Somatoform Disorders in Children: Childhood Psychosomatics

In working with children's somatization, I integrate tools from schema therapy and Transference-Focused Psychotherapy (TFP). We gently explore how the child constructs relationships with me in the consulting room, projecting their internal expectations, anxieties, and defense styles onto me (transference analysis). This allows us to observe which specific core beliefs and early emotional patterns—such as a belief that expressing anger is dangerous, or a deep fear of loneliness—compel the psyche to resort to bodily defenses.

We work with the psyche's tendency to split the world and one's own feelings into absolutely good or absolutely bad, leaving no room for nuances and creating intolerable internal tension (splitting mechanism). By helping the child recognize different parts of themselves and tolerate contradictory emotions, we gradually build a more integrated and stable sense of the "Self" (identity integration). Regardless of whether we are dealing with a complex, vulnerable psychic structure struggling to regulate affects (borderline personality organization, or BPO) or with internal conflicts based on strict prohibitions and rules (neurotic structure), the goal is to develop the child's capacity to tolerate and experience emotions so that the body no longer has to fall ill in their stead.

When a child suffers from real physical pain—whether constant migraines, nausea, or digestive disorders—and doctors throw up their hands after all examinations, finding no organic cause, it becomes an ordeal for the entire family. The child's body begins to "speak" for them. In the psychoanalytic understanding, when emotional pain, anxiety, or internal conflict are too complex for the child's psyche to comprehend (deficit in mentalization), these experiences are repressed and transformed into bodily symptoms (somatization).

A child, whose psyche does not yet possess enough resources to process complex affects, uses their body as a stage for acting out internal dramas. The symptom becomes a kind of defense mechanism, an unconscious attempt to cope with fear, separation, or repressed aggression. The task of therapy in this case is to hear what the body is "screaming" about, and create a safe space where together we can translate this pain from the language of physiology into the language of feelings.