An adolescent with disabling abdominal pain

Minute, Marta; Cozzi, Giorgio; Barbi, Egidio

doi:10.1136/bmj.i6101

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Compared to DSM-5, the 6 months-duration criteria for the diagnosis of SSD was not attended. Literature shows that symptoms lasting 1 month and connected to psychosocial impairment in childhood or adolescence are highly suggestive of SSD (17); in our opinion, the severity of the whole picture, seen as the result of suffering in a context of vulnerability proper to the pediatric age, warrants immediate care.…”

Section: Discussionmentioning

confidence: 71%

Case Report: Somatic Symptoms Veiling Gender Dysphoria in an Adolescent

et al. 2021

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Background: Somatic symptom disorder is common in children and adolescents; usually, it is an expression of a mental health problem or other conditions that lead to psychosocial impairment and suffering. Among these, in pubertal age, gender dysphoria should be considered.Case Presentation: We present the case of a 15-year-old girl admitted to the hospital because of a 2-month history of scattered arthralgia and myalgia, headache, and fatigue, with repeated visits to the emergency room. The physical exam was unremarkable, except for step walking and pain. Repeated diagnostic tests were normal, and consecutive psychological interviews disclosed intense suffering due to a gender incongruence. Referral to the hospital gender service was offered and refused by the parents.Conclusions: In pubertal age, gender dysphoria may be expressed through somatoform symptoms. Diagnosis is challenging to accept for the parents even in the presence of adequate multi-disciplinary hospital services.

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Section: Discussionmentioning

confidence: 71%

Case Report: Somatic Symptoms Veiling Gender Dysphoria in an Adolescent

et al. 2021

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“…The Somatic Symptom Scale shows promise in measuring somatic symptom burden. A common feature of these patients is that they often undergo an extensive, repeated and poorly justified diagnostic work-up, sometimes magnified by ‘doctor shopping’ in the constant search for different medical opinions 11…”

Section: Discussionmentioning

confidence: 99%

Somatic symptom disorder: a diagnostic dilemma

2019

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Somatic symptom disorder (SSD) is a diagnosis that was introduced with publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013. It eliminated the diagnoses of somatisation disorder, undifferentiated somatoform disorder, hypochondriasis and pain disorder; most of the patients who previously received these diagnoses are now diagnosed in DSM-5 with SSD. The main feature of this disorder is a patient’s concern with physical symptoms for which no biological cause is found. It requires psychiatric assessment to exclude comorbid psychiatric disease. Failure to recognise this disorder may lead the unwary physician or surgeon to embark on investigations or diagnostic procedures which may result in iatrogenic complications. It also poses a significant financial burden on the healthcare service. Patients with non-specific abdominal pain have a poor symptomatic prognosis with continuing use of medical services. Proven treatments include cognitive behavioural therapy, mindfulness therapy and pharmacological treatment using selective serotonin reuptake inhibitors or tricyclic antidepressants. The authors describe the case of a 31-year-old woman with an emotionally unstable personality disorder and comorbid disease presenting to the emergency department with a 3-week history of left-sided abdominal and leg pain. Despite a plethora of investigations, no organic cause for her pain was found. She was reviewed by the multidisciplinary team including surgeons, physicians, neurologists and psychiatrists. A diagnosis of somatoform symptom disorder was subsequently rendered. As patients with SSD will present to general practice and the emergency department rather than psychiatric settings, this case provides a cautionary reminder of furthering the need for appropriate recognition of this condition.

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“…Families are frequently worried about their children's obscure disease, which makes every day worse, which does not respond to medications and which has no overt cause despite repeated diagnostic tests and medical evaluations. A common feature of these patients is that they often undergo an extensive, repeated and poorly justified diagnostic workup, sometimes magnified by ‘doctor shopping’, in the constant search for different medical opinions and evaluations …”

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confidence: 99%

Facing somatic symptom disorder in the emergency department

Cozzi

Barbi

2018

J Paediatrics Child Health

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Somatic symptom disorder is a condition in which a patient's subjective report of physical symptoms is associated with distress; disruption of day-to-day functioning; or disproportionate thoughts, feelings and behaviours regarding the symptoms, whether or not they are associated with an identified medical condition. While somatic symptom disorder affects a considerable proportion of children and adolescents presenting to the emergency department (ED), it has not been well investigated in the ED literature, nor is there much formal training in, or guidelines for, how to care for affected patients in the ED. The aim of this paper is to highlight the historical clues commonly reported by these patients in order to try to help the emergency physicians recognise patients affected by a somatic symptom disorder. Adolescent age, the presence of daily subjective symptoms presenting daily for weeks or months, a long medical history record, an extensive diagnostic workup and, most of all, disproportionate functional impairment related to the symptoms are all features strongly suggestive of this disorder. Emergency physicians should become used to taking advantage of these clues to formulate a positive diagnosis of somatic symptom disorder according to the most recent diagnostic criteria. Emergency physicians have the unique opportunity to contribute to the correct diagnosis and treatment of these patients and to have a positive impact on their prognosis.

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An adolescent with disabling abdominal pain

Cited by 3 publications

References 7 publications

Case Report: Somatic Symptoms Veiling Gender Dysphoria in an Adolescent

Case Report: Somatic Symptoms Veiling Gender Dysphoria in an Adolescent

Somatic symptom disorder: a diagnostic dilemma

Facing somatic symptom disorder in the emergency department

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