Adolescents with functional somatic syndromes: Symptom profiles, illness perception, illness worry and attachment orientation, 2021, Kallesoe et al

No abstract, my bolding.

Introduction

Impairing functional somatic symptoms without explanatory physical pathological findings are common in adolescents with prevalence estimates of 4–10% depending on study population [1]. Suffering from functional somatic symptoms in adolescence often has high implications including school absenteeism, social withdrawal and low quality of life [2], with frequent comorbid anxiety and depression [3–5]. Furthermore, there is a considerable risk of continuity of symptoms into adulthood consequently leading to lower educational attainment and high healthcare costs [6–8].

A lack of international consensus on nomenclature for impairing functional somatic symptoms has entailed various diagnostic classifications including functional somatic syndromes (FSS) (e.g. fibromyalgia, irritable bowel syndrome, chronic fatigue (CFS) and idiopathic pain syndrome), somatoform disorders (ICD-10) and somatic symptom and related disorders (DSM-5). Generally, the diagnoses are based on adult descriptors and do not take developmental perspectives into account (e. g. higher prevalence of mono-symptomatic presentation in younger people) [1,9]. Furthermore, due to a large overlap in their symptomatology, there is an ongoing discussion as to whether the diagnostic concepts describe distinct entities or, rather, mirror medical subspecialisation [10,11]. This notion could also explain the findings in epidemiological studies in adults suggesting that FSS rarely occur in their pure form, i.e. without comorbidity with other FSS, even in the general population [12]. A recently introduced empirically supported diagnostic category of Bodily Distress Syndrome (BDS) encompasses the majority of FSS and somatoform disorders in adults [13,14]. The diagnosis describes four symptom groups (i.e. musculoskeletal, cardiopulmonary, gastrointestinal and general symptoms) and can be divided into a single- or multi-organ type dependent on number of symptom groups involved [15]. Although the diagnostic category of BDS is not empirically founded in youth, equivalent functional somatic symptom clusters have been reported based on factor analyses on data from youth-orientated questionnaires, i.e. clusters with pain, gastrointestinal symptoms, cardiopulmonary symptoms and general symptoms, respectively [16,17].

Symptom profiles in adult FSS suggest that patients experience the same symptoms as individuals in the general population but with higher prevalence and symptom load [15]. Furthermore, psychological characteristics of adult patients with FSS have been reported, including maladaptive illness perception such as monocausal symptom attribution and expectations of long symptom duration [18] and higher degree of illness worry [19]. In addition, the disruption of secure attachment (i.e. the ability to form ‘lasting psychological connectedness between human beings’ developed through the early interaction with caregivers [20]) has been proposed as both a vulnerability and maintaining factor for FSS through maladaptive emotion regulation and symptom coping and a more easily and strongly activated stress response [21–23]. Thus, in adults with FSS attachment insecurity has been associated with implications on illness-related behaviour including higher health care seeking [24–27].

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0022399921000751

 

Higher health-care seeking behaviour, higher degree of illness worry, etc as psychological characteristics of adult patients- well, that is my sister, who goes to the doctor with every little thing and is super-worried whenever she gets any kind of minor infection and is also always ill with something somehow and has been like that since she was a kid - and who also has no ME/CFS at all.

I, on the other hand, was the one famous for having the superhero level of immune system, never getting ill with anything and even if that happened, I just ignored it and went on living my life, working, socializing, because those infections were always so mild - yet I ended up with ME/CFS.

And as strange as it sounds, with all this recent maladaptive attitude of mine, I still couldn't influence my sister, such a susceptible personality and cause a mini mass hysteria in the family. Strange, very strange.

 

I was the one who was sick a lot as a kid. I flippin' hated it and would hide it for as long as I could. Often to be ratted out by my own sister.

Even then I wouldn't go to the doctor willingly. The only reason I didn't just disappear off when they did make me an appointment was because I was too sick to climb out the window & scarper.

To me, as a youngster, being sick was wholly negative. It was disruptive to my parents & I got more attention than I wanted - handy distraction for the siblings though. Plus sick is unpleasant, painful and can be exhausting. For me being sick meant a loss of freedom. No internet either so you were stuck in one room.

In my teens my health issues improved dramatically and I never, ever wanted to go back to being sick.

 

These people are so freaking weird. Textbook example of rejecting reality and substituting their own.

 

BDS moving into paediatrics.
FII will no doubt have a strong association . ...

ETA tagging @Tilly

 

+ Wicksell from Sweden. He has been teaming up with Gunnar Olsson (who works at Bragée ME Center nowadays) too, for a long time. This close link between Swedish and Danish BPS ME and FSS/BDS research is a worry

 

Ah! More wisdom and insight from the Journal of Psychosomatic Research!

 

Abstract now added to original link.

Abstract

Objective
To describe patterns of somatic symptoms, illness perception, illness worries and attachment in adolescents with functional somatic syndromes (FSS) in comparison with a population-based sample of adolescents.

Methods
Self-reported and clinical data were collected from two studies: 1) Adolescents aged 15-19 with multiple FSS of at least 1 year's duration (n = 91) from the trial AHEAD (Acceptance and Commitment Therapy for Health in Adolescents). 2) A sex-matched population-based sample of adolescents (n = 1573) derived from the 16-17-year follow-up of the Copenhagen Child Cohort 2000 (CCC2000), including a subgroup with high somatic symptom-load (n = 155).

Results
Symptom patterns were similar across groups, but somatic symptoms were approximately 2-3-fold more common in AHEAD compared to CCC2000, with the exception of neurological symptoms, i.e. ‘moving pain’, ‘unpleasant numbness or tingling sensation’ and ‘feeling of paresis’ which were 6.5-9.0 times higher in AHEAD. Adolescents from AHEAD reported considerably more negative illness perception and illness worry compared to both the CCC2000 sample and the high symptom subgroup. Levels of attachment avoidance and anxiety, respectively, were similar in AHEAD as compared with CCC2000 but lower compared to the high symptom subgroup of CCC2000.

Conclusion
Similar symptom profiles in AHEAD and CCC2000 support the concept of a general (i.e. not syndrome-specific) factor for symptom development in FSS. Functional neurological symptoms may be useful indicators of clinical impairment. A high degree of negative illness perception and illness worry in youth may lead to healthcare seeking and should have a specific focus in assessment and treatment of youth with FSS.