Psychosomatic (borderline) disorders in children
Because of the complexity of diagnosis and polymorphism of clinical manifestations of psychosomatic (borderline) disorders in children, specialists admit mistaken diagnoses and inadequate treatment.
Such phenomena have always been the subject of discussions, but they are very little studied. Many specialists group them by separate age periods.
In infancy, these disorders include the third month of colic, meteorism, cud, regurgitation, functional megacolon, anorexia of the breast, developmental arrest, obesity, breathlessness attacks, neurodermatitis, yaktion, spastic crying, sleep disorders, early bronchial asthma, sudden death the baby.
In pre-school age, there are psychosomatic disorders such as constipation, diarrhea, irritated bowel, abdominal pain, cyclic vomiting, refusal to chew, anorexia and bulimia, encopresis, enuresis, obesity, sleep disturbance, fever.
In children of school age and adolescents, migraine, “growth pains”, recurrent pains of varying localization, sleep disturbances, hyperventilation attacks, fainting, vegetative-vascular dystonia, bronchial asthma, anorexia nervosa, bulimia, obesity, gastric ulcer and duodenal ulcer, ulcerative colitis, enuresis, encopresis, neurodermatitis, disorders of the menstrual cycle. (Isaev DN, 2000).
In its classification, H.Zimprich (1984) in children with psychosomatic disorders distinguishes: psychosomatic reactions, functional disorders, psychosomatic diseases with organic manifestation, specific psychosomatoses (colitis, stomach ulcer, etc.).
Jochmus, G.M. Schmitt (1986), depending on psychological factors (difficulties), presented the following groupings of somatic disorders (disorders).
The first group includes functional (psychosomatic) disorders (somatic syndrome), in which there are no organic changes in organs and systems, in particular: in infants and young children – psychogenic disorders, sleep disorders, encopresis, enuresis, constipation, conversion neuroses.
The second group includes psychosomatic diseases: bronchial asthma, ulcerative colitis, gastric ulcer, anorexia nervosa, bulimia, obesity, neurodermatitis, Crohn’s disease.
The third group includes chronic diseases, in which patients experience: cystic fibrosis, diabetes mellitus, chronic renal failure, malignant neoplasms.
In the practice of manifestation of psychosomatic (borderline) disorders in children take such a “monstrous” nature that sometimes the most experienced specialists can not understand these symptoms and the selection of adequate treatment and rehabilitation measures.
One of the differences between neurosis in children and adults is that the complaints of children are not somatically burdened and psychogenic hypertensive syndromes are less pronounced. Expressed manifestations-complaints are always observed suddenly, less often in the pre-pubertal, more often at pubertal age.
The second difference is the erasure, primitiveness and apparent “absence” of the manifestation of these complaints (according to the statements of the parents).
The third difference is emotional desaturation, poverty. But here we should especially emphasize that the fear of children before the “white coat” and pronounced sensitivity (crying, crying) is not a reason for diagnosis.
The fourth difference is negativism and lack of motivation for treatment, especially from adolescents because of egocentrism. But it happens the other way round, some children exaggerate their complaints and look for “excuse” not to go to school and stay at home, they play video games while parents are at work, etc.
Especially it is necessary to pay attention to those psychotraumatic factors that children experience because of inadequate behavior of parents, for example:
- Night disassembly. Parents think that children sleep in another room and begin to discuss their interpersonal relationships, social problems, etc.
- Loudly listen to TV, music, etc.
- An important factor is the transfer by the mother during pregnancy of psychotraumatic situations (psychotrauma, study, stress, etc.).
All these factors form the child’s psyche and such children are a risk group. In the future, unnoticed circumstances contribute to the manifestation of certain forms of neuroses, including individual (systemic) disorders:
- An eating disorder (anorexia, bulimia, etc.)
- Sleep disorder of inorganic origin.
- Disorder of psychological (mental) development.
- Emotional disorder and behavioral disorder (including hyperkinetic disorder, tics, enuresis, encopresis, stammering, etc.)
Personal characteristics of children with neurosis, psychosomatic and borderline disorders
For such children is typical:
- Decrease in the productivity of cognitive and physical processes with mood jumps
- Increased anxiety and anxiety with emotional alertness and self-centered behavior
- Emotionally depressed mood background.
- Constant lack of confidence in yourself, your actions.
- Dependence on relatives.
- Lack of attention.
- Inability to care for themselves, to have their own opinion.
- Requires increased attention and support from relatives.
- Negativism or refusal of examination and treatment.
- Lack of self-criticism and objective assessment of their actions, inflexibility of thinking.
- In their actions unpredictable, inconsistent, irresponsible, incl. and are ambivalent.
It should also be emphasized that with age in children, in the presence of negative social factors and the absence of therapeutic measures, there is an aggravation of such traits of personal reaction as vulnerability, negative perception of external appearance, inability to adapt in a macro environment (in a team), to protect oneself or help others, choose friends, etc.
For some children, depending on the age characteristics and personality characteristics, suggestibility is characteristic (B). High-level В speaks about plasticity, the flexibility of cognitive-communicative processes. Low-level B, on the contrary, indicates the negative internal atmosphere of the family, the negative influence of the macro environment, stiffness and such traits as suspicion, suspicion, high egocentrism, intransigence, impatience, etc., and, in most cases, mirror image of the parents’ characters .
Children with neuroses, neurotic and somatoform disorders, in comparison with their peers, have one or more conflicts in the microenvironment, or too much dependence on relatives, especially symbiosis with the mother. In the macros environment, such children find it difficult to establish contact (equal and immediate adequate communication). At the same time, they often become excessively subordinate in the group, instilled, non-initiative. After establishing contact with peers hyperactive, inconsistent, they struggle with patience and friendliness. In the behavior of children of younger groups, elements of auto- and heteroagression can manifest themselves, in adults – demonstrative (conversion) behavior with elements of subordination to the requirements of the macroenvironment.
In adolescents: it is difficult to formulate the need to obey the requirements of the macro environment and there are many problems in adapting and shaping the creation of social benefits. Social adaptation, the ideology of existence are formed in the form of idealism, incl. individualism or egocentric “withdrawal into oneself.”
Further, the gap between the ability and desire to realize their “lofty ideals, goals” is deepened, to protect oneself (the instinct of self-preservation), to defend one’s opinion, to differentiate vital positive principles,
At the same time, the presence of neurotic personality development constantly pursues them throughout life. They become dissatisfied, unhappy with themselves and often endure this discontent with their relatives.
The crisis of self-consciousness, the lack of criticism in the future, are transformed into an inadequate self-awareness of the world-existence. Self-awareness of own inferiority – dissociation between the meaning of life and values, a sense of own worthlessness. In adult life, this awareness is either exacerbated or compensated, depending on the prevalence of socially favorable or unfavorable factors and psycho-traumatic situations. This is the formation of a future healthy or problematic society, in which everything depends on parents and the public’s attention to healthy and sick children.