by Julie T. Steck, Ph.D., HSPP
Children and adolescents who are experiencing internalized conditions, including anxiety and depression, often present with physical symptoms of headaches, stomach aches or other vague physical complaints. When there is no identifiable medical cause, or when the medical cause should not be causing the level of physical distress, the root of the symptoms may be due more to emotional distress. These symptoms are referred to as “somatic” symptoms. Somatization is the term used when physical symptoms are caused by or exacerbated by an underlying emotional issue.
The incidence of internalized emotional conditions in youth today is high. According to the 2016 National Survey of Drug Use and Health, an estimated 2 million adolescents in the U.S. (approximately 9% of those between the ages of 12 and 17) experienced an episode of depression in 2016. The lifetime prevalence of anxiety disorders in adolescents is 31.9%, according to the National Comorbidity Survey Replication (2010). These conditions are accompanied by a high rate of somatic symptoms that may include:
* headaches and other body pains
* stomachaches, nausea and vomiting
* fatigue
* trouble with seeing or hearing
* seizure-like episodes, fainting or odd movements
These symptoms are real, but the underlying cause may not be a physical one. When these somatic symptoms rise to the level of interfering with functioning, a child or adolescent may be diagnosed with a Somatic Symptoms and Related Disorders (SSRD). This mental health diagnosis is made in collaboration with other medical professionals who are addressing the physical symptoms and overall health of the child or adolescent.
Treatment of somatic symptoms focuses on:
* identifying possible underlying stressors such as learning difficulties, bullying, family stress, or history of trauma
* assessment of co-existing mental health conditions including anxiety and depression
* psychotherapy for the young person to learn about the mind-body connection and to identify ways to address stress
* parental support and education about somatic symptoms and how parents can support their child
* a plan to return to normal life activities, including school and extracurricular activities
* consideration of psychotropic medication when indicated
As somatic symptoms often interfere with school attendance and functioning, it is important for mental health providers and parents to work closely with school personnel to formulate a school plan. This is often done through a 504 Plan that may be developed to address necessary accommodations for the student. A 504 Plan may be developed for a student who has a “physical or mental impairment that substantially limits one or more major life activities.” The disability may be temporary or permanent. The accommodations under a 504 Plan do not change the curriculum but allow for adjustments to allow the student equal access to learning. Further information regarding 504 Plans may be found at www.understood.org or www.504idea.org.
For more information, the Kelty Mental Health Resource Centre in British Columbia, Canada provides an excellent resource on Somatic Symptoms and Related Disorders.
