Comparative evaluation of psychopathological characteristics, alexithymia, and quality of life in adolescents with somatic symptom disorder and functional neurological symptom disorder

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Comparative evaluation of psychopathological characteristics, alexithymia, and quality of life in adolescents with somatic symptom disorder and functional neurological symptom disorder SUMMARY Objective: Somatic Symptom Disorder (SSD) and Functional Neurological Symptom Disorder (FNSD) are common presentations of somatic symptom and related disorders in adolescence.Despite shared emotional and functional impairments, these disorders differ in clinical and psychological characteristics.This study aimed to compare SSD and FNSD with each other and with healthy controls in terms of clinical profiles, psychopathology, quality of life, and alexithymia.Method: The sample consisted of 120 adolescents aged 12-17 years, equally divided into three groups: SSD (n = 40), FNSD (n = 40), and healthy controls (HC; n=40).All participants underwent comprehensive clinical assessment using the semi-structured diagnostic interview.Self-report measures included the Brief Symptom Inventory (BSI), Pediatric Quality of Life Inventory (PedsQL), and Toronto Alexithymia Scale (TAS-20).Clinical severity was rated using the Clinical Global Impression-Severity scale (CGI-S).Results: Compared to HCs, both SSD and FNSD groups showed significantly higher symptom burden, lower healthrelated quality of life, and elevated alexithymia.The SSD group demonstrated higher alexithymia total scores, particularly in Difficulty Identifying Feelings and Difficulty Describing Feelings subscales, relative to both FNSD and HC groups.FNSD cases were more frequently associated with motor symptoms and neurological consultations, whereas SSD cases reported longer symptom duration and more extensive somatic evaluations.Discussion: Although SSD and FNSD share psychosocial risk factors such as reduced quality of life and increased alexithymia, SSD is characterized by greater psychological distress and emotional unawareness.Systematic assessment of alexithymia may help refine diagnosis and guide interventions in adolescents with somatic presentations.

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