The persistence, recurrence, and chronicity of RAP differentiate it from the pain of an acute abdomen. However, determining whether RAP is psychogenic, organic, or functional can be difficult. Differences in perception about what precipitates the pain and how the pain is used provide insight into family dynamics, which can be useful in developing a management plan that is consistent yet comfortable for the parents. Inclusion of the parents underlines the potential role of each in precipitating, perpetuating, and overcoming the pain. Psychosocial characteristics consistent with psychogenic RAP include immaturity, unusual dependence on parents, anxiety or depression, apprehension, tension, and perfectionism.
Parents are often anxious, overprotective, authoritarian, and preoccupied with the child.
School records may reveal the effect of the pain on daily functioning in the classroom. The history should include questions about similar or related illnesses in other family members, especially in the parents at a similar age. Most children present when symptom-free. Before a diagnosis of psychogenic RAP is confirmed, the child should be evaluated during a pain episode to look for bowel distention and to ensure that no signs of an organic disorder are overlooked. Except for periumbilical discomfort on palpation of the abdomen, findings are typically negative.