Somatoform disorders: 30 years of debate about criteria! What about children and adolescents?

Objectives: The aim of this study was to evaluate the suitability of the complex somatic symptom disorder, proposed by the DSM-V Somatic Symptom Disorders Workgroup, in classifying children and adolescents who suffer severely from medically unexplained symptoms.

Methods: The existing knowledge about somatoform disorders (SDs) in children and adolescents was delineated by means of a comprehensive search in the psychological, psychiatric, and pediatric literature. It was analyzed to assess whether children and adolescents suffer from SDs according to DSM-IV-TR (prevalence, developmental course, comorbidity, risk factors, and impact on daily functioning). Subsequently, each criterion of the complex somatic symptom disorder was outlined and discussed with respect to its suitability in classifying children and adolescents. The suitability of the DSM-IV-TR criteria of SDs and that of the criteria of the complex somatic symptom disorder were compared.

Results: Current data of sufficient quality are limited but indicate that the DSM-IV-TR criteria are inappropriate for classifying most children and adolescents suffering from somatoform symptoms. The criteria for complex somatic symptom disorder are more appropriate. Nevertheless, it is recommended to include two additional parameters: "parental excessive concern and preoccupation with the child's symptoms" and "high parental health anxieties."

Conclusions: The criteria for complex somatic symptom disorder are more appropriate for children and adolescents than the current DSM-IV-TR criteria; they should be better adapted to the special situation of children and adolescents.