Why Puberty Triggers Pain Disorders in Kids: Understanding the Emotional and Physical Factors

In a recent Parent CHYPchat, parents noticed that most of their kids had started having pain symptoms around the onset of puberty and asked me why that was the case. I thought this might interest all CHYP parents, so I’d like to share the ideas I gave them. These are the topics we discuss during Parent CHYPchats, so join us! All are welcome!

The obvious answer as to why pain symptoms show around puberty is all the hormonal and physical changes that kids go through during puberty can cause emotional distress and physical issues, such as growth spurts causing joint pain. But many other factors influence puberty, being a standard time to develop a pain disorder.

One of the personality characteristics common to youth who develop pain disorders is being people pleasers and trying to be “good” kids. During puberty, children ideally begin to individuate from their parents and form their own identities. Part of this process includes a normal amount of rebellion, which allows them to assert themselves as individuals.

Youth who develop chronic pain tend not to go through this process in the typical teen way. They tend not to be the kids who get into yelling matches with their parents or who do things behind their parents’ backs. They can be almost overly honest because they feel guilty if they even commit a minor infraction. However, they still have the drive towards individuation. This conflict often causes a sort of cognitive and emotional crisis within them.

During puberty, kids also start to notice their parents’ flaws. These realizations help them individuate from their parents. Youth who develop chronic pain often have a tough time accepting those flaws because they cause discomfort. The result is that they usually push down any anger they have toward their parents and don’t express it outwardly. I’ve discussed in other blogs that not expressing negative emotions is a significant contributor and common characteristic in the development of chronic pain.

Over the years, several clients feel so uncomfortable speaking negatively about their parents that they feel like their parents will magically find out if they do. One client said she knew I did not have any cameras recording her in my office, but saying anything negative about her parents made her feel like she would be recorded and they would see it. So, the normal drive of individuation in puberty gets derailed, leading to the development of somatic symptoms.

Another reason chronic pain tends to develop during puberty is that the executive functioning demands get harder during this transition. When kids are in the last year of elementary school, teachers unfortunately fixate on “preparing them for middle school” instead of letting them be kids for one last year. Thus, they pile on developmentally inappropriate academic and cognitive demands. Then, when they get to middle school, our youth suddenly have a more significant load on their executive functioning, such as multiple classrooms and binders, more homework, various deadlines, numerous tests on the same day, long-term projects, and so on.

For youth with undiagnosed learning differences, puberty is a time when the demands may cause more stress than they did in elementary school. If this does not happen in middle school, the stepped-up demands of high school will often reveal these difficulties. Kids who develop pain disorders tend to be perfectionistic and high achievers. If they are suddenly not performing at the level they wish to, or it is taking a massive chunk of time or energy to perform at their desired level, they may develop somatic symptoms.

This common occurrence is one reason we typically recommend neuropsychological testing to ensure there is not an undiagnosed learning issue causing stress. Children often rely on their innate above-average intelligence in elementary school to get by. However, these stepped-up cognitive demands during puberty tend to cause a lot of anxiety and somatic symptoms.

Puberty is also when kids typically turn away from their parents and toward their peers for support. Studies show that for most teens, their peers have more influence on them than their parents. This process can be complicated for kids with more difficulty making friends, feeling tied to their parents, or uncomfortable moving toward peers. Some kids think that their parents need them to stay close, and because they are sensitive, they abide by their parents, either consciously or subconsciously. But this dynamic can cause inner turmoil because their natural drive to become more independent from their parents is being suppressed, which can lead to somatic symptoms.

For other kids, perhaps because they are neurodivergent, the social complexity that develops around the end of elementary school and into middle school can be very challenging. Kids who are on the autism spectrum, especially those who have not been identified and thus wonder why they are different than their peers, find the social scene to be very difficult to navigate, starting around puberty. It becomes much more challenging to mask as neurotypical starting around this age. They can become confused and lost and often do not know how to fit in. This difficulty can be very upsetting and lead to chronic pain and other somatic symptoms.

One client sat with a teacher every day for lunch in 7th grade because he said, "Watching the other kids is like viewing a sports game that no one told me the rules to.” Many youths with chronic pain are not as socially “advanced” as their peers and thus do not have as much in common with them, which can make it difficult to find friends. On one hand, these kids are often more emotionally and behaviorally mature. On the other hand, they are often younger in activities they enjoy. While that is wonderful and healthier in many ways, it does not help them fit in socially.

I had a 6th-grade client who still liked playing with her American Girl dolls. (The other 6th-grade girls probably did, too, but they would not admit it! They liked to put on makeup and watch YouTube videos.) My client reconnected with a friend who was in 5th grade and also liked to play with dolls, so she at least had a peer to play with. Many of my clients relate better to younger peers because of shared interests or older peers because they are more mature in other ways. During puberty, so many social situations become more complex to navigate, which can lead to stress, anxiety, fear, and pain.

Puberty is a fraught time for so many kids. The changes in their bodies, going to new schools, navigating peer relationships, and meeting challenging cognitive and academic demands can all be very stressful. With the addition of social media becoming a big part of their lives around puberty, it adds another stressor. Therefore, it is not surprising that most of our patients develop pain disorders between the 6th and 9th grades. Determining what anxieties, fears, or stressors contribute to your child’s symptoms is essential to addressing the root causes.