Emotional awareness in children and adolescents with functional somatic disorders: a systematic review

Functional somatic symptoms (FSS) and functional somatic disorders (FSDs) are common in children and adolescents and are associated with reduced quality of life. Emotional awareness (EA) has been proposed as a psychological factor potentially associated with FSS/FSDs. This review investigated the association between EA and FSS/FSDs in children and adolescents. PubMed, PsycINFO, Embase, and Scopus were systematically searched using predefined terms related to EA and FSS/FSDs in children and adolescents (0–18 years). Title/abstract screening, full-text review, and data extraction were performed independently by two reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Of 1,579 records identified, 17 studies comprising 7,023 participants met the inclusion criteria. Sixteen studies included questionnaire-based measures of EA and generally indicated greater difficulties in several aspects of EA among children and adolescents with FSS/FSDs compared with healthy or clinical controls or peers with varying levels of somatic complaints. The most consistent finding was greater Difficulty Identifying Emotions. Three studies included task-based measures, with differences observed in Difficulty Verbally Expressing Emotions and Experiencing Negative Emotions. Children and adolescents with FSS/FSDs show greater difficulties in several aspects of EA, with the most consistent association observed for Difficulty Identifying Emotions. However, substantial heterogeneity in populations, measures, comparison groups, and study quality limits the strength of the conclusions. The findings provide a rationale for further investigating the role of EA in pediatric FSS/FSD, including whether EA may represent a relevant treatment target. Future research should use longitudinal designs, integrate questionnaire- and task-based measures, and account for psychiatric comorbidities.