Evaluation of psychosomatic recurrent abdominal pain in an adolescent girl: a case report

Treatment of a disorder should be based on knowledge of its cause(s) and its pathophysiological mechanisms. During the last few decades, our understanding of recurrent abdominal pain (RAP) of non-organic origin has increased. Criteria for diagnosing functional RAP according to the abdominal symptoms have been elaborated. There is a growing realization that stress is of importance in the etiology of many cases, and that stress can be of importance in allodynia and hyperalgesia of the intestine. The stressor, as well as the susceptibility to stress, differs markedly. The diagnosis of psychosomatic RAP should be based on a clear medical understanding of the bodily consequences of stress and according to clear diagnostic criteria. Cognitive therapy has been shown to be helpful for non-organic RAP according to several studies. In this presentation we aimed to present psychiatric evaluation and treatment process of a case that have had psychosomatic RAP for three years. A 14 years old girl applied to Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine with the symptoms of RAP and anxiety. She had been evaluated physically for any organic disease for many times but no organic disease was thought. Then physicians had suggested psychiatric evaluation for her. She was evaluated for depression and anxiety disorder; her intelligence was measured. Cognitive behavior therapy sessions were planned for this girl and she began to take down her pain during daytime. In psychosomatic RAP pathophysiology; prolonged stress can inşuence the muscular system, hormonal regulation, intestinal sensitivity and motility, and the pain system, leading to muscular involvement, altered hormonal regulation, disturbed intestinal function and recurrent pain. A treatment method for psychosomatic RAP should effectively implement our knowledge of stress and its consequences for the brain and body by resolving psychosocial problems, focusing on coping and improving body regulation of stress. A decrease in stress, better coping and improvement in bodily reactions should lead to reduce pain, which can be a treatment of psychosomatic RAP.