'Needs expressed' and 'offers of care': an observational study of mothers with somatisation disorder and their children

Familial risk factors for the development of somatoform symptoms and disorders in children and adolescents: a systematic review

The aim of this study was to examine whether familial risk factors for the development of somatoform symptoms and somatoform disorders in children and adolescents can be deduced from studies which investigated the intergenerational transmission of functional abdominal pain and somatoform disorders. A systematic review of articles published in English and German since 1990 was performed. Twenty-three relevant studies were found. The following putative familial risk factors for the development of somatoform symptoms and somatoform disorders were identified: somatization of parents, organic disease of a significant other, psychopathology of close family members, dysfunctional family climate, traumatic experiences in childhood and insecure attachment. Most of the putative familial risk factors are associated with many other psychiatric child disorders and are therefore mostly nonspecific. Further longitudinal studies, in which comorbidity and other putative risk factors are taken into account, are needed to identify specific familial risk factors for the development of somatoform symptoms and somatoform disorders.

Somatoform disorders: 30 years of debate about criteria! What about children and adolescents?

OBJECTIVES

The aim of this study was to evaluate the suitability of the complex somatic symptom disorder, proposed by the DSM-V Somatic Symptom Disorders Workgroup, in classifying children and adolescents who suffer severely from medically unexplained symptoms.

METHODS

The existing knowledge about somatoform disorders (SDs) in children and adolescents was delineated by means of a comprehensive search in the psychological, psychiatric, and pediatric literature. It was analyzed to assess whether children and adolescents suffer from SDs according to DSM-IV-TR (prevalence, developmental course, comorbidity, risk factors, and impact on daily functioning). Subsequently, each criterion of the complex somatic symptom disorder was outlined and discussed with respect to its suitability in classifying children and adolescents. The suitability of the DSM-IV-TR criteria of SDs and that of the criteria of the complex somatic symptom disorder were compared.

RESULTS

Current data of sufficient quality are limited but indicate that the DSM-IV-TR criteria are inappropriate for classifying most children and adolescents suffering from somatoform symptoms. The criteria for complex somatic symptom disorder are more appropriate. Nevertheless, it is recommended to include two additional parameters: "parental excessive concern and preoccupation with the child's symptoms" and "high parental health anxieties."

CONCLUSIONS

The criteria for complex somatic symptom disorder are more appropriate for children and adolescents than the current DSM-IV-TR criteria; they should be better adapted to the special situation of children and adolescents.

Towards positive diagnostic criteria: a systematic review of somatoform disorder diagnoses and suggestions for future classification

OBJECTIVES

The classification of somatoform disorders is currently being revised in order to improve its validity for the DSM-V and ICD-11. In this article, we compare the validity and clinical utility of current and several new diagnostic proposals of those somatoform disorders that focus on medically unexplained somatic symptoms.

METHODS

We searched the Medline, PsycInfo, and Cochrane databases, as well as relevant reference lists. We included review papers and original articles on the subject of somatoform classification in general, subtypes of validity of the diagnoses, or single diagnostic criteria.

RESULTS

Of all diagnostic proposals, only complex somatic symptom disorder and the Conceptual Issues in Somatoform and Similar Disorders (CISSD) example criteria reflect all dimensions of current biopsychosocial models of somatization (construct validity) and go beyond somatic symptom counts by including psychological and behavioral symptoms that are specific to somatization (descriptive validity). Predictive validity of most of the diagnostic proposals has not yet been investigated. However, the number of somatic symptoms has been found to be a strong predictor of disability. Some evidence indicates that psychological symptoms can predict disease course and treatment outcome (e.g., therapeutic modification of catastrophizing is associated with positive outcome). Lengthy symptom lists, the requirement of lifetime symptom report (as in abridged somatization), complicated symptom patterns (as in current somatization disorder), and imprecise definitions of diagnostic procedures (e.g., missing symptom threshold in complex somatic symptom disorder) reduce clinical utility.

CONCLUSION

Results from the reviewed studies suggest that, of all current and new diagnostic suggestions, complex somatic symptom disorder and the CISSD definition appear to have advantages regarding validity and clinical utility. The integration of psychological and behavioral criteria could enhance construct and descriptive validity, and confers prospectively relevant treatment implications. The incorporation of a dimensional approach that reflects both somatic and psychological symptom severity also has the potential to improve predictive validity and clinical utility.