BHIPP Bulletin

Volume 11, Issue 9

March 2026

This month's BHIPP Bulletin is a contribution from

Rheanna Platt, MD, Associate Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine and BHIPP Consultant.

Somatic symptom and related disorders (SSRDs) are a group of disorders (e.g., illness anxiety disorder, functional neurologic symptom disorder, somatic symptom disorder (SSD)) characterized by prominent somatic symptoms and/or illness anxiety and significant distress and impairment; typically lasting 6 months or more. In these disorders, physical symptoms (or distress about the symptoms) may be disproportionate or inconsistent with history, physical, and other findings (e.g., laboratory workup). In addition to their association with increased health care utilization (and potential harm from invasive procedures), SSRDs can be associated with substantial impairment in function among youth including school absenteeism. Additionally, patients with SSD and their families may often feel dismissed by health care providers, who may also become anxious about missing something in the medical workup and frustrated with the patient/family, leading to challenges maintaining therapeutic alliance over time.¹ The prevalence of SSRDs in the pediatric population is not clear, with wide variation in estimates (between 3-31% for disorders and symptoms, respectively).² Among youth, the most common presenting somatic symptoms are abdominal pain and headache, followed by back pain, limb pain, other neurologic symptoms, and fatigue. Of note, the presence of another medical condition does not preclude a comorbid SSD diagnosis. 

Risk factors for SSRDs include individual or temperamental characteristics (e.g., limited repertoire of coping strategies, perfectionism, preference to avoid negative affect or emotions); a personal history of medical illness, anxiety or depressive disorders or of cognitive impairment; family history of medical illness, functional symptoms, or anxiety, depression or substance use disorders; family conflicts or major life events (e.g., divorce); and youth history of trauma, including bullying. For youth with a history of physical illness, new physical symptoms may trigger concerns (from either the child or caregivers) about relapse or worsening of disease. While SSRDs are more common in younger children, the presentation tends to be more complex and/or impairing in older children.  

When SSRDs are suspected, it is important to conduct a thorough medical evaluation while being mindful of the risks of unnecessary evaluations. A family medical and psychiatric history should be obtained, as well as an understanding of the family’s response to the child’s symptoms (including the possibility of caregiver catastrophizing to reinforce youth symptoms), as well as the family’s strengths. A recent review of Pediatric Somatic Symptom Disorders published in Current Psychiatry Reports¹ recommended early involvement of mental health professionals, when possible, to allow evaluations to occur in parallel, avoiding the potential perception or concern of the patient being “handed off” to a mental health provider. Involvement of a mental health professional can also help the patient and family with coping and functioning. While there is no standard/widely utilized screener for SSRDs and proprietary measures (e.g., somatic complaints subscale of the Child Behavior Checklist) can be cost prohibitive, a brief, freely available measure is the Children’s Somatic Symptom Inventory-8.³ Of note, because anxiety and/or mood disorders are frequently comorbid with SSRDs (with estimates that about 50% of those with SSRD have comorbid depressive or anxiety disorders⁴), screening for depression and anxiety should occur in parallel.

When making/discussing the diagnosis of a SSRD, it is important to communicate in a non-judgmental manner, to acknowledge the difficulties experienced by the family, and to avoid blame. It can be helpful to emphasize the mind-body connection (e.g., amplification of sensory perceptions/experiences) in discussing symptoms. It can also be helpful to focus on the patient’s functioning and potentially shifting the patient/family from identifying the cause of symptoms to focusing on improving patient functioning. Cognitive Behavioral Therapy (CBT) based treatments are foundational and can focus on development of relaxation skills and strategies and encouraging family reinforcement of health-focused behaviors rather than reinforcement of the “sick role.” Family involvement in treatment is often essential. Rehabilitation therapies (e.g., physical therapy) can help patients with functioning and address deconditioning that may have occurred. While there has been limited evidence/study of medications in SSRDs, given the frequency of comorbid mood and anxiety symptoms, selective serotonin reuptake inhibitors (SSRIs) may be considered. 

It is recommended that patients have scheduled regular follow-up with their primary care provider to help maintain the therapeutic alliance and recognize the need for additional services (e.g., physical therapy). Below are several resources that may be helpful to families:  

• AACAP Factors for Families: Physical Symptoms of Emotional Distress: Somatic Symptoms and Related Disorders
• Sick Kids (Toronto) Learning Hub: Somatization
• Child Mind Institute: Quick Guide to Somatic Symptom Disorder

As always, if you have questions about the behavioral health needs of your patients, we encourage you to call the BHIPP consultation line at 

855-MD-BHIPP (632-4477), open 9am-5pm Monday-Friday, for resource/referral networking or consultation support.

We will keep you informed about all our services and training events through our website (www.mdbhipp.org) and monthly e-newsletters. Additionally, BHIPP is on LinkedIn and Facebook. We invite you to follow us there to stay up-to-date on upcoming training events, pediatric mental health research, and resources for providers, families and children.

There is still time to register for this week's BHIPP Webinar!

Register for the next BHIPP Webinar on April 2nd at 12:00pm! BHIPP Webinars are a series of interactive, web-based learning sessions that are a virtual space for pediatric primary care, emergency medicine, and behavioral health providers to connect, learn and share about strategies, practices and resources to promote mental health and resilience among children and families as well as providers. Free CME and CEU credit is available for participation!

Register for the BHIPP ECHO PMHNP Series!

Register for the new BHIPP PMHNP ECHO series! The first session will be held on April 7th from 11:00am-12:00pm. Join our multidisciplinary team of child behavioral health experts every month between October 2025 and May 2026 for virtual case-based learning and didactic presentations. This series is designed for Maryland Psychiatric-Mental Health Nurse Practitioners (PMHNPs) who want to deepen their knowledge of child and adolescent mental health.

Join the BHIPP ECHO Series for Pediatric Primary Care Providers!

Register for the BHIPP ECHO Series for Pediatric Primary Care Providers! The first session will be held on April 9th from 12:00-1:00pm. Join our multidisciplinary team of child behavioral health experts bimonthly from October 2025 and May 2026 for virtual case-based learning and didactic presentations. Free CEU, CME, and ABP MOC Part 2 credits are available for participation.