Somatic Symptom and Related Disorders (SSRD) Clinical Pathway — Emergency Department and Inpatient

Child with Suspected Somatic Symptom and Related Disorder

This pathway guides the diagnosis of a set of disorders called Somatic Symptom and Related Disorders (SSRDs).
SSRD includes a broad and heterogeneous set of disorders in which history and physical exam of the child’s chief complaint do not align with known organic medical causes of the presenting symptoms. SSRD may occur in isolation or with organic medical illness.
This pathway is not meant to rule out organic, medical illness exhaustively or to replace validated diagnostic algorithms to evaluate for underlying medical illnesses. This pathway empowers clinicians to discuss somatic symptoms with children and families even if medical work-up is ongoing, as many children have somatic components associated with medical disorders.

SSRD Umbrella

Manifestations of somatic symptoms are termed disorders when they significantly interfere with functioning. Each individual Somatic Symptom and Related Disorder (SSRD) has its own diagnostic criteria, but all SSRDs are caused by disruptions in mind-body connections and all SSRDs are treated similarly. SSRDs include a variety of other named conditions and share overlapping features and treatment options with other conditions including:

Functional neurological disorder (FND):
- Functional movement disorders
- Psychogenic non-epileptic seizures or events (PNEE or PNES), previously called “pseudoseizure”
Disorders of gut brain interaction (DGBI)
- Functional abdominal pain
- Visceral hyperalgesia

Reference

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.