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Comment & Response
May 18, 2020

Somatic Symptom Disorder and the Physician’s Role

Author Affiliations
  • 1Perelman School of Medicine, The Children’s Hospital of Philadelphia, Division of Rheumatology, University of Pennsylvania, Philadelphia
JAMA Pediatr. Published online May 18, 2020. doi:10.1001/jamapediatrics.2020.0710

To the Editor We applaud the Viewpoint penned by Morabito et al1 on somatic symptom disorder. In addition to having multiple somatic symptoms, these children frequently are disproportionately dysfunctional. Recognizing somatic symptom disorder is the initial step; however, in our patient population, which frequently reports 20 to 30 symptoms, along with pain and marked dysfunction, we have found it helpful to validate their symptoms by using the analogy of amplification. The body feels a sensation, and then it becomes amplified so that dizziness, abdominal upset, and touch become severe and disabling and lead to dysfunction. This, in turn, leads to overmedicalization, which perpetuates the somatic symptom disorder. We have documented the overmedicalization of these patients.2 It is extremely hard for parents and physicians to seem to do nothing, when doing nothing, ie, not another test or medication, is part of their therapy. Additionally, we have found that directly addressing the dysfunction with intense physical and occupational therapy to work these patients through their symptoms, with aerobics and desensitization to the symptoms, has been successful, along with cognitive behavioral therapy.3 However, cognitive behavioral therapy is not in itself sufficient in restoring full physical function.4 Reestablishing normal function, especially school, family, and friend activities, is paramount and a very realistic and tangible goal for them to be successful relatively quickly. Although we do not have the data, it seems effective mental health support along with physical and occupational therapy is critical for successful long-term outcomes in youths with SSD.