Somatic symptoms in children and adolescents with anxiety disorders.
OBJECTIVE
To evaluate the prevalence of somatic symptoms (SSs) in children and adolescents with anxiety disorders; the relationship between SSs and anxiety severity, impairment, and child global functioning; and the impact of fluvoxamine (FLV) versus pill placebo (PBO) on reducing SSs.


METHODS
As part of a double-blind, placebo-controlled trial, 128 children (mean age, 10.8 years; range, 6-17) with DSM-IV anxiety disorders (i.e., social, separation, and generalized anxiety) were assessed by expert clinicians on 16 SSs using the Pediatric Anxiety Rating Scale.


RESULTS
The most common SSs at baseline were restlessness (74%), stomachaches (70%), blushing (51%), palpitations (48%), muscle tension (45%), sweating (45%), and trembling/shaking (43%). Older children (age 12 and older) reported more SSs than younger children, boys and girls reported similar numbers of SSs, and SSs were higher among children with than without generalized anxiety disorder. SSs were significantly and positively correlated with anxiety severity, impairment, and global functioning. Pre-/postreductions in SSs were statistically significant in both PBO and FLV conditions; however, FLV was superior to PBO in reducing SSs.


CONCLUSIONS
SSs are highly prevalent among children and adolescents with anxiety disorders and are associated with greater anxiety severity and impairment. Treatment with FLV was effective in reducing rather than increasing SSs. The high rates of SSs in youths with each of the three anxiety disorders suggest a re-evaluation of SSs in the DSM-IV diagnostic criteria for the most common anxiety disorders among children and adolescents.
Ginsburg
Golda S
GS
Drs. Ginsburg and Riddle are with the Division of Child and Adolescent Psychiatry, Department of Psychiatry, Johns Hopkins University School of Medicine Dr. Davies is with Columbia University and New York State Psychiatric Institute, New York, and Division of Child and Adolescent Psychiatry, Department of Psychiatry. Electronic address: gginsbu@jhmi.edu.
Riddle
Mark A
MA
Drs. Ginsburg and Riddle are with the Division of Child and Adolescent Psychiatry, Department of Psychiatry, Johns Hopkins University School of Medicine Dr. Davies is with Columbia University and New York State Psychiatric Institute, New York, and Division of Child and Adolescent Psychiatry, Department of Psychiatry.
Davies
Mark
M
Drs. Ginsburg and Riddle are with the Division of Child and Adolescent Psychiatry, Department of Psychiatry, Johns Hopkins University School of Medicine Dr. Davies is with Columbia University and New York State Psychiatric Institute, New York, and Division of Child and Adolescent Psychiatry, Department of Psychiatry.
D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D004311:Double-Blind Method; D005260:Female; D016666:Fluvoxamine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*
D016666:Fluvoxamine; D017367:Selective Serotonin Reuptake Inhibitors