Medically unexplained physical symptoms: information
for parents, carers and anyone who works with young people
About this leaflet
This is one in a series of leaflets for parents, teachers and
young people entitled Mental Health and Growing Up. The
aims of these leaflets are to provide practical, up-to-date
information about mental health problems (emotional, behavioural
and psychiatric disorders) that can affect children and young
people. This leaflet looks at why some young people suffer from
problematic physical symptoms when there seems to be no medical
cause. It also offers advice about how to recognise and deal with
the problem.
Introduction
One in 10 children suffer from physical symptoms for which no
medical cause can be found. Common symptoms are headaches,
tiredness, sore muscles, sickness, upset stomach, back pains,
blurred vision, weakness and food intolerance. In many children,
these symptoms can be made worse by worries - most commonly about
school, friendships or family.
What are the causes?
Physical illness or injury may be a factor at the beginning,
but when no obvious physical explanation can be found, emotional or
psychological factors need to be thought about. These problems are
more common in children and young people who:
- are feeling stressed, for whatever reason
- are very sensitive to physical symptoms and pains
- are very sensitive to others
- tend to be fussy or perfectionists
- are very anxious and worry more than most
- worry continuously about the symptoms and their effects on
everyday activities _ this can cause the symptoms to continue, and
even get worse
- have a tendency to develop mental health problems, such as
anxiety or depressive disorders.
Unexplained physical symptoms may be part of psychiatric
disorders, such as depression or anxiety.
What are the effects of unexplained
symptoms?
Everyday life can become very uncomfortable and stressful for
these children. Unexplained
symptoms can also be very worrying for parents.
Most children learn to cope with these symptoms. But for some,
the symptoms may result in:
- missing a lot of school; they may not achieve what they should
academically
- seeing less of their friends - this means fewer interests,
hobbies and fun
- being less mature and independent than other children because
of their dependence on the family.
Who can help?
Your general practitioner or school doctor will be able to
assess your child and help decide if any specialist investigation
or treatment is required. If necessary, they will refer your child
to the local paediatrician or child psychiatrist.
Specialists, such as psychiatrists, can help to distinguish
unexplained physical symptoms from mental health problems such as
depression or anxiety. Psychiatrists can also help identify
psychological factors that may be contributing to the
symptoms.
Talking treatments can help the family to cope with these
problems. Medication may also play a part, particularly in
overcoming anxiety and depression, or in dealing with eating or
sleep problems. Relaxation exercises can be very helpful with
recurrent headaches.
A planned approach
Psychiatric help can also be helpful in developing a planned
approach to the problem. For it to be effective, everyone needs to
work together as a team towards the same goals: you, your child,
the paediatrician, psychiatrist, general practitioner and school
may all need to get involved.
The aim is to help the child to recover gradually by creating
more effective ways of coping with the symptoms and getting back to
a normal daily routine. This is best done with active participation
from the family. It will involve:
- finding ways of paying less attention to the symptoms
- a small but steady increase in everyday and social
activities
- the child will be encouraged to do more for themselves and to
regain their confidence and independence
- asking teachers to help with looking at ways of overcoming any
school or education problems.
Carers of children with unexplained physical symptoms can
suffer a lot of stress. Family life may become dominated by the
child's problem. Parents will need to be caring, but also
determined and positive even when things seem bleak and uncertain.
Often parents find it hard to know what to do for the best when to
encourage and when to comfort, when to insist and when to take the
pressure off. They may benefit from expert help and advice about
this.
Family or individual counselling may be helpful if focused on
issues such as how to:
- respond to pain and other symptoms more effectively
- increase levels of physical and social activity
- overcome depression, anxiety, lack of confidence and poor
motivation
- deal with family relationship difficulties when these become
part of the problem.
It can be helpful for everyone involved in helping the child
to meet and review progress from time to time. This allows everyone
to share their ideas about the best ways forward - physical,
psychological and educational.
References
- Garralda, M. E. (1999) Practitioner review: assessment and
management of somatisation in childhood and adolescence: a
practical perspective. Journal of Child Psychology and
Psychiatry, 40, 1159-1167.
- Garralda, M. E. (2000) The links between somatisation in
children and adults. in Family Matters: Interfaces Between
Child and Adult Mental Health (eds P. Reder, M. McClure &
A. Jolley), pp.122-231. London: Routledge.
- Taylor, S. & Garralda, E. (2003) The management of
somatoform disorder in childhood. Current Opinion in
Psychiatry, 16, 227-231.
Sources of further information
- ChildLine provides a free and confidential telephone service
for children. Helpline 0800 1111; www.childline.org.uk.
- The Mental Health Foundation, Sea Containers House, 20 Upper
Ground, London SE1 9QB. tel. 020 7802 0300; www.mentalhealth.org.uk.
- Parentline offers help and advice to parents on bringing up
children and teenagers. Helpline 0808 800 2222; textphone 0800 783
6783; www.parentlineplus.org.uk.
- YoungMinds provides information and advice on child mental
health issues. 102-108 Clerkenwell Road, London EC1M 5SA; Parents'
Information Service 0800 018 2138; www.youngminds.org.uk.
- The Mental Health and Growing Up series contains 36
leaflets on a range of common mental health problems. To order the
pack, contact Book Sales at the Royal College of Psychiatrists, 17
Belgrave Square, London SW1X 8PG; tel. 020 7235 2351, ext. 146; fax
020 7245 1231; e-mail: booksales@rcpsych.ac.uk, or
you can download them from this website.
© [2004] Royal College of
Psychiatrists. This leaflet may be downloaded, printed out,
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