Research Article
Self-Esteem, Emotional And Behavioral Problems and Psychopathology In Children With Somatic Symptoms and Related Disorders
Abstract
Objective: There are few studies in the literature on somatic symptoms and related disorders (SSRD) in children. The aim of this study is to investigate emotional and behavioral difficulties, self-esteem, psychopathology, and clinical characteristics in children with somatic symptoms.
Method: This study included 44 children with recurrent and distressing somatic complaint(s) and 49 healthy children. The diagnosis of SSRD was evaluated in detail according to DSM-5 criteria. Self-esteem, emotional and behavioral difficulties, and somatization were assessed using the Rosenberg Self-Esteem Scale (RSES), Strengths and Difficulties Questionnaire (SDQ), and Children's Somatization Inventory (CSI-24), respectively.
Results: Children with somatization had significantly greater rates of having at least one comorbid mental disorder, emotional symptoms scores, and peer relationship problems. On the other hand, these children's prosocial behavior scores (Strengths Score), self-esteem scores, and academic performance were significantly lower than the control group. In addition, children with SSRD had more disadvantaged familial characteristics such as low father education, high family history of psychiatric and medical illness and somatization, high marital problems, and domestic violence.
Conclusions: This study revealed that somatization in children is associated with increased emotional, peer, and academic problems and psychopathology rates, and low self-esteem and prosocial behaviors. In clinical practice, it would be advisable to evaluate thoroughly children with SSRD in terms of familial disadvantages, emotional, peer, and academic problems, and psychopathology, rather than focusing solely on somatic symptoms.
Supporting Institution
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Project Number
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Thanks
The authors would like to thank all the children and their families for their collaboration with the study.
References
- 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association, 2013.
- 2. Rief W, Martin A. How to use the new DSM-5 somatic symptom disorder diagnosis in research and practice: a critical evaluation and a proposal for modifications. Annu Rev Clin Psychol 2014;10:339-367. doi:10.1146/annurev-clinpsy-032813-153745.
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- 6. Haller H, Cramer H, Lauche R, Dobos G. Somatoform disorders and medically unexplained symptoms in primary care. Dtsch Arztebl Int 2015;112(16):279-287. doi:10.3238/arztebl.2015.0279
- 7. Lieb R, Pfister H, Mastaler M, Wittchen HU. Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments. Acta Psychiatr Scand 2000;101(3):194-208.
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- 9. Hart SL, Hodgkinson SC, Belcher HM, Hyman C, Cooley-Strickland M. Somatic symptoms, peer and school stress, and family and community violence exposure among urban elementary school children. J Behav Med 2013;36(5):454-465. doi:10.1007/s10865-012-9440-2
- 10. Ayaz AB, Ayaz M, Perdahlı Fiş N, Güler AS. Anxiety Level, Maternal Attachment Style and Family Functioning in Adolescents' Somatoform Disorders. J Clin Psy 2012; 15(2): 121-128
- 11. Şahin Özen EM, Türkcan Solmaz A, Belene A, Yeşlilbursa D, Yurt E. Somatization: Cultural and sociologic factors. Yeni Symposium 2009;47(4):187-193.
- 12. Eminson DM. Medically unexplained symptoms in children and adolescents. Clin Psychol Rev 2007;27(7):855-871. doi:10.1016/j.cpr.2007.07.007
- 13. White KS, Farrell AD. Anxiety and psychosocial stress as predictors of headache and abdominal pain in urban early adolescents. J Pediatr Psychol 2006;31(6):582-596. doi:10.1093/jpepsy/jsj050
- 14. Kozlowska K. The developmental origins of conversion disorders. Clin Child Psychol Psychiatry 2007;12(4):487-510. doi:10.1177/1359104507080977
- 15. Sarı SA, Fettahoğlu EÇ, Özatalay E, Uzun A. Traumatic life history and co-existing psychiatric disorders in adolescents with a diagnosis of conversion disorder. Cumhuriyet Medical Journal 2016;38(4):271-278. doi:10.7197/cmj.v38i3.5000163351
- 16. Janssens KA, Rosmalen JG, Ormel J, van Oort FV, Oldehinkel AJ. Anxiety and depression are risk factors rather than consequences of functional somatic symptoms in a general population of adolescents: the TRAILS study. J Child Psychol Psychiatry 2010;51(3):304-312. doi:10.1111/j.1469-7610.2009.02174.x
- 17. Meerum-Terwogt M, Rieffe C, Miers AC, Jellesma FC, Tolland A. Emotions and self-esteem as indicators of somatic complaints in children. Infant and Child Development 2006;15(6):581-592. doi:10.1002/icd.479
- 18. Bujoreanu S, Randall E, Thomson K, Ibeziako P. Characteristics of medically hospitalized pediatric patients with somatoform diagnoses. Hosp Pediatr 2014;4(5):283-290. doi:10.1542/hpeds.2014-0023
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- 20. Campo JV. Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice. J Child Psychol Psychiatry 2012;53(5):575-592. doi:10.1111/j.1469-7610.2012.02535.x
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- 23. Rosenberg M. Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press, 1965 doi:10.1515/9781400876136
- 24. Çuhadaroglu F. Self-esteem in adolescents [in Turkish]. Unpublished master's thesis. Ankara, Turkey: Hacettepe University, 1986.
