.
These vicious cycles, and some of the factors moderating or triggering
them, are shown in Box 21.1. Family beliefs about illness play a key role.
People differ in the extent to which they make ‘normalising’ or ‘pathol-
ogising’ attributions about the causes of somatic symptoms: normalising
attributions relate the symptoms to environmental or psychological factors
(for example, ‘I have a headache because I am under stress and stayed up
too late last night’), whereas pathologising attributions focus on organic or
pathological causes (for example, ‘perhaps it’s a brain tumour’). Normal-
ising attributions are reassuring and can prevent anxiety-related vicious
cycles from taking over. Within any one family, the balance of normalising
and pathologising attributions will vary over time and according to the
nature of the symptom. For example, family stresses may undermine
normalising attributions, and having a relative who has recently died of a
Box 21.1Escalating anxiety and somatic symptomsPhysical trigger Symptom
in childAnxiety
in childAnxiety
in familyStressTemperamentBeliefs
about
illness