FFFPhysical Symptoms of Emotional Distress: Somatic Symptoms and Related Disorders

No. 124; Updated October 2023 

What are Somatic Symptoms?
Physical complaints are common in children. As many as 1 in 10 children will complain of an ache, pain, or worry about their body on any given day. There may be no medical illness that fully explains the complaint, it may be that emotions are being felt as physical symptoms. Physical symptoms of emotional distress are called somatic symptoms. Somatization is the name used when emotional distress is expressed by physical symptoms. Everyone experiences somatization at times. Examples can include your heart beating fast or butterflies in your stomach when you feel nervous, or muscles becoming tense and sore when you feel angry or under stress. These symptoms are very real to your child; they are not "faking it."

What are Somatic Symptoms and Related Disorders?
A Somatic Symptom and Related Disorder (SSRD) is diagnosed when your child has physical symptoms that are not explained by a medical illness or when symptoms of a known illness affect your child much more than expected and these symptoms interfere with daily life such as missing school, not wanting to play with friends, or avoiding fun activities.

SSRD Symptoms may include:

  • body pains including headaches, joint pains
  • stomach aches, nausea, vomiting
  • fatigue, dizziness, memory problems
  • weakness, numbness
  • trouble breathing, shortness of breath
  • changes in vision or hearing including sudden blindness
  • a "stuck" feeling or a "lump" in the throat
  • seizure-like episodes, fainting, abnormal movements

There are different types of SSRDs. Your child may be diagnosed with: Psychological Factors Affecting a Medical Condition, Somatic Symptom Disorder, or Conversion Disorder (Functional Neurological Symptom Disorder). Terms like "functional," "nonorganic," "psychogenic," "psychosomatic," "pseudo seizures," "amplified," and "medically unexplained" are also sometimes used.

Why does my child have an SSRD?
A child may have an SSRD for many reasons. Sometimes it starts with an illness, injury, or infection, but the symptoms do not go away after the illness has been treated. Other times somatic symptoms start without any prior illness or injury. Some people are born with a higher awareness of body sensations, but then may misinterpret what the sensation means. Somatic symptoms may also be strong feelings or struggles that a child has not been able to share in words. When a child's feelings build up inside, their body may express those feelings physically. 

How are SSRD diagnoses made?
Varied professionals including your child's primary care provider, pediatric specialists (for example, neurologists or gastroenterologists), child and adolescent psychiatrists, and pediatric psychologists may be involved in the assessment, diagnosis, and treatment.

The evaluation typically involves:

  • an evaluation of physical, emotional, and behavioral symptoms and daily functioning
  • a physical exam
  • reviewing the results of medical tests (lab work, imaging, or procedures)

How are SSRDs treated?
SSRDs are treatable. Sometimes symptoms are short-lived and disappear quickly without treatment. Other times, a child needs a course of treatment. Psychotherapy (talk therapy) focusing on helping a child express feelings is very important. The main goal of treatment is to help a child return to normal levels of functioning.

Treatment will be based on the needs of your individual child and may include:

  • Psychotherapy to help understand the connection between feelings and physical symptoms and to teach skills like breathing exercises, relaxation, and biofeedback
  • Physiotherapy and occupational therapy to help muscle strength, balance, and movement
  • Actions to relieve physical discomfort such as massage, ice, or heat
  • Small, gradual steps to improve function
  • Return to school with the help of school accommodations and support from teachers, nurses, and school counselors
  • Return to after school activities as soon as possible (e.g. spending time with friends, sports, clubs)Regular check-ins with your health care team to check for improvements and any new treatment changes

What can I do to help my child?
As a family member, you are an important member of the treatment team; you know your child best and can help others understand your child.

Ways you can help include:

  • Asking for medical and behavioral health providers who understand the mind body connection
  • Encouraging new ways for your child to talk about uncomfortable feelings
  • Helping your child practice coping and relaxation strategies
  • Supporting your child's efforts to focus less on physical symptoms
  • Working with school and other programs to help your child return to usual activities as soon as possible
  • Celebrating success and improved function
  • Helping your own anxiety that may develop, as a concerned parent or other family member 

Where can I get more information about SSRDs?

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