« Troubles à symptomatologie somatique » chez les adolescents. Une revue systématique

L’expression corporelle de la souffrance psychique est fréquente à l’adolescence. L’objectif est de faire une revue systématique de la littérature anglophone de ces cinq dernières années sur les « troubles à symptomatologie somatique », selon le DSM-5 (Diagnostic and Statistical Manual) à l’adolescence. Cette revue suit les critères PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) et a été réalisée à partir des bases de données Medline, Psychinfo, Google Scholar, etc. Un processus de sélection des articles et d’extraction des données a été effectué et une analyse des thèmes émergents, réalisée. Quatre-vingt-deux articles ont été inclus. Une synthèse descriptive des résultats est présentée. Premièrement, il en ressort une terminologie pas encore adoptée, avec une hétérogénéité des appellations utilisées. D’autre part, peu d’études concernent spécifiquement les adolescents, regroupés méthodologiquement avec les enfants. Les cas cliniques sont les plus représentés, et décrivent dans chaque spécialité médicale l’originalité et la complexité des symptômes. Divers modèles explicatifs sont rapportés, parmi lesquels la piste traumatique au premier plan, des facteurs environnementaux ou encore des altérations sur le plan neurobiologique. Enfin, l’efficacité des thérapies cognitivocomportementales est décrite, et l’importance d’une prise en charge pluridisciplinaire. Les études qualitatives sont peu représentées. Seuls dix articles comprennent dans leurs titres la terminologie de « troubles à symptomatologie somatique », pourtant valorisée par de nombreux auteurs. L’hétérogénéité des appellations et modèles explicatifs témoigne d’un manque de ponts entre les différentes spécialités médicales et peut expliquer en miroir l’errance des adolescents et de leurs familles dans le système de soins. Body expression of mental disorders is common in adolescence. Only two literature reviews over the last five years have been identified about somatoform disorders in children., The present article provides a systematic review of articles in English, which concern “Somatic Symptom and Related Disorders” according to the DSM-5 (Diagnostic and Statistical Manual – 5th Edition) among adolescents. The article search was made on Medline, Psychinfo, Google Scholar, BiomedCentral, Central and tripdatabase (for grey literature) according to PRISMA criteria and with the items “somatoform disorders” or “somatic symptom disorders”. An age filter was applied for “adolescents”, and a selection was done from the last five years. All articles concerning adolescents (often associated with children) were initially included, except for articles concerning eating disorders, dysmorphic disorders or adult population. Comments, editorials, opinion or descriptive articles were also excluded. The authors then carried out an analysis of the main topics, themes and questions covered in the selected publications and presented a descriptive synthesis. A total of seventy-seven publications were included in the analysis, from three hundred and seventy-two publications. First, the terms used to refer to these “somatic symptom disorders” were varied, such as “somatization”, “somatic complaints/symptoms”, “functional disorder”, “unexplained symptoms” and “somatoform disorders”. Then, studies related just to adolescents were limited: most of studies included children and adolescents in their methodologies; and some of them questioned somatic symptoms from a developmental perspective. Case reports were the most represented articles among all medical specialties, with clinical descriptions about “functional neurological symptom disorder”, “factitious disorder” and “somatic symptom disorder” with a medical disease, among children and adolescents. We sometimes observed a controversial borderline between psychological and somatic disorders. Various explanatory models appeared, especially the trauma path; familial and social environment was also pointed out, with a possible peer group effect; neurocognitive theories were finally described. The literature highlights the effectiveness of psychosocial therapies (especially the cognitive-behavioral therapy) and the importance of multidisciplinary management. Finally, a few studies with a qualitative methodology are represented. Only nine articles included “somatic symptom disorder” in their titles, despite a terminology valued by many authors (compared to “somatoform disorders” from the DSM-IV). The heterogeneity of terminologies, case reports and explanatory models witness a lack of connexions between medical specialties. This could explain in part the wandering of adolescents and their families in the health care system. It could also contribute to the delay before diagnosis, especially when neurological symptoms exist, and a late referral for psychiatric consultation. Further studies are needed to understand difficulties to use a clinical pathway among medical specialties, when the benefit of amultidisciplinary approach seems to be unanimous.