When the body speaks what the mind cannot put into words.
The symptoms are real. They are not invented, not deliberate, not manipulative. Somatic symptom disorder means the body expresses psychological distress through physical symptoms — this is a biological process, not a character weakness.
Somatic symptom disorder (SSD) — previously called somatoform disorder — is a condition in which a child or adolescent experiences one or more persistent physical symptoms (pain, fatigue, neurological symptoms) that cause significant distress or interfere with everyday life, while at the same time being accompanied by disproportionate thoughts, feelings, or behaviours relating to those symptoms.
This is not a situation where the tests "show nothing" and doctors give up. It is a recognised medical condition with identifiable biological mechanisms — an oversensitive stress system, disrupted pain perception, altered gut–brain communication.
In children and adolescents, somatic symptom disorder is more common than is often assumed. Research suggests that up to 10% of children who visit their doctor for physical symptoms have a primarily psychosomatic aetiology. It is most common in the 8–16 age group and is somewhat more frequent in girls.
Symptoms are varied and can affect any organ system. The most common in children and adolescents:
A key feature is that symptoms fluctuate — they often worsen in stressful situations (before school, during conflicts, at the end of the week) and improve during holidays or at weekends. This does not mean they are "invented" — it is direct evidence that the stress system is involved.
The body and mind are not separate. Psychological stress directly activates the hormonal system (the HPA axis), the autonomic nervous system, and the immune system — all of which can generate very real physical symptoms.
In children with somatic symptom disorder, the stress response system has become over-sensitised: the alarm is set too high. This can be the result of genetic predisposition, prolonged stress (school, family, peers), previous illness, or an unrecognised emotional burden.
An important role is played by the child's ability — or inability — to put emotions into words (alexithymia). When a child cannot say "I'm scared" or "I'm sad," the body says it instead.
Parents are the most important factor in a child's recovery. Their response to symptoms — regardless of its intentions — can either help or inadvertently maintain the disorder.
Never say "there's nothing wrong with you" or "it's all in your head." The symptoms are real, even if tests are normal. Believing is the foundation of trust — and trust is the foundation of recovery.
Even when the child is suffering, complete withdrawal from school, friends, and activities usually makes the disorder worse. Gradual, supported participation — with appropriate adjustments — helps recovery more than complete rest.
Ask about feelings, not just symptoms. "How are you today?" not "Does your head still hurt?" Teach that emotions are normal and need not be hidden. This is perhaps the most powerful preventive intervention.
If symptoms persist for more than a few weeks and interfere with the child's life, seek help from a paediatrician, child psychiatrist, or psychologist with experience in psychosomatic disorders. Earlier is better.
School is often both a source of stress and the arena in which symptoms most clearly manifest. Teachers and school counsellors can play a crucial role in the child's recovery — or, if they respond inappropriately, inadvertently deepen the problem.
A pupil who frequently goes to the school nurse is not shirking. They are struggling. Acknowledgement of this — without irony or scepticism — is already a therapeutic act.
On difficult days: a shorter school day, adapted exam scheduling, a quiet corner, permission to leave the classroom briefly. The goal is to keep the child connected to school — not to grant a general exemption from it.
Regular communication between school, parents, and the treating team (physician, psychologist) makes a significant difference. A shared plan — how to handle difficult days, what to do when a child wants to go home — prevents confusion and inconsistency.
Social exclusion, bullying, or a damaged class dynamic often lie at the heart of a child's difficulties. The school counsellor can help identify and address these factors without exposing the child.
Treatment of somatic symptom disorder is always multidimensional. The aim is not to "prove there is nothing physically wrong" — that approach is counterproductive and damages trust. The aim is to help the child function well and return to everyday life, while at the same time understanding what their body is communicating.
The most researched approach is cognitive-behavioural therapy (CBT), which helps the child recognise thought and behaviour patterns that maintain symptoms, and gradually change them. For younger children, parents are an important part of therapy.
Alongside therapy, foundation work is crucial: regular sleep, physical activity, balanced nutrition, a predictable daily structure, and reduced unnecessary pressure.
The aim of treatment is not to "prove it isn't physical" — that question is long past. The aim is to help the child live well, understand their body, and return to the life they want.
Nika was 11 when she started complaining of stomach pain every morning before school. By the time she was 13, she had barely attended the last two years.
Nika is now 15 and attends school regularly. She still sees her psychologist once a month. She says: "I've learnt that my body is very honest. When something is too much for me, it tells me. Now I can finally listen."
The name has been changed. The story was published with the family's permission.
