Somatic symptom and related disorders

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]