Psychosocial Morbidities In Children With Medically Unexplained Pain Symptoms: A Study From India
- Author:
Sharmishtha S Deshpande
;
Vidya Ganapathy
;
Neelima Bendre
- Publication Type:Journal Article
- Keywords:
Pediatric Somatization;
Medically Unexplained Pain in Children;
Psychosocial Adversities and Unexplained Pain;
Somatoform Pain Disorder in Children
- From:ASEAN Journal of Psychiatry
2015;16(1):18-27
- CountryMalaysia
- Language:English
-
Abstract:
Objective: Medically unexplained pain is a common manifestation of
psychological distress in children, though establishing this diagnosis is seldom an
easy task. This study aimed to enhance and share clinical insights in the complex
interplay of medical and/ or psychological factors in these children as revealed
by multidimensional assessment, to help in their effective management.
Methods: Researchers assessed 65 consecutive children with unexplained pain
for more than a month, referred by pediatrician. Of these, 59 consented and
completed the interview. Clinical interview by psychiatrist generated psychiatric
diagnosis as per ICD – 10 research criteria. Global functioning of the child
(CGAS) and relational functioning of the family (GARF) were assessed before
and after treatment. Psychosocial stresses were assessed clinically and
treatments given to child and/or parent were recorded. Psychologist assessed
intelligence of the child using Raven’s Coloured Progressive Matrices and
administered Children’s Apperception Test (CAT). Results: A total of 38
(64.4%) children fulfilled criteria for Persistent Somatoform Pain Disorder.
Most of them (89.8 %) were undergoing personal, familial and social stresses,
many of which were revealed only after detailed clinical assessment. Major
depression (28.8%), intellectual subnormality (11.9%), non-organic enuresis
(8.5%) and ADHD (8.5%) were common co-morbid psychiatric diagnoses.
Children with varying intellectual levels were proportionately represented, and
colored the clinical complexity. Repression and reaction formation were common
defenses and fear of loss of love of parent, injury, being overpowered were
common fears as revealed on CAT. Conclusion: Unexplained pain was often a
somatic expression of emotional needs in these children. Psychosocial adversities
were common and often causative. However being subtle, these were routinely
unidentified. Precise assessment is the key to effective management of these
cases.
- Full text:P020150206316329020343.pdf
