Stefan M. van Geelen

Somatic symptoms and psychological concerns in a general adolescent population: Exploring the relevance of DSM-5 Somatic Symptom Disorder

OBJECTIVE DSM-5 somatic symptom disorder (SSD) constitutes a major change for psychosomatic medicine and psychiatry, as well as for epidemiological research in these fields. This study investigates somatic symptoms and psychological concerns among adolescents in order to systematically explore the relevance of SSD for general adolescent populations. METHODS A cross-sectional population-based design, with a symptoms-based strategy and a symptom-and-psychological-concern-based strategy, was used to estimate the prevalence of somatic symptoms and psychological concerns in a general adolescent population (n=2476, mean age=16years, 49% boys, 51% girls). Somatic symptoms and psychological concerns in relation to gender, and self-reported medical and psychiatric conditions were investigated. The association between somatic symptoms, psychological concerns, and functional impairment in school-, family-, peer- and physical activities was studied. RESULTS Reporting 3+ persistent distressing somatic symptoms was significantly more common than reporting one or more persistent distressing somatic symptom(s) combined with serious psychological concern. The prevalence of such complaints was significantly higher in girls. The proportion of medical and psychiatric conditions was highest in the group reporting 3+ persistent distressing somatic symptoms combined with serious psychological concern. Belonging to this group most significantly increased odds ratios for functional impairment. CONCLUSION For large-scale studies on SSD, results suggest the use of measures based on multiple somatic items in combination with psychological concerns, and a methodologically sound standardized measure of functional impairment. To further enhance clinical decision-making, the relation of symptoms to functional impairment, and the substantial overlap of SSD with medical and psychiatric conditions during adolescence should be addressed.

Psychological intervention for adolescents with juvenile idiopathic arthritis: for whom and when?

Objective. To study which adolescents with juvenile idiopathic arthritis (JIA) benefit from psychological intervention, and what is the best moment for it. Methods. In 3 months, 28 adolescents with JIA and 14 healthy adolescents as a control group received psychological intervention with the Self-confrontation Method (SCM), which combines the personal narrative with its affective structure. The adolescents with JIA were split into groups with low health-related quality of life (HRQOL) and high HRQOL. The Child Health Questionnaire, Checklist Individual Strength, and Childhood Health Assessment Questionnaire were used to measure fatigue and physical and psychosocial functioning at baseline, and at 3 months and 9 months after baseline. Results. Adolescents with JIA and low HRQOL at baseline reported less fatigue and better HRQOL after psychological intervention. These changes could not be explained by changes in disease activity. Low HRQOL at baseline was associated with a more recent onset of JIA, higher levels of pain, more severe physical disability, and higher levels of fatigue. Conclusion. Two-thirds of adolescents with JIA function well before and after psychological intervention. One-third of adolescents with JIA reporting low HRQOL at baseline benefit from guided self-reflections and should be the focus of psychological intervention. The most effective moment for this psychological intervention is when the adolescent reports difficulties in HRQOL.

Self-investigation to explore the impact of juvenile arthritis on adolescent life: a case-study.

OBJECTIVE To gain insight into the personal experience and feelings of an adolescent with a chronic disease. METHODS We report on the application of the self-confrontation method (SCM), illustrated by a case-example of an adolescent with juvenile idiopathic arthritis. RESULTS Although taken at face value she was not impeded by the arthritis, through self-assessment with the SCM this adolescent acknowledged and addressed the emotional struggle to keep the arthritis secret and to constantly test the physical limits of her body. After the process of self-reflection, the adolescent showed a better integration of her arthritis experiences into her life story. CONCLUSION With the SCM the adolescent could explore her own functioning and well-being on a manifest, as well as on an emotional and motivational level. PRACTICE IMPLICATIONS In future research, by studying the self-investigations of a group of adolescents with chronic diseases, common risk factors for the development of a stable identity during adolescence might be identified. In clinical care, the SCM promotes self-knowledge, allowing for an intrinsic motivation to deal with the emotional impact of the disease.

Health and identity: Self-positioning in adolescent chronic fatigue syndrome and juvenile idiopathic arthritis.

The aim of this study is to gain more insight into basic aspects of identity, in relation to adolescent chronic fatigue syndrome (CFS) and juvenile idiopathic arthritis (JIA). In dialogical self theory, identity is regarded as incorporating multiple self-positions, such as ‘I as tired’, ‘I as pessimistic’, or ‘I as decisive’. Physical and psychosocial impairment might alter the organization of these self-positions. The Personal Position Repertoire procedure, a quantitative method to analyse the prominence of self-positions, the Child Health Questionnaire, assessing health-related functioning, and the Checklist Individual Strength, measuring fatigue, were completed by 42 adolescents with CFS, 37 adolescents with JIA and 23 healthy teenagers. Adolescents with JIA report impaired physical functioning and general health. However, they position themselves very similar to healthy teenagers – i.e. as strong and healthy. While this self-positioning approach might be adequate and sustainable in adolescence, it could prove too strenuous to maintain throughout adult life. Adolescents with CFS, besides indicating severe physical difficulties, also report more psychosocial problems. They position themselves as significantly less strong and more unwell. With this emphasis on positions relating to their illness, there seems to be little room left for stronger positions. It is regarded of clinical importance to address these issues in this crucial developmental period.

