Great Debate on Somatic Symptom and Related Disorders

IN THIS ISSUE: Somatic Symptom and Related Disorders | Posters | Visiting Professors | Distinguished Service | A&E Abstracts 

Great Debate on Somatic Symptom and Related Disorders

‘I felt the topic needed a revival’—ACLP president

Children with Somatic Symptom and Related Disorders (SSRDs) account for 10% to 15% of medical visits in primary care, and somatization is the second leading reason for consultation requests received by child and adolescent psychiatrists in pediatric hospitals.

The functional system disorder topic has been highlighted at many previous Academy annual meetings—“but I felt the topic needed a bit of revival,” says ACLP president Maryland Pao, MD, FACLP, whose roots are in child psychiatry.

So, within her theme of Integrating Care and Evidence Across the Lifespan at CLP 2023 in November, Dr. Pao proposed that the Saturday Great Debate at the meeting (11:45 AM–12:45 PM CST) should be dedicated to the topic.


Claire De Souza, MD, FRCPC, and Jeffrey Staab, MD, FACLP,
Claire De Souza, MD, FRCPC, and Jeffrey Staab, MD, FACLP

Claire De Souza, MD, FRCPC, and Jeffrey Staab, MD, FACLP, will debate Is only thy name our enemy? Perspectives on somatic symptom & functional disorders through the lifespan. Moderator will be Durga Roy, MD, FACLP, associate professor, Johns Hopkins University School of Medicine.


Durga Roy, MD, FACLP
Durga Roy, MD, FACLP

Dr. De Souza contends: “The developmental perspective, which includes the biopsychosocial contributions a child is exposed to during formative years (including medical illness and traumatic experiences), plays a critical role in somatization.”

Dr. Staab disagrees: “Functional disorders and somatic symptoms are highly prevalent in persons who have not experienced trauma, and clinicians cannot rest their assumptions on the sole theory of traumatic experiences. There is strong evidence for a biological component of these disorders.”

Attendees at The Great Debate will be offered the opportunity to:

  • Appreciate the continued importance of C-L psychiatrists to consider somatic ‎symptom and functional disorders in the treatment of patients.
  • Apply knowledge about the developmental aspects of somatic symptom disorders into the treatment ‎of one’s patient population.
  • Understand somatic symptom disorders from a biopsychosocial, developmental, and system-based ‎perspective to educate our colleagues in other specialties via a coordinated interdisciplinary team ‎approach.

Dr. De Souza is child and adolescent psychiatrist with the C-L Psychiatry Service at SickKids in Toronto, Canada. She is an associate professor in the Department of Psychiatry, University of Toronto, and deputy (past) president of the Canadian Academy of Child and Adolescent Psychiatry (CACAP). She is also a board member of the Canadian Academy of C-L Psychiatry (CACLP) and the CACAP representative on the American Academy of Child and Adolescent Psychiatry (AACAP) Physically Ill Child Committee.

Dr. De Souza developed and led a System-Wide Strategy for Pediatric Somatization at SickKids as part of a project involving pathway and protocol development. She has collaborated on developing therapies, a four-phase model and integrated approach for somatization, and educational resources for families and clinicians. 

Dr. Staab is professor and chair of the Department of Psychiatry and Psychology at Mayo Clinic, where he works with a team of clinicians and researchers in the fields of neurology, rehabilitation medicine, ENT, and audiology, to investigate functional neurological and neuro-otological disorders.

He and his colleagues in the Behavioral Medicine Program evaluate and treat more than 1,500 patients with psychosomatic problems, functional neurologic, neuro-otologic, and gastrointestinal disorders, and cancer distress each year.

Dr. Staab chaired the international workgroup that defined the functional vestibular disorder of persistent postural-perceptual dizziness for inclusion in the ICD-11. He was a founding Member of the Board of the Functional Neurological Disorder Society and co-chairs its Classification Committee.

In the debate at CLP 2023, Dr. Staab will identify deeply rooted concepts of somatization and functional disorders that persist in our field despite shallow (or even contradictory) evidence. He will point out how these beliefs are limiting our understanding of these illnesses and impeding our ability to engage our medical and surgical colleagues to create practical solutions for our patients.

Dr. De Souza will assert that the many diagnoses and terms associated with SSRDs can be confusing for everyone. “Unfortunately, mental health stigma has led not only to a medicalization of distress, but also to discomfort with addressing it,” she says.

“Having a unifying concept such as somatization across syndromes can help demystify and normalize distress that is experienced through physical symptoms, along a continuum. It can also engage interdisciplinary teams in an integrated approach and pathway with defined roles and responsibilities.

“C-L psychiatrists have a key role in countering the tendency for patients and health care teams to focus on biological factors alone. Additional consideration of psychosocial, developmental, and system factors is key to effectively understanding and managing SSRDs through the lifespan.”

Background reading on the topic is here and here.

Registration for the November 8-11 annual meeting in Austin is here.

An increased presence of child and adolescent psychiatrists are expected at the meeting which will also be addressed at a plenary by AACAP president Warren Ng, MD, MPH. See: Intervening Earlier is Critical, ACLP News, September.


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