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 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 physical cause. It also offers advice
about how to recognise and manage these problems.
Introduction
One in 10 children and adolescents suffer from
physical symptoms for which no underlying physical cause can be
found. Common symptoms are headaches, stomach aches, joint pains
and tiredness. Less commonly young people can have significant
unexplained physical symptoms, including muscle weakness,
collapses, ‘fit-like’ episodes, and severe and chronic pain.
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
instance about moving schools, friendship problems or not
managing school work
- are very sensitive to physical symptoms and
pain
- are very sensitive to others
- have low self-esteem
- tend to be fussy or perfectionistic
- 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.
Unexplained physical symptoms may also be part
of another psychiatric condition, such as depression or anxiety.
There may also be a family history of unexplained physical
symptoms.
What are the effects of unexplained physical
symptoms?
For most children and young people, with
appropriate reassurance, the symptoms are short-lived. However, for
some, everyday life can become very uncomfortable and stressful .
Unexplained physical symptoms can also be very worrying for
parents.
The symptoms may result in young people:
- missing a lot of school; they may not achieve
what they should socially and academically;
- seeing less of their friends – this means
fewer interests, hobbies and fun;
- becoming anxious and depressed;
- being less independent than other young
people their age.
Who can help?
Your GP 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 and
adolescent mental health service.
Specialists, such as psychiatrists, can help
identify psychological factors that may be contributing to the
symptoms, and can also help to distinguish unexplained physical
symptoms from other mental health problems, such as depression.
Talking treatments can help you and your child
to manage unexplained physical symptoms better. Medication can also
play a part, particularly in treating any anxiety and depression
that is also present.
A planned approach
For the most severe unexplained physical
symptoms, psychiatric input can be helpful in developing a planned
approach to the problem. 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. This will help your 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 young person 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.
Caring for a young person with unexplained
physical symptoms can be very stressful. Family life can become
dominated by your child’s difficulties. 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. You 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
- manage 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 ideas to be shared about the best ways forward –
physical, psychological and educational.
Sources of further information
- ChildLine
provides a free and confidential telephone service for children.
Helpline 0800 1111.
- Mental Health
Foundation
- Parentline
offers help and advice to parents on bringing up children and
teenagers. Helpline 0808 800 2222
- YoungMinds
provides information and advice on child mental health
issues. Parents’ Information Service 0800 802 5544.
Recommended reading
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.
Eminson, M. (2001). Somatising in children and
adolescents. 1. Clinical presentations and aetiological factors.
Advances in Psychiatric Treatment. 7, 266-274
Eminson, M (2001) Somatising in children and
adolescents. 2. Management and outcomes. Advances in Psychiatric
Treatment. 7, 388-398
Series editor: Dr Mona Freeman
Expert review: Dr Warren Levine
Editorial Board: Child and Family Public
Education Editorial Board.
Revised: March 2010; next due for review: March
2012
© [2004] Royal College of
Psychiatrists. This leaflet may be downloaded, printed out,
photocopied and distributed free of charge as long as the Royal
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