Psychosomatic Issues Among School Children

More often than not, we all have experienced days when we are down with fever or cold (which has a biological cause to it) and we may become irritable or feel very low (an emotional aspect) about it. On days we may have felt low, irritable, which leave us feeling exhausted, heaviness in head etc. (a physical aspect).These seemingly different incidents are tied together by the interdependent relationship between our 'Mind (psyche) and Body (soma)'. This relationship is significant in the holistic development and wellbeing of an individual but at the same can be a source to myriad ailments.

Helen Dunbar and Franz Alexander in the 1930s and 40s offered profile of physical ailments such as ulcer, rheumatoid etc. which is actually caused by emotional disturbances. This helped shape the field of Psychosomatic Medicine, thus, cementing the mind-body relationship. Psychosomatic conditions can be understood as a group of diseases that include physical symptoms (e.g., pain, nausea, and dizziness) of vague, varying or fluctuating severity, for which signs in an adequate medical examination cannot be found. Detailed investigation would indicate emotional conflict as precursor to such physical complaints that goes on to impair daily living of the individuals.

It is important that we realize that psychosomatic concerns are not only present in adults but children too. A study in 2001 revealed that nearly 10-25% of children and adolescents report psychosomatic issues. Junichi Oki in his study in 2010 reported that in an outpatient clinic setting children as young as 3 years presented with psychosomatic problems. Stomach ache, headaches, musculoskeletal and chest pain are the most common psychosomatic complaints in children. Other commonly reported symptoms are of breathing difficulty, fainting, pseudo seizure (seizure like presentation with no biological cause) etc. Stress stemming from environment such as school or family is the root to psychosomatic illnesses in children. Changes in school, school workload, difficulty with peers, conflict with teachers, rigid parenting, family financial issues, illness of family member, physical or sexual abuse are some of the potential sources of stress that could lead to development of such condition.

Vivek (name changed), 10 years old, and studying in 5th grade was rushed to the emergency department of the hospital due to intense pain in the chest and difficulty in breathing. On questioning, parents reported that he had been complaining of chest pain, especially during evenings, for the last 5 days. Due to this he has been staying at home, missing out on school and tuition classes. He refuses to go out to play with his friends as well. Parents reported that by night he is usually relieved of his headache. Medical examinations such as chest X-ray, blood tests were done, however, results were negative. The primary consulting team then referred the child to the psychologist and there it was revealed that the child was being bullied by his group mates in the tuition since the last 1 month. Multidisciplinary team of the hospital suggested management regime which included regular counseling sessions and over the next several days, Vivek showed gradual improvement in his symptoms and goes out to play with his friends with a big and content smile on his face.

Often, such symptoms are a cry for help. Children might not be able to comprehend the distress that they're experiencing or might not have the necessary resources to vocalize their emotional pain. Overtly showing their pain is their way to draw the attention of their family towards their woes. Culture too plays an important role here. In India, most often than not people seem to provide emotional and social support when they "see" someone suffering from physical distress. Psychological/mental distressisstigmatizedandscornedat.Anotherpossibilityischildrenlearning such 'sick-role' behavior from elders in their family, where they have witnessed how family members take care and pay attention to the needs of the person who is down with a physical illness.

It is imperative that we not only acknowledge the distress of the child but also teach them the appropriate coping skills so that they are able to deal with stressors without assuming a sick role and avoiding the conflict altogether. As the saying goes 'It takes a village to raise a child', it is important that not only the family environment, but the school environment as well the community they reside in is able to contribute towards the holistic and positive development(physical, mental and social) of the child.

By: Ms. Procheta Mahanta

Clinical Psychologist

Consultant, MIND India

Ask Dr Sangeeta Goswami

Question: My son, currently 11 years old has been complaining of frequent stomach achessince the last 2 weeks. His medical reports are clear and doctors have suggested for consultationwith psychologists as they suspect anxiety. His final exams are coming up and he hasn't beenable to study for it due to his pain and we are afraid if this continues then he would lose out ononeacademicyear.Theentire situation isveryconfusingforus.WhatdoIdo?

As a parent it must verydistressing for you to watch your son suffer. Asobserved by the doctors, his stomach ache could be very much due to his anxiety about hisperformance in examination. Many a times the stress they're experiencing could be manifestedthroughphysicalsymptoms,sothattheycouldcope withitbetter.

The firstthing you could do is to acknowledge the pain he is undergoing. He is notproducing the symptoms knowingly. Talk to your child and assess if he needs help with his exampreparation.

Discuss with your child about his stomach ache and the possibility of anxiety beingthe cause so that he is able to understand his situation better. Coping statements such as 'I ambigger than my anxiety' could be taught. Deep breathing exercises can help him calm down. Asdifficult as itmight be to watch him in pain butit is important that you encourage him to studyfor theexamsand engageinhisroutineactivitiessothathissymptomsreduces. If it persist , please consult a mental health specialist at your earliest

Also Read: How to Talk about Mental Illness with your Children

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