- 25. Goodman R. The Strengths and Difficulties Questionnaire: A research note. J Child Psychol Psychiatry 1997;38:581-586.
- 26. Guvenir T, Ozbek A, Baykara B, Arkar H, Senturk B, Incekas S. Psychometric properties of the Turkish version of the Strengths and Difficulties Questionnaire (SDQ). Turk J Child AdolescMent Health 2008;15(2):65-74.
- 27. Gini G, Carli G, Pozzoli T. Social support, peer victimisation, and somatic complaints: a mediational analysis. J Paediatr Child Health 2009;45(6):358-363. doi:10.1111/j.1440-1754.2009.01501.x
- 28. Aro H, Hänninen V, Paronen O. Social support, life events and psychosomatic symptoms among 14-16-year-old adolescents. Soc Sci Med 1989;29(9):1051-1056. doi:10.1016/0277-9536(89)90015-4
- 29. Beck JE. A developmental perspective on functional somatic symptoms. J Pediatr Psychol 2008;33(5):547-562. doi:10.1093/jpepsy/jsm113
- 30. Schulte IE, Petermann F. Familial risk factors for the development of somatoform symptoms and disorders in children and adolescents: a systematic review. Child Psychiatry Hum Dev 2011;42(5):569-583. doi:10.1007/s10578-011-0233-6
- 31. Brown RJ, Schrag A, Trimble MR. Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. Am J Psychiatry 2005;162(5):899-905. doi:10.1176/appi.ajp.162.5.899
- 32. Craig TK, Cox AD, Klein K. Intergenerational transmission of somatization behaviour: a study of chronic somatizers and their children. Psychol Med 2002;32(5):805-816. doi:10.1017/s0033291702005846
- 33. Burns AR, Solis JM, Shadur JM, Hussong AM. Comparing Psychiatric Symptoms among Children of Substance-Abusing Parents With Different Treatment Histories. Vulnerable Child Youth Stud 2013;8(3):10.1080/17450128.2012.738948. doi:10.1080/17450128.2012.738948
- 34. Schulte IE, Petermann F, Noeker M. Functional abdominal pain in childhood: from etiology to maladaptation. Psychother Psychosom 2010;79(2):73-86. doi:10.1159/000270915
- 35. Rask CU, Ørnbøl E, Fink PK, Skovgaard AM. Functional somatic symptoms and consultation patterns in 5- to 7-year-olds. Pediatrics 2013;132(2):e459-e467. doi:10.1542/peds.2013-0159
- 36. Tolan PH, Gorman–Smith D, Henry D, Chung KS, Hunt M. The relation of patterns of coping of inner–city youth to psychopathology symptoms. Journal of Research on Adolescence 2002;12(4):423-449. doi:10.1111/1532-7795.00040
- 37. Gutman LM, Codiroli McMaster N. Gendered Pathways of Internalizing Problems from Early Childhood to Adolescence and Associated Adolescent Outcomes. J Abnorm Child Psychol 2020;48(5):703-718. doi:10.1007/s10802-020-00623-w
- 38. Braquehais MD, Picouto MD, Casas M, Sher L. Hypothalamic-pituitary-adrenal axis dysfunction as a neurobiological correlate of emotion dysregulation in adolescent suicide. World J Pediatr 2012;8(3):197-206. doi:10.1007/s12519-012-0358-0
- 39. Andresen JM, Woolfolk RL, Allen LA, et al. Physical symptoms and psychosocial correlates of somatization in pediatric primary care. Clin Pediatr (Phila) 2011;50(10):904-909. doi:10.1177/0009922811406717
- 40. Kirmayer LJ, Looper KJ. Abnormal illness behaviour: physiological, psychological and social dimensions of coping with distress. Curr Opin Psychiatry 2006;19(1):54-60. doi:10.1097/01.yco.0000194810.76096.f2
Year 2022,
Volume: 44 Issue: 2, 172 - 180, 30.06.2022
Abstract
Project Number
None
References
- 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association, 2013.
- 2. Rief W, Martin A. How to use the new DSM-5 somatic symptom disorder diagnosis in research and practice: a critical evaluation and a proposal for modifications. Annu Rev Clin Psychol 2014;10:339-367. doi:10.1146/annurev-clinpsy-032813-153745.
