Somatising in children and adolescents. 1. Clinical presentations and aetiological factors

complaints, attributing significance (or reassurance) to these complaints, facilitating (or otherwise) the children’s use of health care facilities and their involvement in (or withdrawal from) normal life activities. Other developmental factors, especially the level of cognitive and verbal competence, have long been recognised as important determinants of the ability to express emotional distress directly by speech. Early in development, those who are less sophisticated in their understanding and are less skilled in their direct verbal expression of psychological distress by speech are, it is suggested, more likely to express their feelings in other, more indirect ways. As psychological distress inevitably has somatic concomitants, complaints about somatic symptoms may therefore be one way in which emotional distress is both experienced and communicated by young people, just as for young children a variety of other primitive and regressive behaviours are commonly recognised as signalling emotional discomfort of various kinds. It is assumed that the process itself, of somatising emotional distress, is a common if not ubiquitous experience in childhood. This is not to suggest that just being a child can, in itself, be sufficient to cause the extent of somatising presentations in childhood and adolescence, the different forms of distress seen clinically or the natural history of these disorders. A variety of other explanations are relevant and must be sought, including temperamental, psychosocial, cultural and possibly genetic factors.