Child Psychology and Psychiatry

Somatization and somatoform disorders
DIFFERENTIAL DIAGNOSIS
Physical symptoms are commonly found in chil-
dren and adolescents with psychiatric disorders.
The following should be considered in differential
psychiatric diagnosis:
•
school phobia and refusal, where key features
are marked fear and avoidance of school;
•
anorexia nervosa, with deliberate weight loss
and an intrusive dread of fatness;
•
depressive disorder, with consistent and persis-
tent lowering of mood;
•
anxiety disorders, with prominent, prolonged
and persistent feelings of anxiety, worry and
restlessness.
Factors that raise suspicion that psychological
factors are playing a part in somatic presentations
include:
•
when stress and physical symptoms occur close
together;
•
a symptom whose severity is out of keeping with
the established pathophysiology;
•
concurrent psychiatric disorder;
•
the presence of the characteristic child, family
and illness factors described above.