- 3. Jenkins W, Smart K. Somatization in acute care pediatrics: Respecting the mind-body connection. Clin Child Psychol Psychiatry 2020;25(3):604-609. doi:10.1177/1359104520905065
- 4. Malas N, Ortiz-Aguayo R, Giles L, Ibeziako P. Pediatric Somatic Symptom Disorders. Curr Psychiatry Rep 2017;19(2):11. doi:10.1007/s11920-017-0760-3
- 5. Romero-Acosta K, Canals J, Hernández-Martínez C, Penelo E, Zolog TC, Domènech-Llaberia E. Age and gender differences of somatic symptoms in children and adolescents. J Ment Health 2013;22(1):33-41. doi:10.3109/09638237.2012.734655
- 6. Haller H, Cramer H, Lauche R, Dobos G. Somatoform disorders and medically unexplained symptoms in primary care. Dtsch Arztebl Int 2015;112(16):279-287. doi:10.3238/arztebl.2015.0279
- 7. Lieb R, Pfister H, Mastaler M, Wittchen HU. Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments. Acta Psychiatr Scand 2000;101(3):194-208.
- 8. Kadıoğlu H, Sişman FN, Ergün A. Reliability and Validity of the Turkish Version of Children's Somatization Inventory. Asian Nurs Res (Korean Soc Nurs Sci) 2012;6(1):9-12. doi:10.1016/j.anr.2012.02.004
- 9. Hart SL, Hodgkinson SC, Belcher HM, Hyman C, Cooley-Strickland M. Somatic symptoms, peer and school stress, and family and community violence exposure among urban elementary school children. J Behav Med 2013;36(5):454-465. doi:10.1007/s10865-012-9440-2
- 10. Ayaz AB, Ayaz M, Perdahlı Fiş N, Güler AS. Anxiety Level, Maternal Attachment Style and Family Functioning in Adolescents' Somatoform Disorders. J Clin Psy 2012; 15(2): 121-128
- 11. Şahin Özen EM, Türkcan Solmaz A, Belene A, Yeşlilbursa D, Yurt E. Somatization: Cultural and sociologic factors. Yeni Symposium 2009;47(4):187-193.
- 12. Eminson DM. Medically unexplained symptoms in children and adolescents. Clin Psychol Rev 2007;27(7):855-871. doi:10.1016/j.cpr.2007.07.007
- 13. White KS, Farrell AD. Anxiety and psychosocial stress as predictors of headache and abdominal pain in urban early adolescents. J Pediatr Psychol 2006;31(6):582-596. doi:10.1093/jpepsy/jsj050
- 14. Kozlowska K. The developmental origins of conversion disorders. Clin Child Psychol Psychiatry 2007;12(4):487-510. doi:10.1177/1359104507080977
- 15. Sarı SA, Fettahoğlu EÇ, Özatalay E, Uzun A. Traumatic life history and co-existing psychiatric disorders in adolescents with a diagnosis of conversion disorder. Cumhuriyet Medical Journal 2016;38(4):271-278. doi:10.7197/cmj.v38i3.5000163351
- 16. Janssens KA, Rosmalen JG, Ormel J, van Oort FV, Oldehinkel AJ. Anxiety and depression are risk factors rather than consequences of functional somatic symptoms in a general population of adolescents: the TRAILS study. J Child Psychol Psychiatry 2010;51(3):304-312. doi:10.1111/j.1469-7610.2009.02174.x
- 17. Meerum-Terwogt M, Rieffe C, Miers AC, Jellesma FC, Tolland A. Emotions and self-esteem as indicators of somatic complaints in children. Infant and Child Development 2006;15(6):581-592. doi:10.1002/icd.479
- 18. Bujoreanu S, Randall E, Thomson K, Ibeziako P. Characteristics of medically hospitalized pediatric patients with somatoform diagnoses. Hosp Pediatr 2014;4(5):283-290. doi:10.1542/hpeds.2014-0023
- 19. Walker LS, Beck JE, Garber J, Lambert W. Children's Somatization Inventory: psychometric properties of the revised form (CSI-24). J Pediatr Psychol 2009;34(4):430-440. doi:10.1093/jpepsy/jsn093
- 20. Campo JV. Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice. J Child Psychol Psychiatry 2012;53(5):575-592. doi:10.1111/j.1469-7610.2012.02535.x
- 21. Kaufman J, Birmaher B, Axelson D, Perepletchikova F, Brent D, Ryan N. Schedule for affective disorders and schizophrenia for school-aged children: present and lifetime version (K-SADS-PL) DSM-5 working draft. New Haven: Yale University Child and Adolescent Research and Education, 2016
- 22. Ünal F, Öktem F, Çetin Çuhadaroğlu F, Çengel Kültür SE, Akdemir D, Foto Özdemir D, Çak HT, Ünal D, Tıraş K, Aslan C, Kalaycı BM, Aydos BS, Kütük F, Taşyürek E, Karaokur R, Karabucak B, Karakök B, Karaer Y, Artık A. Reliability and validity of the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime version, DSM-5 November 2016–Turkish adaptation (K-SADS-PL-DSM-5-T). Turk Psikiyatri Derg 2019;30(1):42-50.
