Somatoform Disorders

Soma and somato are both Greek words that mean body. Disorder means an ailment in the body. Thus, a somatoform disorder is a physical illness or illness in the body. Somatoform disorders vary by type and frequency of occurrence among school-age children. Depending on the type of disorder and age and gender of the person, prevalence rates range from less than 1% to 15%. Somatoform disorders rarely begin before age six years, and usually begin in late childhood and early adolescence.

According to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSMIV), somatoform disorders include (American Psychiatric Association, 1994):

• Somatization disorder
• Undifferentiated somatoform disorder
• Conversion disorder
• Pain disorder
• Hypochondriasis
• Body dysmorphic disorder

All the somatoform disorders result in significant problems at school, home, or in other social situations.

In somatization disorder, pain or other medical symptoms are not explained by a medical problem. For example, when a child's arm is broken, the swelling and pain that result are explained by the injury. However, a child with a somatization disorder will complain about physical pains such as stomachaches and headaches, but a medical doctor is unable to find a cause for the pain. A child may also experience backaches, dizziness, fatigue, and muscle aches. More pain is seen in a somatization disorder than an undifferentiated somatoform disorder. Both disorders may last for long periods of time. The physical symptoms are real to the child and typically result in medical treatment, or the continuous complaints cause problems in school and at home. For example, a child with these types of somatoform disorders may spend an excessive amount of time in the nurse's office and miss important academic learning time.

Conversion disorders may include a variety of medical symptoms that are related to psychological factors. Generally, a stressful situation is linked to the onset of this disorder. The symptoms of a conversion disorder may result in “secondary gains” (American Psychiatric Association, 1994). Secondary gains refer to benefits the individual receives or obtains, such as attention from a teacher or parent or a reduction in work requirements and other responsibilities, as a result of the physical complaints.

Severe body pain in one or more places for any length of time is typical of a pain disorder. Pain that lasts less than six months is considered acute; if it lasts more than six months, it is considered chronic. The pain [Page 521]symptoms are significantly linked to psychological factors and the severity of the pain leads the individual to seek medical care. According to the DSM-IV, the pain in this disorder becomes the focus of the sufferer's life (American Psychiatric Association, 1994).

Fear of having a disease is known as hypochondriasis. A person may experience pain and mistakenly think that the symptom is caused by a disease, despite a doctor's reassurance. Although hypochondriasis may start at any age, generally it begins in early adulthood and lasts for at least six months.

Concern about real or imagined body flaws is typical of those with body dysmorphic disorder. Types of defects include skin tone, facial hair, nose size, and shape of different body parts. Typically, the individual has excessive thoughts about the real or imagined body flaw, and these lead to unnecessary searches for medical cures to correct the defect. This disorder does not occur typically before adolescence and may result in dropping out of school. The adolescent's thoughts are centered on the flaw and not focused on learning resulting in a refusal to attend school.

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