Pediatric Annals

Feature Article 

Psychiatric Comorbidity and Functional Abdominal Pain

John V. Campo, MD; Richard H. Gilchrist, MD

Abstract

The lack of a satisfactory biomedical explanation for the suffering and functional impairment experienced by children and adolescents with functional abdominal pain (FAP) led many clinicians and early investigators to suggest that FAP might be “psychogenic,” essentially the consequence of a psychological disturbance or disorder. Current perspectives are more sophisticated in emphasizing a biopsychosocial understanding of FAP, with the disorder considered to be the confluence of biological, psychological, and social determinants. However, the conviction that FAP is linked closely with emotional life remains strong. Interest in the relationship between FAP and psychiatric comorbidity has also been stimulated by the apparent clinical overlap between FAP and anxiety and depressive disorders, known collectively as emotional or internalizing disorders. Like the emotional disorders, FAP is associated with considerable psychosocial impairment, most notably poor school attendance and performance, peer-related and social difficulties, and self-perceived health limitations in excess of those expected from the physical symptoms. In addition, the rising prevalence of FAP during adolescence and shift in gender ratio from equal in childhood to a female preponderance in adolescence parallels the epidemiology of internalizing symptoms and disorders.

Abstract

The lack of a satisfactory biomedical explanation for the suffering and functional impairment experienced by children and adolescents with functional abdominal pain (FAP) led many clinicians and early investigators to suggest that FAP might be “psychogenic,” essentially the consequence of a psychological disturbance or disorder. Current perspectives are more sophisticated in emphasizing a biopsychosocial understanding of FAP, with the disorder considered to be the confluence of biological, psychological, and social determinants. However, the conviction that FAP is linked closely with emotional life remains strong. Interest in the relationship between FAP and psychiatric comorbidity has also been stimulated by the apparent clinical overlap between FAP and anxiety and depressive disorders, known collectively as emotional or internalizing disorders. Like the emotional disorders, FAP is associated with considerable psychosocial impairment, most notably poor school attendance and performance, peer-related and social difficulties, and self-perceived health limitations in excess of those expected from the physical symptoms. In addition, the rising prevalence of FAP during adolescence and shift in gender ratio from equal in childhood to a female preponderance in adolescence parallels the epidemiology of internalizing symptoms and disorders.

The lack of a satisfactory biomedical explanation for the suffering and functional impairment experienced by children and adolescents with functional abdominal pain (FAP) led many clinicians and early investigators to suggest that FAP might be “psychogenic,” essentially the consequence of a psychological disturbance or disorder. Current perspectives are more sophisticated in emphasizing a biopsychosocial understanding of FAP, with the disorder considered to be the confluence of biological, psychological, and social determinants. However, the conviction that FAP is linked closely with emotional life remains strong. Interest in the relationship between FAP and psychiatric comorbidity has also been stimulated by the apparent clinical overlap between FAP and anxiety and depressive disorders, known collectively as emotional or internalizing disorders. Like the emotional disorders, FAP is associated with considerable psychosocial impairment, most notably poor school attendance and performance, peer-related and social difficulties, and self-perceived health limitations in excess of those expected from the physical symptoms. In addition, the rising prevalence of FAP during adolescence and shift in gender ratio from equal in childhood to a female preponderance in adolescence parallels the epidemiology of internalizing symptoms and disorders.

10.3928/00904481-20090501-10

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