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Psychosomatic Disorders in children

Psychosomatic Disorders – Although emotional stress is a known precipitating/ exacerbating event for many medical illnesses e.g. asthma, diarrhea or epilepsy; two specific and important psychosomatic illnesses are conversion disorder and Munchausen syndrome by proxy, discussed here.

Conversion disorder denotes loss or alteration of physical functioning without a demonstrable illness. This disorder is usually seen in adolescents and older children and more common in females.

Etiologically, it is considered as a physical medium of expression (somatization) of suppressed anger or frustration, especially in over-disciplined children.

Clinically, these cases may present with —

a) Conversion reactions with motor component (hysteria) e.g. mimicked seizures, paralysis, blindness etc. or rarely,

b) Dissociative reactions e.g. recurrent abdominal pain, vague body aches/pains, anorexia etc.

Psychosomatic Disorders – Diagnosis is usually based on exclusion of organic cause, absence/inconsistency of clinical signs and prolonged observation of behavior.

Conversion reactions tend to increase during family/doctor’s attention, though frequently, these responses are not within the patient’s voluntary control (did fictitious illnesses).

Treatment for Psychosomatic Disorders is non-specific during acute phase except exclusion of organic/concomitant illnesses, while psychotherapy is necessary on recovery to prevent recurrence.

Munchausen syndrome by proxy: is a form of child abuse, characterized by fabricated illnesses in children by their parents, usually mother, in order to get medical attention.

Clinically, these children present with large spectrum of unexplained symptoms e.g. fever, vomiting, diarrhea, seizures, hematuria etc. Important ecological factors of Psychosomatic Disorders include disturbed family, mentally unstable mother or unwanted child.

Diagnostic indicators of Psychosomatic Disorders include — a) unexplained recurrent illnesses in child or other siblings, b) inconsistent history, c) unusually calm or concerned mother in the hospital, d) poor response to rational therapy, and e) absence of symptoms on separation from parents.

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