Prof. Dr. Vagif Rakhmanov, Director of Scientific Research Institute of Child and Family Therapy, Psychology, Medical Rehabilitation, Ukraine
Due to the complexity of diagnostics and polymorphy of clinical manifestations of psychosomatic (borderline) disorders among children medical specialists establish error diagnosis and prescribe inadequate treatment.
Besides, amid increasing neurological disorders under psychogenic factors there appear more and more unsound children with arising somatoform neurological disorders of cardiovascular and respiratory system, gastrointestinal tract and skin.
Often generalists are not familiar with children’s neuroses and psychosomatic disorders in their practice.
During the period of early infancy such disorders include infantile colic, aerocolia, posseting, functional megacolon, early infancy anorexia, arrest of development, obesity, attacks of respiratory disturbance, neurodermatitis, jactitation (a restless tossing of the body being awake or asleep), affect spasms, sleep disorders, infantile bronchial asthma, sudden infant death syndrome.
In preschool age we observe such psychosomatic disorders as constipation, diarrhea, irritable bowl, abdomen pains, recurrent vomiting, refusal of chawing, anorexia and bulimia, encopresis, enuresis, obesity, sleep disorder, fever. More often children aging 6-8 years have sensation of pain during intensive growth. Similar phenomena can be observed among 40-50% of children having psychotraumatic experience in perinatal medical history.
School-aged children and adolescents can suffer following psychosomatic disorders: headache, migraine, pain during intensive growth, recurrent wandering pains, circadian rhythm sleep and nutrition disorder, attacks of hyperventilation, vertigo, faintness, vegetative-vascular dystonia, bronchial asthma, abnormality of food skills, anorexia nervosa, bulimia, obesity, dyskinesia of gastrointestinal tract, fecal retention, gastritis, gastroduodenal ulcer, ulcerative colitis, encopresis, enuresis, neurodermatitis, menstrual disorder.
In medical practice manifestations of psychosomatic (borderline) disorders among children are distorted in such a way that even the most experienced specialists cannot sort the symptoms out and find adequate medical rehabilitation measures.
One of the differences between childhood and adult neurosis is that children’s complains are not burdened somatically, and psychogenic hypertensive syndromes are less apparent. Manifested complains always are observed abruptly, more seldom in prepubertal and more often in pubertal stages.
The second difference is blurring, primitivity and seeming absence of manifestations of complains (according to parents).
The third difference involves emotional poorness, weakness. But we should highlight that children’s fear of white coat and manifested sensitivity (cries, weeping) are not a subject to determine the diagnosis.
The fourth difference is negativism and absence of the motive to receive treatment especially concerning egocentric adolescents. But there are sometimes opposite cases when some children exaggerate their complains and look for a reason to stay away from school at home and play computer games while parents are at work etc.
As a result of thorough examination we can rate following reasons of psychosomatic (borderline) disorders according to their significance. The first place for both children and adults is taken by psychotraumatic factors in the family life. The difference between children and adults is that social psychotraumatic factors have indirect influence on a child through stress of adult family members.
The second place is occupied by symbiosis of parents’ complaints, especially those of mothers’.
The third group of reasons is divided according to early infancy stage.
- In prenatal stage somatic, psychological and physiological characteristics of both future parents’ organisms come to the first place. For example, such factors as mother’s and father’s unhealthy work, living in contaminated areas, surgery and disease history influence parents’ organisms.
- In perinatal like in prenatal stage a great significance is drawn to carrying of pregnancy and social, psychological idiosyncratic factors influencing gestation. Such important thing as, for example, mother’s studying across pregnancy (taking exams) has direct influence in form of emotional stress, excitement.
- In postnatal stage the nature of child delivery (birth injury, asphyxia) and period after delivery are added to above-mentioned factors.
The fourth place among reasons of psychosomatic (borderline) disorders is taken by family separation. In particular, it is when children start attending public nursery, kindergarten or school.
The fifth reason is somatic overfatigue. It’s extremely popular among parents to make their child to attend athletic training, musical and different expanded classes.
The attitude of parents towards the child’s disorder hereafter is the main factor for development of one or another form of neurotic and somatic disorders.