Network analysis in adolescent patients with somatic symptom disorders

TL;DR

This study uses network analysis to explore the relationships between somatic symptoms in adolescents with SSD, identifying key symptoms that may guide future treatment strategies.

Contribution

The novel use of Bayesian network analysis to explore causal relationships among somatic symptoms in adolescent SSD patients.

Findings

Nausea, dizziness, shortness of breath, and chest pain showed the highest centrality in the symptom network.

The symptom 'cannot breathe' was identified as a top node in the Directed Acyclic Graph, suggesting it may trigger other symptoms.

Abstract

Somatic symptom disorder (SSD) is one of the most common conditions in adolescents. Persistent symptoms are closely associated with impaired academic performance, reduced social functioning, high healthcare utilization, and increased risk of comorbid psychiatric conditions such as depression, eating disorders, and self-harm. Despite its substantial burden, the clinical mechanisms underlying SSD remain poorly understood, limiting the development of effective, targeted interventions. Clarifying the interrelationships among core somatic symptoms may therefore provide critical insights for clinical management and improve treatment precision.

A total of 585 patients were recruited between June 2024 and January 2025. All participants completed the Chinese versions of the Patient Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Disorder-B Criteria Scale-12 (SSD-12). To quantify the structure of the somatic symptom network, centrality indices including strength and expected influence were used to identify key symptoms. Bayesian network analysis was further applied to explore potential causal relationships, offering the advantage of directional interpretation within the network framework.

The symptoms of nausea, dizziness, shortness of breath, and chest pain exhibited the highest centrality values, indicating that they occupied the most central positions within the somatic symptom network. In the Directed Acyclic Graph (DAG), “cannot breathe” is located at the top of the network, indicating its potential directional influences and being more likely to trigger other symptoms.

While the evidence remains inconclusive regarding their direct suitability as treatment targets, psychological and neurobiological research may provide further insights into these central symptoms. Focusing on these nodes could inform future investigations and guide the development of more refined clinical strategies.

Not applicable.

The online version contains supplementary material available at 10.1186/s12888-025-07686-3.

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