Functional Somatic Symptoms in Children and Young People
by Moira Fallon
Functional Somatic Symptoms (FSS) can be thought of as the body’s expression of stress and emotions. FSS can be distressing for children and their families because despite the very real experience of symptoms, tests may not reveal an underlying physical issue or disease. It may also feel that other people think the problems are imaginary or they are being made up and all in the mind. Functional symptoms are very common. For example, in a person’s lifetime, nearly everyone will experience a headache when they are stressed. That is, it is neither all in the mind nor are they all in the body.
FSS are commonly experienced in children and young people. Symptoms can contribute to emotional and physical distress (ranging from mild to severe) that impairs daily functioning. Types of somatic symptoms in children include pain (e.g., limb, abdominal, heart or chest pain, and headaches), gastrointestinal symptoms (e.g., constipation, nausea or diarrhoea), numbness, tingling sensation in parts of the body, feeling fatigued, non-epileptic seizures and difficulty breathing.
There is no one known cause of FSS. Emotions and stress may cause the physical symptoms – an example of this would be whereby chronic stress at school leads to a child having fainting episodes. Emotions and stress can also make the symptoms of a medical condition stronger or more intense. For instance, when a child who has a pre-existing gastrointestinal disorder such as Crohn’s disease experiences anxiety or stress they see an exacerbation in physical symptoms. For others, a medical illness may cause anxiety and distress, which then leads to the development of somatic symptoms. For instance, after sustaining an injury, a child experiences a considerable amount of pain and misses weeks of school for the purpose of recovery. After
completing their physical recovery, the child reports a return of pain, resulting in school absences, low mood, and isolation.
In the above examples, biological, psychological, and social factors, or what is called a biopsychosocial framework, are considered and serve to demonstrate the mind-body connection. It may be helpful to think about the fight-flight response as an example of the mind-body connection. When
feeling scared or worried (i.e. mind), a powerful physical response (i.e. body) is triggered. Your heart beats faster, your muscles tense, and your stomach slows down to get you ready for action. All of these physical reactions happen to help you survive what you may perceive as danger by fighting or escaping (flight), even if the "danger" is not life threatening. Sometimes there is an obvious trigger for FSS, but often there is no clear
explanation. Every young person will vary greatly in what biopsychosocial factors are relevant. Good psychological assessment including quality formulation, and treatment that is tailored to take these unique factors into consideration can contribute to symptom reduction, symptom management,
and support to families