Psychosomatics 175success. However, by the time their symptoms are being presented to
health professionals, the child or adolescent would lose face if they got
better in response to being told that they were putting it on, or making a
mountain out of a molehill, and parents would probably feel foolish and
angry too, for having been taken in. Predictably enough, ‘pull yourself
together and stop wasting our time’ suggestions may lead to persistence
or worsening of symptoms as the individual demonstrates that he or she
really is ill. Indeed, it is not just explicitly critical comments that can
be counterproductive; any hint that professionals are being dismissive or
condemnatory can have a negative effect.
Factors in the child or adolescent
Children and adolescents with psychosomatic disorders are commonly
described as conscientious, obsessional, sensitive, insecure or anxious;
these are best seen as personality traits rather than as disorders. Affected
individuals may be temperamentally predisposed to withdraw from new
situations, and have sometimes had problems with peer relationships.
Only a minority have a co-existent psychiatric disorder, and it is difficult to
know how often this is a consequence rather than a cause of their somatic
complaints: ‘Of course, I’m depressed, doctor. Wouldn’t you be if you had
my symptoms?’
Factors in the family
Family members with somatic symptoms may provide models – in terms
of the symptoms themselves, and also in terms of coping style. If rela-
tives have stomach complaints, headaches or seizures, this may sensitise
children and adolescents to these problems or even provide them with
a model for conscious or unconscious imitation. If adults in the family
typically respond anxiously to their own somatic symptoms, assuming that
something beyond their control is seriously wrong, this may well foster
anxiety, ‘pathologising’ attributions, and an external locus of control in
children and adolescents too.
Although family stresses may initiate or aggravate ill health, there is no
convincing evidence that specific types of family stresses are linked with
specific types of ill health. ‘Psychosomatic’ families are sometimes charac-
terised as close families who find it hard to express psychological concerns
directly, seeking and providing attention and reassurance through the
currency of somatic concern. Other family characteristics that have been
said to predispose to psychosomatic disorders are:
one over-involved parent, with the other distant;
parental disharmony;
parental overprotection;
a rigid or disorganised set of rules rather than a stable and flexible set;
dysfunctional communication without conflict resolution.Favourable characteristics are said to include warmth, cohesion and
satisfactory adaptation to the realities of the family situation. While these