The Controversy Over Pediatric Bariatric Surgery

Despite the reported limited success of conventional treatments and growing evidence of the effectiveness of adult bariatric surgery, weight loss operations for (morbidly) obese children and adolescents are still considered to be controversial by health care professionals and lay people alike. This paper describes an explorative, qualitative study involving obesity specialists, morbidly obese adolescents, and parents and identifies attitudes and normative beliefs regarding pediatric bariatric surgery. Views on the etiology of obesity—whether it should be considered primarily a medical condition or more a psychosocial problem—seem to affect the specialists’ normative opinions concerning the acceptability of bariatric procedures as a treatment option, the parents’ feelings regarding both being able to influence their child’s health and their child being able to control their own condition, and the adolescents’ sense of competence and motivation for treatment. Moreover, parents and adolescents who saw obesity as something that they could influence themselves were more in favor of non-surgical treatment and vice versa. Conflicting attitudes and normative views—e.g., with regard to concepts of disease, personal influence on health, motivation, and the possibility of a careful informed consent procedure—play an important role in the acceptability of bariatric surgery for childhood obesity.

Redefining Self-Management as “Management of the Self”: A New Approach to Person-centered Care in Chronic Fatigue Syndrome

As Smaranda Ene (2013) convincingly points out, chronic fatigue syndrome (CFS) has always been surrounded by controversy. Whether pertaining to its etiology or treatment, it appears as if there is no agreement on any aspect of CFS. However, there is one fact virtually everyone acknowledges: Individuals with CFS are seriously fatigued, and severely limited both physically and psychosocially. Furthermore, this self-experience is real and undeniable, and in this regard persons with CFS differ from other individuals (Van Geelen et al. 2007). In line with Ene’s approach, at present this self-experience is usually studied through an analysis of patients’ narratives (Larun and Malterud 2007), and attempts are made to include patients’ self-experience into the treatment of the syndrome (Van Geelen et al. 2011). In this commentary, I argue that to effectively incorporate the phenomenological self-experience of patients into personcentered care for CFS—as Ene advocates—we need to establish a redefined form of self-management understood as management of the self .

Management of the self: An interdisciplinary approach to self-management in psychiatry and psychosomatic medicine

In lieu of an abstract, here is a brief excerpt of the content: In recent years, there has been a rapidly increasing interest in self-management strategies in psychiatry and psychosomatic medicine (Siantz & Aranda, 2014; Crawford et al., 2014; Kemp, 2011). Among the conditions in which self-management is currently investigated in these contexts are bipolar disorder (Jones et al., 2011; Depp et al., 2009), depression (Van Grieken et al., 2015; Houle et al., 2013), post-traumatic stress disorder (Engel et al., 2015; Possemato et al., 2015), schizophrenia (Saito et al., 2013; Cimo et al., 2012), attention deficit hyperactivity disorder (Bussing et al., 2016; Christiansen et al., 2014), irritable bowel syndrome (Eugenio et al., 2012), chronic fatigue syndrome (Meng, Friedberg, & Castora-Binkley, 2014, Friedberg et al., 2013), and fibromyalgia (Bourgault et al., 2015; Hamnes et al., 2012). These approaches aim to stimulate patients to be more actively engaged in their own care, and they intend to shift the burden of the responsibility for treatment success away from psychiatrists, doctors, nurses and other healthcare professionals (Lawn et al., 2007; Davidson, 2005). Thus, acquiring the mastery of self-management is a critical component for patients in dealing with their conditions, and within mental healthcare it is commonly regarded as an innovative person-centered approach to provide individuals with the necessary skills to deal with the unique challenges they face in everyday life (Janney, Bauer, & Kilbourne, 2014; Stanghellini, Bolton, & Fulford, 2013).

Healthy play, better coping: The importance of play for the development of children in health and disease

&NA; Play is of vital importance for the healthy development of children. From a developmental perspective, play offers ample physical, emotional, cognitive, and social benefits. It allows children and adolescents to develop motor skills, experiment with their (social) behavioural repertoire, simulate alternative scenarios, and address the various positive and negative consequences of their behaviour in a safe and engaging context. Children with a chronic or life‐threatening disease may face obstacles that negatively impact play and play development, possibly impeding developmental milestones, beyond the actual illness itself. Currently, there is limited understanding of the impact of (1) aberrant or suppressed play and (2) play‐related interventions on the development of chronic diseased children. We argue that stimulating play behaviour enhances the adaptability of a child to a (chronic) stressful condition and promotes cognitive, social, emotional and psychomotor functioning, thereby strengthening the basis for their future health. Systematic play research will help to develop interventions for young patients, to better cope with the negative consequences of their illness and stimulate healthy development.

Reopening the Dialogue Between Literary Theory and Medicine: Toward Further Understanding and Management of Patients' Self-Experience

good decisions must be informed decisions. Configurations is a fairly unique journal, but its position in the always already shifting terrain of the academy is not unique; our peer-review process could serve as a model for other journals that handle submissions with multiple disciplinary investments. Reimagining peer review as another point of intervention depends on a certain openness, the dispelling of gatekeeping fears, and the shared intent to move knowledge(s) forward in interesting and sometimes unexpected ways. More than anything, though, an interdisciplinary peerreview process recognizes that scholarship depends, at least in part, on the authority of the disciplines from which it draws its examples, information, and critiques. Likewise, it would make sense that the peer-review processes of scientific publications could and should draw from the expertise of those in the humanities and sciences to question, validate, and enhance their peerreviewed publications. &