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. In younger children, a complete physical examination generally should be performed with the parents present to impress on them its care and thoroughness. If comfortable for a preadolescent or older child, the parent of the same sex should stay for the examination. This record often reveals inappropriate behavior patterns and exaggerated responses to pain, which support the diagnosis.