Dear Therapist:

Our teenage son has always been a bit of a complicated personality but he does well socially and academically.  Recently we have noticed a trend where he keeps on asking to go to the doctor because of different things that are bothering him physically. My husband and I recently calculated that he has had 6 separate issues in the last year or so. Only once was there actually something wrong (strep); the other times the doctor said he was fine. He has been sent for X-rays and ultrasounds and once even wound up in the emergency room for a CT scan when he complained about a massive headache. He has complained about pain in his chest, his stomach, and his head at different times. Obviously something is going on here but it is hard to discount him when he says he isn’t feeling well. He actually went to see a therapist a few times but it didn’t really go anywhere. We also got no plan from the therapist as to how we are supposed to handle him. We are at a bit of a loss here and would appreciate your input. Thank you.

Response:

Your son’s complaints of pain can be related to several issues.  Without more specific information about the settings, circumstances, history, and other criteria, my response can only be very general, as based on the specific symptoms mentioned.  That being said, I will briefly address a few possibilities. 

I don’t know what you mean when you refer to your son’s “complicated personality.”  You follow that designation with the fact that he does well socially and academically.  Does this mean that his complicated personality generally manifests in the family setting?  Does he appear to be an anxious person?  Does he tend to obsess about things?  Has he expressed concern about a particular illness—or about illness in general—or do his complaints refer only to the pain itself?  

Somatic complaints can be a bid for attention.  They can be due to general anxiety, or to a specific anxiety that is being repressed.  In addition, they can be an indication of general obsessiveness, or of an obsession that is limited to a specific area (like preoccupation with death).  

When the main focus of concern is a preoccupation with illness, this can be due to illness anxiety disorder, which is essentially a constant fear of being or becoming ill.  This often includes a focus on pain.  However, in illness anxiety disorder the pain is secondary to the fear of illness.  

If your son’s complaints are limited to pain, and discounting other possible causes like a need for attention, your son may have a condition known as somatic symptom disorder.  Somatic symptom disorder used to be commonly known as hypochondriasis.  The fact that this term was well known was a significant factor in the renaming of this disorder.  Since the term had become a part of the regular vernacular, it was paradoxically both stigmatized and largely dismissed.  It was renamed in part to give the issue more significance so that it would be taken more seriously. 

Although you mention that your son saw a therapist, I don’t know what was done, or whether this therapist has experience with anxiety or with somatic pain.  Appropriate treatment would largely depend on factors like those mentioned above.  Assuming that all medical possibilities have been ruled out, a psychotherapist can help to identify the cause of the problem.  Once the root causes and associated issues are identified, therapy can focus on understanding and dealing with the causes (like general anxiety or obsessive thinking), in addition to the pain itself. 

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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