Evaluation and Management of Psychosomatic Symptoms in Adolescence

Abstract

Adolescent patients commonly experience symptoms such as headache, chest pain, abdominal pain, or dizziness that are psychophysiologic responses to stress, anxiety, and depression. Because most symptomatic adolescents initially visit medical providers, and not mental health professionals, the clinician is faced with the challenge of providing a comprehensive evaluation that is not merely focused on the symptom. In addition to a careful medical assessment, this evaluation must include a review of psychosocial functioning in the family, school, peer group, and community. Appropriate management may include supportive counseling, instruction in relaxation techniques, anti-depressant medication, and referral for psychotherapy.

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References

Oster J. Recurrent abdominal pain, headache and limb pains in children and adolescents . Pediatrics 1972;50:429-36.

Starfield B. , Gross E. , Wood M. , et al. Psychosocial and psychosomatic diagnoses in primary care of children. Pediatrics 1980 ;66:159-67.

Barsky III AJ Patients who amplify bodily sensations. Ann Intern Med 1979;91:63-70.

Garfield SR , Collen MF , Feldman R. , et al. Evaluation of an ambulatory medical-care delivery system. N Engl J Med 1976;294:426-31.

Barsky III AJ Hidden reasons some patients visit doctors . Ann Intern Med 1981;94(Part I):492-8.

Greene JW , Walker LS , Hickson G. , et al. Stressful life events and somatic complaints in adolescents . Pediatrics 1985;75: 19-22.

Minuchin S. , Baker L. , Rosman BL , et al. A conceptual model of psychosomatic illness in children. Arch Gen Psychiatry 1975;32:1031-8.

Brown JT , Mulrow CD , Stoudemire GA , et al. The anxiety disorders. Ann Intern Med 1984;100:558-64.

Van Winter JT , Stickler GB Panic attack syndrome. J Pediatr 1984;105:661-5.

10.

Pauls DL , Bucher KD , Crowe RR , et al. A genetic study of panic disorder pedigrees. Am J Hum Genet 1980;32:639.

11.

Katon W. , Kleinman A. , Rosen G. Depression and somatization: a review. Am J Med 1982;72:127-35, 241-7.

12.

Friedman RC , Hurt SW , Clarkin JF , et al. Symptoms of depression among adolescents and young adults. J Affect Dis 1983;37-43.

13.

Carlson G. , Strober M. Affective disorders in adolescence. Psych Clin North Am 1979;2:511-25.

14.

Smith MS An approach to the adolescent for the primary care clinician. J Fam Pract 1979;8:63-6.

15.

Bernstein DA , Boukovec TD Progressive relaxation training: a manual for the helping professional . Champaign, IL, Research Press , 1973 .

16.

Benson H. The relaxation response. New York: William Morrow, 1975.

17.

Goldberg RJ Anxiety reduction by self-regulation: theory, practice and evaluation. Ann Intern Med 1982 ;96:483-7.