Noncardiac chest pain and psychopathology in children and adolescents

Noncardiac Chest Pain in Children and Adolescents: A Biopsychosocial Conceptualization

“…These findings also demonstrate that while some pediatric NCCP patients do meet criteria for panic disorder or another anxiety disorder, a number do not; this emphasizes that at least some NCCP patients suffer from a singular ailment that is distinct from undiagnosed panic or anxiety disorder. Still, the relatively small and homogenous samples utilized in these studies limits the generalizability of these findings and indicates the need for replication with larger, more diverse samples [13,15].…”

“…Unfortunately, details regarding the nature of the psychiatric interviews used in these three studies [27][28][29] are not reported. Structured diagnostic interviews demonstrated lower prevalence of depression, with 8-19% of patients meeting DSM-IV diagnostic criteria for a depressive disorder [13,15], although again the small sample sizes constitute a limitation. However, standardized self-report measures also suggest a lower rate of depression, with 11% of patients reporting elevated depressive symptoms, comparable to depressive symptoms reported by patients with benign heart murmurs [14].…”

“…Because many patients report intermittent episodes of chest pain that reoccur over time, the accompanying fear may also lead to persistent worry among children and their families. Accordingly, some researchers have found that clinically significant emotional distress is associated with many cases of pediatric NCCP [13,14,29]. Because emotional distress may constitute a cause or exacerbating factor of chest pain, in addition to being a possible reaction to the pain itself, this research regarding emotional distress is examined in greater detail during our discussion of NCCP etiology.…”

“…Based on interviews using a structured protocol (the Anxiety Disorder Interview Schedule for DSM-IV: Child and Parent Versions ADIS-IV:C-P) that assesses anxiety, mood, somatoform and behavioral disorders [43], 59-81% of patients met DSM-IV diagnostic criteria for a current anxiety disorder, and 30-59% met criteria for two or more current anxiety disorders [13,15]. Among patients with anxiety disorders, approximately one-third to one-half meet criteria for panic disorder [13,15]. This is unsurprising, as the central feature of NCCP, chest pain, is also a physical symptom experienced by some individuals during panic attacks.…”

“…Although recent empirical research regarding psychosocial correlates of pediatric NCCP [12][13][14][15] has provided the invaluable beginnings of a psychological perspective on this complaint, these findings have yet to be integrated with extant medical research within a cohesive conceptual framework. We propose that pediatric NCCP is currently best conceptualized using a diathesis-stress model in which multiple elements independently or in combination confer a degree of risk for NCCP, which may then be triggered by various instigating factors.…”