Model of Pediatric Somatization

Figure 8-1 outlines a model of pediatric somatiza-tion that details the pathways associated with the development of somatic symptoms. Physical symptoms may be generated by authentic physical illness and/or as an indirect result of psychological distress. Physical symptoms may be promoted and given more attention by the individual through the process of somatosensory amplification, described earlier in "Personality Traits and Coping Styles." In so-matoform disorders, these physical symptoms are frequently reinterpreted and attributed to medical illness. Patients who have had a prior traumatic physical illness (e.g., cancer) may be particularly prone to scan their bodies for physical symptoms and interpret these symptoms, often incorrectly, as heralding recurrence of illness. This pathway continues toward clinically significant somatization and the diagnosis of somatoform disorder.

The process of somatization may be reinforced by attention from caregivers and physicians and/or avoidance of stressful situations (e.g., attending school, participating in competitive athletics) as a consequence of the illness behavior. These feedback loops may help establish a pattern of the illness behavior that persists beyond the original reason for the symptom, whether it was physiological or psychological in nature. Psychological trauma may play an important role in amplifying and fostering so-matoform symptoms.

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