Psychosomatics 177and adolescents who have a psychiatric disorder, such as depression, in
addition to their somatic symptoms, may need to have their psychiatric
disorder treated in its own right if it does not resolve as a result of the
other psychological interventions.
Recurrent abdominal pain (RAP)
This affects some 10–25% of children and adolescents, with peak preva-
lence between the ages of 3 and 9 years. Most parents recognise links
between the episodes of pain and psychological stresses and provide
psychosomatic management without the need for any medical input.
Nevertheless, the minority of cases that do get referred on for specialist
opinions are sufficiently numerous to account for about 10% of all new
paediatric out-patient visits. Even in tertiary paediatric centres, less than
10% of RAP proves to be associated with a serious organic disorder.
Though there is suggestive evidence that some children and adolescents
are physically predisposed to RAP, psychological stresses are thought to
play major roles as precipitating and perpetuating factors.
Factors in the children and adolescents
Most children and adolescents with RAP are psychiatrically normal; the
slightly elevated rate of psychiatric problems is comparable to that of
children and adolescents with chronic abdominal pain of known organic
aetiology. Affected individuals are often described as timid, high-strung,
over-conscientious, or particularly keen on adult approval. Some with-
draw from new challenges and others tend to become awkward and
irritable when stressed.
Factors in the family
Clinical descriptions of the families emphasise their closeness, their high
expectations, and the high level of parental concern about their children.
Family members have an elevated rate both of emotional symptoms and
of somatic complaints, particularly gastrointestinal complaints, some with
known organic bases and some not. It has yet to be established whether
this familial aggregation reflects modelling, genetic transmission, or shared
exposure to adverse environments.
External stressors
There is an association with life events. Most stresses are of an ‘everyday’
variety, such as a change in school or an impending examination. It
is distinctly unusual for children and adolescents suffering from sexual
abuse to present with RAP without other symptoms of more widespread
disturbance.