- 23. Rosenberg M. Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press, 1965 doi:10.1515/9781400876136
- 24. Çuhadaroglu F. Self-esteem in adolescents [in Turkish]. Unpublished master's thesis. Ankara, Turkey: Hacettepe University, 1986.
- 25. Goodman R. The Strengths and Difficulties Questionnaire: A research note. J Child Psychol Psychiatry 1997;38:581-586.
- 26. Guvenir T, Ozbek A, Baykara B, Arkar H, Senturk B, Incekas S. Psychometric properties of the Turkish version of the Strengths and Difficulties Questionnaire (SDQ). Turk J Child AdolescMent Health 2008;15(2):65-74.
- 27. Gini G, Carli G, Pozzoli T. Social support, peer victimisation, and somatic complaints: a mediational analysis. J Paediatr Child Health 2009;45(6):358-363. doi:10.1111/j.1440-1754.2009.01501.x
- 28. Aro H, Hänninen V, Paronen O. Social support, life events and psychosomatic symptoms among 14-16-year-old adolescents. Soc Sci Med 1989;29(9):1051-1056. doi:10.1016/0277-9536(89)90015-4
- 29. Beck JE. A developmental perspective on functional somatic symptoms. J Pediatr Psychol 2008;33(5):547-562. doi:10.1093/jpepsy/jsm113
- 30. Schulte IE, Petermann F. Familial risk factors for the development of somatoform symptoms and disorders in children and adolescents: a systematic review. Child Psychiatry Hum Dev 2011;42(5):569-583. doi:10.1007/s10578-011-0233-6
- 31. Brown RJ, Schrag A, Trimble MR. Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. Am J Psychiatry 2005;162(5):899-905. doi:10.1176/appi.ajp.162.5.899
- 32. Craig TK, Cox AD, Klein K. Intergenerational transmission of somatization behaviour: a study of chronic somatizers and their children. Psychol Med 2002;32(5):805-816. doi:10.1017/s0033291702005846
- 33. Burns AR, Solis JM, Shadur JM, Hussong AM. Comparing Psychiatric Symptoms among Children of Substance-Abusing Parents With Different Treatment Histories. Vulnerable Child Youth Stud 2013;8(3):10.1080/17450128.2012.738948. doi:10.1080/17450128.2012.738948
- 34. Schulte IE, Petermann F, Noeker M. Functional abdominal pain in childhood: from etiology to maladaptation. Psychother Psychosom 2010;79(2):73-86. doi:10.1159/000270915
- 35. Rask CU, Ørnbøl E, Fink PK, Skovgaard AM. Functional somatic symptoms and consultation patterns in 5- to 7-year-olds. Pediatrics 2013;132(2):e459-e467. doi:10.1542/peds.2013-0159
- 36. Tolan PH, Gorman–Smith D, Henry D, Chung KS, Hunt M. The relation of patterns of coping of inner–city youth to psychopathology symptoms. Journal of Research on Adolescence 2002;12(4):423-449. doi:10.1111/1532-7795.00040
- 37. Gutman LM, Codiroli McMaster N. Gendered Pathways of Internalizing Problems from Early Childhood to Adolescence and Associated Adolescent Outcomes. J Abnorm Child Psychol 2020;48(5):703-718. doi:10.1007/s10802-020-00623-w
- 38. Braquehais MD, Picouto MD, Casas M, Sher L. Hypothalamic-pituitary-adrenal axis dysfunction as a neurobiological correlate of emotion dysregulation in adolescent suicide. World J Pediatr 2012;8(3):197-206. doi:10.1007/s12519-012-0358-0
- 39. Andresen JM, Woolfolk RL, Allen LA, et al. Physical symptoms and psychosocial correlates of somatization in pediatric primary care. Clin Pediatr (Phila) 2011;50(10):904-909. doi:10.1177/0009922811406717
- 40. Kirmayer LJ, Looper KJ. Abnormal illness behaviour: physiological, psychological and social dimensions of coping with distress. Curr Opin Psychiatry 2006;19(1):54-60. doi:10.1097/01.yco.0000194810.76096.f2
There are 40 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Medical Science Research Articles |
| Authors | |
| Project Number | None |
| Publication Date | June 30, 2022 |
| Acceptance Date | June 12, 2022 |
| Published in Issue | Year 2022Volume: 44 Issue: 2 |