Psychosocial Adjustment

Youth with FAP can easily fall through the cracks of the existing health care delivery system, primarily because the pain is "medically unexplained" in the traditional sense. Consequently, many patients, family members, and clinicians may assume that the pain must then be "psychological" in nature or even a fabrication by the patients. Although true illness fabrication is quite unusual in youth with chronic abdominal pain, patients and families may appear hypersensitive to any suggestion that the pain may be "all in the head." Youth with FAP and their families are thus at risk for a variety of negative experiences with health care professionals, with many feeling dismissed or misunderstood after hearing that the doctor "cannot find anything wrong." Similarly, patients and families are often distressed by professionals' attempts to explain the pain using a psychological model and may feel that clinicians minimize the abdominal pain by attributing the child's symptoms to an anxiety or depressive disorder.

Compared with peers without FAP, youth with FAP as a group are considerably more impaired (e.g., poor school attendance and performance); use more ambulatory health services; are at heightened risk to undergo potentially dangerous medical investigations; and have more somatic, anxiety, and depressive symptoms and disorders (Campo 2007). Anxiety disorders and depressive disorders have been reported in approximately 75% and 40% of youth with FAP, respectively (Campo et al. 2004a; Garber et al. 1990; Liakopoulou-Kairis et al. 2002). Unfortunately, comorbid anxiety and depressive disorders are seldom recognized in clinical settings, and specialty mental health referral rates are low (Edwards et al. 1994). Temperamental constructs related to neuroticism, such as trait anxiety, negative affect, and harm avoidance, have been associated with FAP in clinical samples (Campo et al. 2004a; Davison et al. 1986). These traits have been associated with pessimistic worry, fear of uncertainty, and sensitivity to environmental change or adversity (Andrews 1996), as well as a vulnerability to develop anxiety, depression, and functional somatic disorders (Watson and Pennebaker 1989), including irritable bowel syndrome (Talley et al. 1998). Youth with FAP who have higher levels of negative affect are more likely to develop abdominal pain in response to daily life stresses and hassles (Walker et al. 2001). Youth with FAP may be especially sensitive to both internal and external threats, as suggested by attentional biases toward words conveying threatening messages of pain and to those implying social danger (Boyer et al. 2006).

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