Paeds · mental-behavioural-and-psychosomatic
Somatic symptom and related disorders
Also known as Somatic symptom disorder in children · Illness anxiety disorder in children · Conversion disorder (functional neurological symptom disorder) in children · Paediatric psychosomatic disorder · Medically unexplained symptoms in children · Somatisation in childhood and adolescence · Psychological factors affecting medical condition
A fellowship approach to somatic symptom and related disorders (DSM-5) in children and adolescents: a validating, biopsychosocial, function-first model. Recognise the disorder on positive grounds (distressing symptoms plus disproportionate thoughts, feelings and behaviours — not 'medically unexplained'), screen once for organic disease, stop the test cascade, and co-build an interdisciplinary plan across ANZ, UK, US and Canada.
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Target exams
Red flags
- Weight loss, growth failure or failure to regain weight suggesting organic disease or malignancy
- New or progressive neurological deficit suggesting spinal cord, neuromuscular or central pathology
- Fever, night sweats or other systemic features suggesting inflammatory or malignant disease
- Symptoms consistently waking the child from sleep, or a consistent diurnal pattern unrelated to activity
- Disclosed or suspected self-harm, suicidal ideation or acute mental-health deterioration
- Features of fabricated or induced illness — inexplicable, only-in-carer's-presence symptoms, discordant histories, eagerness for procedures
- Complete and prolonged school absence with worsening function and escalating healthcare use
- Pattern of escalating analgesic (especially opioid) or benzodiazepine use for a somatic presentation
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Developmental / Behavioural Paediatrics
- Paediatric mental health and psychosomatic medicine
- Current 2026 PREP curriculum — Learning Objective 1.2.1: Communicate with a child or young person in a way which is appropriate to the position of that child within their own culture
- Current 2026 PREP curriculum — Learning Objective 1.2.2: Communicate with parents or carers
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Clinical Applications
- Mental health and psychosomatic medicine
- Long Cases
- Short Cases
- Communication stations
- 1. Healthy child: promoting health and preventing disease
- 4. Professional skills and knowledge: Patient management
- 8. Child safeguarding / mental health
- 10. Behavioural, emotional and mental health presentations
- General Paediatrics: Provides a validating, function-first, biopsychosocial assessment and interdisciplinary management of children and adolescents with somatic symptom and related disorders, screening once for organic disease, avoiding over-investigation and opioid escalation, and coordinating psychology, physiotherapy, mental-health and school reintegration
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Behavioural paediatrics, somatisation/functional presentations and mental health
- History
- Communication
- Clinical
- Child development
- General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
- General Pediatrics Content Outline — Domain 4: Adolescent Medicine and Growth
- General Pediatrics Content Outline — Domain 16: Mental and Behavioral Health
- General Pediatrics EPA 3: Providing well-child and adolescent care including preventive care and anticipatory guidance
- General Pediatrics EPA 11: Promoting equitable care at the level of each individual patient and the population
- Patient Care 1: History and Physical Examination
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Systems-Based Practice 3: System Navigation for Patient Centered Care – Coordination of Care
- Professionalism 1: Professional Behavior and Ethical Principles
- Professionalism 2: Accountability and Conscientiousness
- Communicator
- Collaborator
- Health Advocate
- Professional
- Pediatrics: Foundations EPA — Assessing and managing behavioural and mental-health presentations
- Pediatrics: Core EPA — Providing preventive care and anticipatory guidance
Overview & Definition
A 13-year-old has had daily abdominal pain, headaches and tiredness for eight months. She has seen four specialists, had three normal scans and a long list of normal bloods. She now attends school only two days a week, her mother is convinced something is being missed, and the folder of results is thicker than your textbook. The temptation is to order one more test, or to tell the family "the tests are normal, so there's nothing wrong." Both are harmful. The clinician who understands this presentation does a third thing: recognises a real nervous-system and coping problem, completes the targeted exclusion honestly, and starts a recovery plan. [1] [2]
The modern name for this cluster is the somatic symptom and related disorders (SSRD), a DSM-5 family that replaces the older, stigmatising "somatoform disorders" and "somatisation" labels. The defining idea is not the symptom itself but the relationship the child and family have with it: a distressing bodily symptom is paired with excessive, disproportionate thoughts, feelings or behaviours, and persists in a way that disrupts life. The symptom is genuine; the problem is the amplifying pattern around it. [2] [1]
The single most important sentence for the exam — and for the family — is that the symptoms need not be "medically unexplained". Under DSM-5-TR, a child with a genuine medical illness (coeliac disease, asthma, epilepsy) can still meet criteria for an SSRD if they also have the disproportionate cognitive and behavioural response. You diagnose the positive pattern of thoughts and behaviours, never the absence of disease. This shift is why the older "medically unexplained symptoms" framing is now a trap, and why the examiner expects DSM-5 language. [2]
Two facts anchor everything that follows. First, symptoms commonly shift between body systems in the same child — abdominal pain this year, fatigue and dizziness next — and the SSRD family shares a common biology and a common management approach, so a rigid single-organ diagnostic hunt is the wrong frame. Second, outcomes are far more modifiable than frightened families believe, and the lever that matters most is restoration of function: getting the child back to school, sleep, movement and friends. [1] [7]
References11ShowHide
- [1]Garralda ME Practitioner review: Assessment and management of somatisation in childhood and adolescence: a practical perspective. Journal of child psychology and psychiatry, and allied disciplines, 1999.PMID 10604395
- [2]Garralda ME Unexplained physical complaints. Child and adolescent psychiatric clinics of North America, 2010.PMID 20478496
- [3]Kozlowska K; English M; Savage B Connecting body and mind: the first interview with somatising patients and their families. Clinical child psychology and psychiatry, 2013.PMID 22969165
- [4]Ibeziako P; Randall E; Vassilopoulos A; Choi C; Thomson K Prevalence, Patterns, and Correlates of Pain in Medically Hospitalized Pediatric Patients With Somatic Symptom and Related Disorders. Journal of the Academy of Consultation and Liaison Psychiatry, 2021.PMID 32641234
- [5]Bedard-Thomas KK; Bujoreanu S; Choi CH; Ibeziako PI Perception and Impact of Life Events in Medically Hospitalized Patients With Somatic Symptom and Related Disorders. Hospital pediatrics, 2018.PMID 30327327
- [6]Ibeziako P; Choi C; Randall E; Bujoreanu S Bullying Victimization in Medically Hospitalized Patients With Somatic Symptom and Related Disorders: Prevalence and Associated Factors. Hospital pediatrics, 2016.PMID 27073256
- [7]Claar RL; Walker LS Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory. Pain, 2006.PMID 16480823
- [8]Pehlivantürk B; Unal F Conversion disorder in children and adolescents: a 4-year follow-up study. Journal of psychosomatic research, 2002.PMID 11943237
- [9]Pehlivantürk B; Unal F Conversion disorder in children and adolescents: clinical features and comorbidity with depressive and anxiety disorders. Turkish journal of pediatrics, 2000.PMID 10936979
- [10]Puri PR; Dimsdale JE Health care utilization and poor reassurance: potential predictors of somatoform disorders. Psychiatric clinics of North America, 2011.PMID 21889677
- [11]Smakowski A; Hüsing P; Völcker S; Löwe B; Rosmalen JGM Psychological risk factors of somatic symptom disorder: A systematic review and meta-analysis of cross-sectional and longitudinal studies. Journal of psychosomatic research, 2024.PMID 38365462