Somatomorphic and factitious disorders.: Our experience in a regional reference neuropaediatric department

Introduction and objectives. Children often consult for fictional or very exaggerated symptoms, grouped together as factitious disorders (TF), disorders due to somatomorphic pain (TDS), disorders due to somatization (TS) and conversion disorders (TC). Patients and method. We studied cases of TF, TDS, TS and TC evaluated by the neuropaediatric department of the Hospital Miguel Servet de Zaragoza between May 1990 and August 2001. Results. There were 134 children identified as having TF-TDS-TS-TC. There were 91 girls (67.9%) and 43 boys (32.1%). They made up 2.47% of the 5,417 children included in the neuropaediatric data-base. The mean age was 10 years and 9 months, ranging between 3 and 16 years with only 9 children aged under 7 years. The commonest syndromes were:paroxystic disorders, headache, other pain, paraesthesia, hypovision, and other visual alterations, paresias, tremors and other disorders of movement, disorders of gait, lack of air, hyperventilation and dysphagia. There was often more than one motive for consultation, with sometimes more than four. The commonest complementary tests done were: EEG, fundus oculi, cranial CAT scan, CPK EMG/ENG, cranial MR, spinal MR, CSF and osseous gammography. No further studies were made of 12 children (9%). Conclusions. The TF-TDS-TS-TC are a common cause of assessment in neuropaediatric practice. It should be suspected in cases of multiple symptoms in children aged over 6 years, usually in girls. It is often necessary to carry out various complementary tests to rule out organic disorders.