Somatic Symptom Disorder 313
In children, the most common  symptoms are recurrent abdominal pain, headache, fa-
tigue, and nausea. A single  prominent symptom is more common in children than in
adults. While young children may have somatic complaints, they rarely worry about “ill-
ness” per se prior to adolescence. The parents’ response to the sy mptom is important, as
this may determine the level of associated dist ress. It is the parent who may determine the
interpretation of symptoms and the associated time off school and medical help seeking. 
Risk and Prognostic Factors
Temperamental. The personality trait of negative affe ctivity (neuroticism ) has been identi-
fied as an independent correlate/risk factor of a high number of somatic symptoms. Comorbid
anxiety or depression is common and ma y exacerbate symptoms and impairment.
Environmental. Somatic symptom disorder is more freq uent in individuals with few years
of education and low socioeconomic status, an d in those who have recently experienced
stressful life events. 
Course modifiers. Persistent somatic symptoms are associated with demographic fea-
tures (female sex, older age, fewer years of education, lo wer socioeconomic status, un-
employment), a reported history of sexual ab use or other childhood adversity, concurrent
chronic physical illness or psychiatric disorder (depression, anxiety, persistent depressive
disorder [dysthymia], panic), social stress, and reinforcing social factors such as illness
benefits. Cognitive factors that affect clinical course include sensitization to pain, height-
ened attention to bodily sen sations, and attribution of bod ily symptoms to a possible med-
ical illness rather than recognizing them as a normal phenomenon or psychological stress. 
Culture-Related Diagnostic Issues