Responding to an adolescent with somatic complaints from bullying

What it is

An adolescent may be brought in for physical symptoms that the examination does not explain, and the history then brings out a stressor at school. In pediatric and elderly patients the low mood presents as a somatic complaint rather than as a low mood, so an adolescent with depression may never say that the mood itself is low. Children with depression may present with irritability rather than depressed mood. Adjustment disorder is the other name used in this setting, and it needs a clear precipitating stressor for its diagnosis.

How it presents

The complaints cross several systems. An adolescent boy may be brought to the office by his mother for stomachaches, and on review of systems he also reports headaches, occasional bedwetting and trouble sleeping, while his examination is within normal limits. Abdominal pain is another presenting complaint that raises the same question.

Around the symptoms sit the school clues: he is often in the nurse's office at school and does not seem to have any friends. The history that matters comes out only when the problems are discussed with him, and he then admits to being teased and called names at school.