儿童和青少年的躯体形式障碍

Deptt. of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka.

Bangladesh Med Res Counc Bull. 2002 Dec;28(3):112-22.

Somatization is common among children and adolescents. A consecutive series of 112 children and adolescents who fulfilled the ICD-10 clinical diagnostic criteria for somatoform disorders attended at a psychiatric consultation center were included in this study to delineate the pattern of presenting features and to find out associated abnormal psychosocial situations and disabilities. Out of 112 cases 52 were boys, 60 girls, of them 59 were children and 53 adolescents. Polysymptomatic presentation was commoner (92%) than monosymptomatic presentation (8%). Pain was the most prevalent symptom. Children showed significantly higher rates of abdominal complaints and adolescents showed higher rates of headaches. All cases reported an average of 14.21 somatic symptoms. Boys and girls reported an average of 13.75 and 14.61 somatic symptoms respectively and this difference between two groups was not significant. Whereas children reported an average of 12.66 somatic symptoms and adolescents reported an average of 15.94 somatic symptoms. The difference was significant. Differences were also found in the diagnostic categories of somatoform disorders. Girls reported higher rates of somatization disorder and persistent somatoform pain disorder than that of boys. Children reported higher rates of undifferentiated somatoform disorder and somatoform autonomic dysfunction. In contrast, adolescents reported higher rates of somatization disorder. Abnormal psychosocial situations were found to be associated with predisposition, onset, and course of the disorders in majority of the cases and most common was parental overprotection. Remarkable social impairments particularly, in the domains of academic and peer relationship were found among the cases. Findings suggest that somatoform disorders in children and adolescents are frequent in clinical practice. Better understanding of these disorders can promote early diagnoses and timely treatments and improve the quality of life by preventing negative consequences.

躯体化在儿童和青少年中很常见。本研究纳入了在一家精神科咨询中心就诊的112名符合ICD - 10躯体形式障碍临床诊断标准的儿童和青少年，以描绘其症状表现模式，并找出相关的异常心理社会状况及功能障碍。112例中，男孩52例，女孩60例，其中儿童59例，青少年53例。多症状表现（92%）比单症状表现（8%）更常见。疼痛是最普遍的症状。儿童腹部不适的发生率显著更高，青少年头痛的发生率更高。所有病例平均报告了14.21种躯体症状。男孩和女孩平均分别报告了13.75种和14.61种躯体症状，两组之间的差异不显著。然而，儿童平均报告了12.66种躯体症状，青少年平均报告了15.94种躯体症状。差异显著。在躯体形式障碍的诊断类别中也发现了差异。女孩报告的躯体化障碍和持续性躯体形式疼痛障碍的发生率高于男孩。儿童报告的未分化躯体形式障碍和躯体形式自主神经功能紊乱的发生率更高。相比之下，青少年报告的躯体化障碍发生率更高。在大多数病例中，发现异常心理社会状况与这些障碍的易感性、发病及病程相关，最常见的是父母过度保护。在这些病例中发现了显著的社会功能损害，尤其是在学业和同伴关系方面。研究结果表明，儿童和青少年的躯体形式障碍在临床实践中很常见。更好地了解这些障碍可以促进早期诊断和及时治疗，并通过预防负面后果来提高生活质量。