Child and Adolescent Psychiatry

Psychosomatics 173

brain tumour may sensitise all family members to possible organic causes
of headache. In many instances, anxiety-driven cycles can be interrupted
by the reassurance of a trusted doctor who has carried out an adequate
investigation. Occasionally, however, doctors are themselves drawn into
the vicious cycles of panic and pathologising, with ever more specialist
investigations and second opinions reinforcing the family’s view that there
must be something serious to worry about.

Somatic symptoms can sometimes be a ‘mask’
Distress occasioned by psychological or social factors can sometimes be
displaced onto a somatic symptom. A particularly transparent version of
this can often be witnessed in young children. Thus, a child may fight
back tears after a quarrel with a friend but then cry inconsolably after a
minor fall a short while later. Obtaining relief or sympathy in this way, by
focusing on an ‘acceptable’ somatic symptom such as physical pain, may
have the undesirable long-term effect of training the child to somatise
psychological distress in future too (Box 21.2). Sensitive parenting can
help children and adolescents learn to disclose their psychological distress
without needing to mask it with somatic symptoms (Box 21.3). For both
parents and professionals, however, there is also a danger in going to
the opposite extreme; psychological probing and psychologising of somatic
symptoms can be overdone.

Box 21.2A family’s somatic focus trains the child or adolescent

to somatise

Child complains of

somatic symptoms

Psychological

stress

for example, bullying

Promotes

somatisation on

future occasions

Parents focus

on somatic symptoms

Free-floating

anxiety focuses

on symptoms

Child gets

extra attention

Absence from school

provides partial escape

from bullying