What are somatic symptom and related disorders (SSRDs)?

Somatic symptom and related disorders (SSRDs) occur when there are problems with the body’s communication system. Children with this condition have physical symptoms that can be upsetting but are not harmful. Symptoms may look like other illnesses, but tests and lab results may not find a cause. These symptoms are called “somatic symptoms.” Somatic symptoms are real; they are not imagined.

When the mind and body work together correctly, they continually send messages back and forth. These messages interpret what we feel and tell us how to react. The messages are sent through a complex pathway that includes the brain, spinal cord and nerves. When a child has a SSRD, the messages between the mind and body can be too strong, too weak or sent on the wrong path.

Everyone has experienced somatic symptoms from time to time. Examples include feeling butterflies in the stomach or muscles tightening with anger. Most of the time these symptoms are harmless and pass on their own. For children with somatic symptom and related disorders these may interfere with daily life. Children may miss school or stop participating in activities they once enjoyed.

It may be helpful to think of the symptoms experienced in the body as a fire alarm. When working correctly, a fire alarm alerts people to danger and sends a warning. Similarly, physical symptoms often warn that something is wrong inside the body. However, with SSRDs, the symptoms are like a fire alarm that continues to go off when there is no fire.

What are symptoms of somatic symptom and related disorders?

SSRDs look different for each person. It is common to have more than one symptom. Symptoms may change or worsen over time. They may come and go or be constant. Examples of somatic symptoms include:

• Pain, weakness, difficulty moving
• Headaches, dizziness or extreme tiredness
• Changes in vision or hearing
• Itching, numbness
• Abnormal movements
• Stomach aches, nausea

Though somatic disorders are not easily explained by a test or medical diagnosis, they are real, often upsetting and interfere with daily life. SSRD treatment aims to repair communication between the mind and body. This will improve the child’s ability to function and participate in daily life — at home, at school and with friends.

Types of SSRDs

The names of specific somatic symptom and related disorders describe the symptom or area of the body that is affected.

• Amplified musculoskeletal pain syndrome (AMPS)
• Disorders of gut brain interaction (DGBIs), including functional abdominal pain
• Functional neurologic disorders previously called conversion disorder, including functional movement disorders or dystonia, functional tic disorder, and functional tremor
• Psychogenic non-epileptic events or psychogenic non-epileptic seizures (PNEEs or PNES), previously called pseudoseizure
• Visceral hyperalgesia
• Fibromyalgia
• Autonomic dysfunction

Causes of SSRDs

SSRDs are often triggered by physical stress, like an injury or illness, or psychological stress. Although somatic disorders can be related to stress, this does not mean the child is faking or having symptoms on purpose. Other factors like age, genetics or hormones may also play a role. It is often a combination of these risk factors that lead to SSRDs. However, sometimes a clear reason is not known, and somatic symptoms cannot be connected to a particular cause.

Not knowing the cause of symptoms can be hard for parents, children and the medical team. Many children with SSRDs and their families have faced challenges with peers, school officials and even healthcare professionals who have dismissed the child’s symptoms. Research in this area is new, but it shows these symptoms are not “all in the child’s head.”

Testing and diagnosis of somatic symptom and related disorders

Diagnosis begins by listening carefully to the child’s physical and emotional history to understand how somatic symptoms impact daily activities. It also includes a medical exam and a careful review of medical testing.

It is important to note that test results are most often normal. Unnecessary medical tests and invasive procedures can cause further stress and are unlikely to change the treatment. Additional testing can also delay time to start appropriate treatment.

SSRDs are not diagnosed as a last resort by ruling out all other illnesses. A provider with experience in this area can identify a somatic symptom disorder by looking for specific patterns and characteristics. Diagnosing a somatic disorder can take time. Finding an experienced provider is the first step. Even as the diagnosis is underway, using coping techniques is helpful for managing symptoms.

Treatment for SSRDs

The goal of treatment for all SSRDs is to break the symptom cycle and repair the mind-body connection.

The best outcomes are seen with a return to daily schedules and activities, even if the child still has symptoms. Once children with SSRD understand that using their bodies in a normal way is not harmful, they can often work through their symptoms with an outpatient treatment plan. In some cases, a more intensive treatment program for SSRDs is needed. Your healthcare team will work with you to create an individualized treatment plan.

The treatment plan will likely include psychotherapy, which is key to teach coping strategies and stress management. Depending on the specific symptoms, psychotherapy may be paired with physical, occupational or speech therapy. Therapies will focus on strengthening communication between the mind and body. Lastly, the team will work with you to stop medicines that are not helping your child to repair the mind-body connection.

Outlook for children with somatic symptom and related disorders

SSRDs are treatable, though it may take time and practice to repair the communication pathways. Most children diagnosed with a somatic disorder will see improvement or resolution of their symptoms with proper treatment.

However, some children may experience symptoms again, especially during times of stress. With the tools learned in treatment, children are better prepared to understand and work through flares. The best outcomes are seen when the child takes part in therapy, begins treatment early, and receives support and compassion from their family, school and medical team.