Treatment

Although few prospective studies address prognosis, data suggest that certain types of somatization may persist from childhood into adulthood. For example, 25%-50% of adults who had recurrent abdominal pain as children continue to suffer from similar symptoms in adulthood (Campo and Fritsch 1994). BDD and hypochondriasis are thought to be chronic, unremitting illnesses. By contrast, most conversion disorders are thought to resolve within a few months of diagnosis, although symptoms may recur. Many patients will undergo spontaneous remission of their symptoms, although treatment is thought to hasten recovery and is necessary for patients with chronic or more entrenched symptoms.

Pediatric treatment outcome studies on somato-form disorders are few, with the major limitation being difficulties in participant recruitment. Limited data are available from evidence-based treatment studies, and small case series or case reports provide most of the existing data supporting treatment efficacy. Nevertheless, it is generally accepted that effective treatment of somatoform disorders in childhood needs to incorporate a number of different treatment modalities that target the factors that are believed to be associated with the development of somatization (see Figure 8-2).

Steps for effective intervention often include a de-emphasis on a final diagnosis (so as to ensure a thorough medical workup), use of benign remedies, and reinforcement of wellness (L.K. Brown et al. 1997). The identification of comorbid psychiatric disorders, such as depression and anxiety, not only allows for target interventions but also presents an opportunity for clinicians to discuss the impact of the comorbid disorders in the creation and maintenance of somatic symptoms that are more readily accepted by patients and their families (Rief et al. 2004). Comprehensive reviews of individual psychotherapy, family therapy, and psychopharmaco-logical treatments for physically ill children can be found in Chapters 28, 29, and 30, respectively.

Figure 8-2. Treatment approaches to pediatric somatization.
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