Atypical somatoform disorder following infection in children--a depressive equivalent?

Thirteen cases are reported wherein, following an upper respiratory infection or gastroenteritis, children developed a syndrome involving predominantly somatic complaints and objective signs of dysphoria. The syndrome picture was strikingly protracted compared to the convalescence period that would be expected following transient infectious illnesses. Psychiatric consultation was requested primarily because of extensive nonconclusive medical evaluation by the primary care physician. Most of the children showed a striking inability to recognize or acknowledge dysphoria. A multifactorial etiologic hypothesis that considers possible complementary roles of emotional, cognitive, and biological factors is offered to explain the development of this highly dysfunctional syndrome.