The Development of Somatic Symptom Disorder in Children: Psychological Characteristics and Psychiatric Comorbidity

Avital Gershfeld-Litvin, Nimrod Hertz-Palmor, Anat Shtilerman, Shaylee Rapaport, Doron Gothelf, Hana Weisman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Somatic symptom disorder (SSD) is one of the most common pediatric psychiatric disorders in adolescents, and several biological, psychological, and social factors have been considered to contribute to its development. Objective: The aim of the present study was to elucidate the link between psychological functioning (depression and anxiety), psychological characteristics (perfectionism and alexithymia), negative life events, and parental accommodation in children diagnosed with SSD. Methods: Fifty patients (age range 7–18 years) were diagnosed with SSD in an outpatient clinic and completed multiple self-report questionnaires on SSD symptoms, negative life events, and psychological factors. Linear regression models were used to indicate predictors of SSD symptoms. Cluster analysis was performed to identify gastrointestinal and abdominal complaints and their associations. Results: Association with SSD symptoms was strongest for state anxiety (standardized β = 0.85, 95% confidence interval [CI] = 0.44, 1.27, P = 0.0006), depression (β = 0.72, 95% CI = 0.38, 1.06, P = 0.0006), trait anxiety (β = 0.60, 95% CI = 0.22, 0.98, P = 0.0005), and family accommodation (β = 0. 49, 95% CI = 0.23, 0.75, P = 0.001). These factors were associated with gastrointestinal but not with neurological complaints. Family accommodation was associated with somatic complaints among children younger than 12 years (r = 0.57, P = 0.007), while state anxiety (r = 0.69, P = 0.007) and depression (r = 0.65, P = 0.007) were significantly associated among older children. Conclusions: Several psychological factors may result in a somatic response. The phenotypic expression of these factors may vary among different ages. Somatic complaints were related to parental accommodation among young children, while it was strongly associated with anxiety and depression among adolescents.

Original languageEnglish
Pages (from-to)324-333
Number of pages10
JournalJournal of the Academy of Consultation-Liaison Psychiatry
Issue number4
StatePublished - 1 Jul 2022


FundersFunder number
Foundation Dora
United States-Israel Binational Science Foundation2017369


    • accommodation
    • adolescents
    • anxiety
    • children
    • depression
    • psychosomatics


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