Somatoform Disorders - Is It "Just" a Stomachache?

It's hard enough trying to decipher the behavioral symptoms in children who have psychiatric illness. Trying to determine the root cause of physical complaints where no obvious cause exists is next to impossible.

During the second full week of school, I got a call from the school nurse. Bob was in her office complaining of a stomachache, and he wanted to know if I would pick him up when school dismissed an hour later.

I was skeptical--it was unusually hot that day, and I suspected Bob wanted a ride home rather than to walk. When the nurse put him on the phone, I told him I thought he was probably okay and should go ahead and walk home. An hour later, someone in the office called--Bob was there looking "puny," still complaining about his stomach, and could I please come pick him up?

An hour later, Bob was at the table, eating dinner with gusto, nary a stomach complaint to be heard.

A couple of days later, I received another call from the school nurse--Bob had spent most of the afternoon in her office complaining, again, of stomach issues.

I don't doubt Bob's stomachaches are real. The problem is trying to decipher what's causing them.

Psychosomatic illness (or somatoform disorder) refers to physical symptoms with no discernible physical cause. You may be familiar with somatoform complaints--that feeling of nausea before an important meeting, the nagging headache that won't go away when you're already under too much stress. Somatoform complaints are more or less the body's way of communicating what the mind can't verbalize.

I have personal experience with this--much of my first half of first grade was spent home from school with a stomachache. I was a severely anxious child, and had been placed with a severely mean teacher. Every morning, I woke feeling nauseous--until after my mother called to report my absence. Eventually, she told me to suck it up and sent me to school.

There are other possible causes for Bob's pain--the medications he takes could definitely be to blame, particularly if he hasn't eaten much during the day. It could be he ate something that didn't agree with him. Or it could actually be an intestinal virus.

In the end, I didn't let him miss any school for his stomachaches. I let him convalesce at home in the evening, and encouraged him to eat at least something throughout the day. I also told him that, as the "new" wears off the school year, he'll likely get used to his classmates and routine (and therefore be less anxious).
I tried to validate his complaints without perpetuating them (i.e., letting him stay home from school or leave early). I've also tried to help him learn to minimize his stress (keeping up with homework, for example).

It's hard not to give in to him, especially when he's whimpering and holding his gut. I just hope my methods are a kinder, gentler way of teaching him to "suck it up."