Growing Up Can Be Painful: A Case Report of the Bat Mitzvah and Chronic Pain

Among a subgroup of adolescents with chronic pain syndromes, anxiety about “growing up” appears common and may be exacerbated by developmental transitions. Using the bat mitzvah ceremony as one example of a developmental rite of passage, we present two cases in which adolescent girls facing this transition developed new chronic musculoskeletal pain syndromes or experienced recurrences of pain symptoms. In both cases, the transition to adulthood, symbolized by the bat mitzvah, was associated with anxiety in adolescents who were unusually focused on the negative aspects of becoming independent adults. The aims of this case report are (1) to highlight the role of developmental transitions as a possible factor in the biopsychosocial model of pediatric pain; (2) to illustrate how to address emotional and cognitive responses to these transitions in the context of cognitive-behavioral treatment for pain; and (3) to suggest systematic approaches to investigating this clinically-observed phenomenon in future research.