To the Editor We read with interest the Viewpoint article by Morabito et al1 on somatic symptom disorder (SSD) and the physician’s role in perpetuating the disorder, which appeared online in JAMA Pediatrics on November 18, 2019. The diagnostic journey of patients with SSD mirrors the diagnostic journey commonly seen in our area of practice, dysautonomia of adolescence (DAOA). Dysautonomia of adolescence results from dysregulation of the sympathetic and parasympathetic limbs of the autonomic nervous system. This condition manifests in adolescence during an accelerated period of growth and development. The DAOA symptom complex can limit activities of daily living whereby patients withdraw from school, sports, and other recreational activities2 similar to patients with SSD. Commonly, patients with DAOA report seeing multiple specialists in search of a clinical diagnosis.3 The lack of symptom validation, along with distrust of the medical community, make it difficult for many patients and their families to accept their diagnosis once made. We commend the authors for addressing the negative effects of overinvestigation and overtreatment in conditions where no organic disease is present.
Galvin CR, De Souza AM, Armstrong KR. Somatic Symptom Disorder and the Physician’s Role. JAMA Pediatr. Published online May 18, 2020. doi:10.1001/jamapediatrics.2020.0165
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