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Abstract

Medical unexplained symptoms (UMS) are very frequent in clinical practice, especially in developing countries (5% of referrals to child and adolescent psychiatry clinic in Monastir). Health professionals are often challenged by such symptoms with unclear diagnostic categories, hesitations regarding relevance of sophisticated somatic investigations and non consensual treatment algorithms. They are often referred to as conversions or anxiety related symptoms. The conversions may represent a distinct diagnostic category in psychiatric classifications; however, a thorough mental investigation often leads to consider them as symptoms rather than disorders. We found that most of children with somatic conversions have no underlying mental disorders, whereas 20% meet criteria for DSM IV mood or anxiety disorders and 25% present with unstable emotions and behaviors that ICD and other psychoanalytic oriented classifications refer to as neurotic organizations. An important number of these patients develop conversions and MUS after traumas or important stresses. It seems that conversions are a very common feature in children with depression in Tunisia (33% in the study of Bouden, 2008) and similar countries. Emotional and personality disorders have often â�?�?maskedâ�? clinical presentations with somatic symptoms as chief complaints. Family and cultural contexts often imprint MUS, with frequent similar complaints found in the immediate environment of the child, and several cross-cultural researches highlighting the importance of the body in the expression of mental distress in traditional societies, especially in Mediterranean region. Challenges for practitioners include, beside the complex clinical investigation, an important interventional balance between respecting the distress of the child and the family and promoting resilience through more appropriate expressions of psychological stress. In fact, inappropriately intensive medical interventions may lead to iatrogenic complications of these symptoms.

Biography

Email: naoufel.gaddour@gmail.com