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Medically unexplained physical symptoms are common in childhood. Although potentially chronic and disabling, they often do not result in referrals for psychiatric evaluation or treatment (Campo et al. 1999; Mayou et al. 2003). According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association 2000), somato-form disorders are characterized by the presence of one or more physical complaints for which an adequate medical explanation cannot be found. The symptoms are severe enough to cause significant distress or impairment in functioning and result in the family seeking medical help. Key features of these disorders include a temporal relationship between a stressor and symptom onset, debilitation beyond expected symptom pathophysiology, and concurrent psychiatric disorders (Garralda 1999).

Somatization is a pattern of seeking medical help for physical symptoms that cannot be fully explained by pathophysiological mechanisms but are nevertheless attributed to physical disease by the in dividual (Campo and Fritsch 1994; Lipowski 1988). Between 2% and 20% of children present to medical professionals with "functional" aches and pains that have no known organic cause (Goodman and McGrath 1991). Somatization has been described as the tendency to experience and express psychological distress through somatic complaints (Abbey 1996). Stoudemire (1991) suggested that somatization occurs universally in young children who have not yet developed the cognitive and linguistic skills needed to comprehend and communicate their feelings. Somatization is also common in cultures that accept physical illness but not psychological symptoms as an excuse for disability.

Community surveys of children and adolescents suggest that recurrent somatic complaints generally fall into four symptom clusters: cardiovascular, gastrointestinal, pain/weakness, and pseudoneurologi-cal (Garber et al. 1991). Large community samples have found that children commonly report recurrent complaints of headache and abdominal pain as well as fatigue and gastrointestinal symptoms (De-

This chapter has been adapted from Shaw RJ, DeMaso DR: "Somatoform Disorders," in Clinical Manual of Pediatric Psychosomatic Medicine: Mental Health Consultation With Physically Ill Children and Adolescents. Washington, DC, American Psychiatric Publishing, 2006, pp. 143-168. Copyright 2006, American Psychiatric Publishing. Used with permission.

Maso and Beasley 2005). Nausea, sore muscles, back pain, blurred vision, and food intolerance are also common complaints (Garber et al. 1991). The prevalence of somatization is roughly equal among boys and girls in early childhood, but rates for females may rise in adolescence. A survey of adolescents ages 12-16 found that somatic symptoms were present in 11% of girls and 4% of boys (Silber and Pao 2003). Children and adolescents with a history of somatization are more likely to experience emotional and behavioral difficulties, be absent from school, and exhibit poor academic performance. Pediatric somatization is strongly correlated with the presence of depression and anxiety (Campo et al. 1999). About one-third to one-half of children with somatization have comorbid emotional spectrum disorders, such as depression and anxiety, usually developing after the onset of somatic complaints (Garralda 1999).

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