{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:59:46Z","timestamp":1790197186199,"version":"4.1.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T00:00:00Z","timestamp":1622160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Somatic symptom disorder is common in children and adolescents; usually, it is an expression of a mental health problem or other conditions that lead to psychosocial impairment and suffering. Among these, in pubertal age, gender dysphoria should be considered.<\/jats:p><jats:p><jats:bold>Case Presentation:<\/jats:bold> We present the case of a 15-year-old girl admitted to the hospital because of a 2-month history of scattered arthralgia and myalgia, headache, and fatigue, with repeated visits to the emergency room. The physical exam was unremarkable, except for step walking and pain. Repeated diagnostic tests were normal, and consecutive psychological interviews disclosed intense suffering due to a gender incongruence. Referral to the hospital gender service was offered and refused by the parents.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> In pubertal age, gender dysphoria may be expressed through somatoform symptoms. Diagnosis is challenging to accept for the parents even in the presence of adequate multi-disciplinary hospital services.<\/jats:p>","DOI":"10.3389\/fped.2021.679004","type":"journal-article","created":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T05:04:02Z","timestamp":1622178242000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Case Report: Somatic Symptoms Veiling Gender Dysphoria in an Adolescent"],"prefix":"10.3389","volume":"9","author":[{"given":"Giuliana","family":"Morabito","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dora","family":"Cosentini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Tornese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Gortani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Pastore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rita Lucia","family":"Genovese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Cozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1111\/j.1469-7610.2012.02535.x","article-title":"Annual research review: functional somatic symptoms and associated anxiety and depression\u2013developmental psychopathology in pediatric practice","volume":"53","author":"Campo","year":"2012","journal-title":"J Child Psychol Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/s11920-017-0760-3","article-title":"Pediatric somatic symptom disorders","volume":"19","author":"Malas","year":"2017","journal-title":"Curr Psychiatry Rep"},{"key":"B3","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1111\/apa.13741","article-title":"Somatic symptom disorder was common in children and adolescents attending an emergency department complaining of pain","volume":"106","author":"Cozzi","year":"2017","journal-title":"Acta Paediatr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1542\/hpeds.2014-0023","article-title":"Characteristics of medically hospitalized pediatric patients with somatoform diagnoses","volume":"4","author":"Bujoreanu","year":"2014","journal-title":"Hosp Pediatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e152","DOI":"10.1542\/peds.2004-0682","article-title":"Pain among children and adolescents: restrictions in daily living and triggering factors","volume":"115","author":"Roth-Isigkeit","year":"2005","journal-title":"Pediatrics"},{"key":"B6","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1097\/MOP.0b013e3283483f1c","article-title":"Approach to psychosomatic illness in adolescents","volume":"23","author":"Ibeziako","year":"2011","journal-title":"Curr Opin Pediatr"},{"key":"B7","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/jpc.14246","article-title":"Facing somatic symptom disorder in the emergency department","volume":"55","author":"Cozzi","year":"2019","journal-title":"J Paediatr Child Health"},{"key":"B8","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","year":"2013"},{"key":"B9","first-page":"437","article-title":"About gender dysphoria","volume":"35","author":"Tornese","year":"2016","journal-title":"Medico e Bambino"},{"key":"B10","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.ecl.2019.01.001","article-title":"Size and distribution of transgender and gender nonconforming populations: a narrative review","volume":"48","author":"Goodman","year":"2019","journal-title":"Endocrinol Metab Clin N Am."},{"key":"B11","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1111\/jsm.12817","article-title":"Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria","volume":"12","author":"Aitken","year":"2015","journal-title":"J Sex Med"},{"key":"B12","year":""},{"key":"B13","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1089\/lgbt.2016.0151","article-title":"Mental health concerns and insurance denials among transgender adolescents","volume":"4","author":"Nahata","year":"2017","journal-title":"LGBT Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e20193600","DOI":"10.1542\/peds.2019-3600","article-title":"Mental health and timing of gender-affirming care","volume":"146","author":"Sorbara","year":"2020","journal-title":"Pediatrics"},{"key":"B15","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1111\/sltb.12289","article-title":"Suicidality, self-harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria","volume":"47","author":"Peterson","year":"2017","journal-title":"Suicide Life-Threat Behav"},{"key":"B16","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1136\/archdischild-2016-310846","article-title":"Does changing gender make children happier?","volume":"101","year":"2016","journal-title":"Arch Dis Child"},{"key":"B17","doi-asserted-by":"publisher","first-page":"i6101","DOI":"10.1136\/bmj.i6101","article-title":"An adolescent with disabling abdominal pain","volume":"355","author":"Minute","year":"2016","journal-title":"BMJ"},{"key":"B18","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1186\/s12875-015-0393-8","article-title":"Bodily distress syndrome: a new diagnosis for functional disorders in primary care?","volume":"16","author":"Budtz-Lilly","year":"2015","journal-title":"BMC Fam Pract"},{"key":"B19","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/j.pain.2011.11.004","article-title":"Too sick for school? parent influences on school functioning among children with chronic pain","volume":"153","author":"Logan","year":"2012","journal-title":"Pain"},{"key":"B20","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1542\/hpeds.2015-0207","article-title":"Bullying victimization in medically hospitalized patients with somatic symptom and related disorders: prevalence and associated factors","volume":"6","author":"Ibeziako","year":"2016","journal-title":"Hosp Pediatr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/j.jpsychores.2004.08.010","article-title":"Psychiatric comorbidity in gender identity disorder","volume":"58","author":"Hepp","year":"2005","journal-title":"J Psychosom Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.bodyim.2016.06.004","article-title":"Body image in transgender young people: findings from a qualitative, community-based study","volume":"18","author":"McGuire","year":"2016","journal-title":"Body Image"},{"key":"B23","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1016\/j.jsxm.2018.01.017","article-title":"Association between gender confirmation treatments and perceived gender congruence, body image satisfaction and mental health in a cohort of transgender individuals","volume":"15","author":"Owen-Smith","year":"2018","journal-title":"J Sex Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1186\/s12889-015-1867-2","article-title":"Intervenable factors associated with suicide risk in transgender persons: a respondent- sampling study in Ontario, Canada","volume":"15","author":"Bauer","year":"2015","journal-title":"BMC Public Health"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.679004\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T05:04:05Z","timestamp":1622178245000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.679004\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,28]]},"references-count":24,"alternative-id":["10.3389\/fped.2021.679004"],"URL":"https:\/\/doi.org\/10.3389\/fped.2021.679004","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,28]]},"article-number":"679004"}}