Estado actual de los trastornos somatomorfos y conversivos en ni?os y adolescentes

摘要

Background: Somatoform (SD) and conversion (CD) disorders have increased their incidence during the last two decades in children and adolescents, although both are currentlyunderdiagnosed. Objective: To review the evidence on SD and CD in children and adolescents.Method: A review ofspecialised textbooks and the available literature in Medline/PubMed andSciELO was made. Results: There is a high intercurrence with affective and anxiety disorders andsome riskfactors have been identified, especially higher vulnerability to stress, family disfunction,parental overprotection, and limited mentalization of physical symptoms (alexithymia),which at the same time, perpetuate the symptomatology. From an ethiopathogenicperspective,psychodynamic, psychosomatic, traumatic-environmental and biological hypothesis have beeninvoked. Patients with SD and CD are frequently females, show more introversive personalityfeatures, more stressful life events and executive deficits. Psychogenic non-epileptic seizuresare related with more psychiatric co-morbidities and worse outcome. Cognitive-behaviouralpsychotherapy and psychodynamic-hypnotherapy combined with selective serotonin reuptakeinhibitors have been effective. Conclusions: SD and CD in child and adolescent populationshave been observed in medical and psychiatric contexts. Their recognition is difficult due totheir multifactorial ethiology, the lack of diagnosis consensus and the scarce clinical experience,involving a true therapeutic challenge; therefore, it is imperative to carry out future researcheson this issue. Their management in primary care seems suitable, but in more complex cases thereferral to the specialist is necessary.