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Psychosocial Dimensions and Functioning in Youth With Postural Orthostatic Tachycardia Syndrome

Postural orthostatic tachycardia syndrome (POTS) is characterized by symptoms of lightheadedness, dizziness, actual or near syncope, leg weakness, altered vision, headache, nausea, poor concentration, chest pain, palpitations, feeling warm, and/or tremulousness. These symptoms occur on standing and are relieved when an individual reclines. While initially POTS was more recognized in adults, more recently, it is increasingly being diagnosed in adolescents. Symptoms of POTS can be debilitating and have significant impact on many areas of functioning (eg, academic, peer and familial relationships, extracurricular activities). Furthermore, as these impairments in functioning are occurring within key developmental periods, the impact of the symptoms can result in missed opportunities to develop typical social and emotional skills. Clinical presentation of POTS is heterogeneous, with many patients who do well with medication management and standard nonpharmacological approaches such as increased exercise and increased salt and water intake. However, a portion of pediatric patients with POTS experience significant impairment in functioning and disability similar to pediatric patients experiencing chronic pain. Relationships between psychosocial dimensions and functioning have been clearly demonstrated in pediatric pain populations. Furthermore, a multidimensional biobehavioral model is widely accepted as appropriate for conceptualizing and treating chronic pain in pediatric populations with a focus on increasing the patients’ functioning. A similarly multifaceted approach has been recommended in the treatment of pediatric POTS patients. However, little research has been done on the relationship between psychological factors and overall functioning in this population. The aim of this study is to determine relationships between functioning and symptoms of anxiety, perfectionism, catastrophizing, and/or depression in adolescents diagnosed with POTS who were being treated in an intensive pediatric pain rehabilitation program. Methods