Psychosomatic (borderline) disorders in children
Psychosomatic (borderline) disorders in children
Due to the complexity of diagnosis and polymorphism of the clinical manifestations of psychosomatic (borderline) disorders in children, experts allow erroneous diagnoses and inadequate treatment.
Such phenomena have always been the subject of debate, but they are very little studied. Many experts group them into separate age periods.
In infancy, these disorders include colic of the third month of life, flatulence, chewing gum, regurgitation, functional megacolon, anorexia of infancy, arrest of development, obesity, episodes of respiratory disorders, neurodermatitis, bacteriosis, spastic crying, sleep disorders, early bronchial asthma, sudden death baby
At preschool age, psychosomatic disorders such as constipation, diarrhea, “irritable bowel”, abdominal pain, cyclical vomiting, failure to chew, anorexia and boulemia, encopresis, enuresis, obesity, sleep disturbances, and fever are observed.
In school-age children and adolescents, psychosomatic disorders include migraine, “growing pains”, recurrent pains of varying localization, sleep disorders, episodes of hyperventilation, fainting, vegetative-vascular dystonia, asthma, anorexia nervosa, bullemia, obesity, gastric ulcer and duodenal ulcer, ulcerative colitis, enuresis, encopresis, neurodermatitis, menstrual disorders. (Isaev D.N., 2000).
In its classification, H.Zimprich (1984) in children with psychosomatic disorders identifies: psychosomatic reactions, functional disorders, psychosomatic diseases with organic manifestation, specific psychosomatosis (colitis, gastric 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. br>
The second group includes psychosomatic diseases: bronchial asthma, ulcerative colitis, gastric ulcer, anorexia nervosa, boulemia, obesity, neurodermatitis, Crohn's disease.
The third group includes chronic diseases in which the patients experience: cystic fibrosis, diabetes mellitus, chronic renal failure, and 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 therapeutic and rehabilitation measures.
One of the differences between neurosis in children and adults is that children's complaints are not somatically burdened and psychogenic hypertensive syndromes are less pronounced. Expressed manifestations-complaints are always observed suddenly, less frequently in pre-pubertal, often at puberty.
The second difference is the weariness, primitiveness and the apparent "absence" of the manifestation of these complaints (according to the statements of the parents).
The third difference is emotional unsaturation, poverty. But here it should be emphasized that the children's fear of the “white robe” and pronounced sensitivity (crying, screaming) is not a reason for diagnosis.
The fourth difference is negativism and the absence of a motive for treatment, especially from adolescents because of egocentrism. But it happens the other way around, some children exaggerate their complaints and look for a “reason” to not go to school and stay at home, play on the computer, while parents are at work, etc.
Particular attention should be paid to those stressful factors that children experience because of inadequate behavior of parents, for example:
- Night disassembly. Parents think that children sleep in another room and start discussing their interpersonal relationships, social problems, etc. </ li>
- Listen to TV, music, etc. loudly.
- An important factor is the transfer of psycho-traumatic situations (psychotrauma, study, stress, etc.) to the mother during pregnancy.
All these factors form the child's psyche and such children are at risk. In the future, invisible circumstances contribute to the manifestation of certain forms of neurosis, including individual (systemic) disorders:
- Eating disorder (anorexia, boulemia, etc.).
- Inorganic sleep disorder.
- Disorder of psychological (mental) development.
- Emotional and behavioral disorders (including hyperkinetic disorder, tics, enuresis, encopresis, stuttering, etc.)
Personal characteristics of children with neurosis, psychosomatic and borderline disorders
For such children is characteristic:
- Decreased productivity of cognitive and physical processes with mood swings.
- Increased anxiety and anxiety with emotional alertness and self-centered type of behavior.
- Emotionally depressed mood background.
- Constant insecurity, their actions.
- Dependence on relatives.
- Lack of attention.
- Inability to care for yourself, to have an opinion.
- Requires increased attention and support from relatives.
- Negativism or refusal of examination and treatment.
- Lack of self-criticism and an objective assessment of their actions, inflexibility of thinking.
- In their actions, unpredictable, inconsistent, irresponsible, incl. and ambivalent.
It should also be emphasized that with age in children, in the presence of negative social factors and the absence of remedial measures, such personal response features as vulnerability (touchiness), negative perception of external forms, inability to adapt in the macroenvironment (in the team), protect themselves or help others, choose friends, etc.
For some children, depending on the age characteristics and personality traits, suggestibility is typical (B). High-level B speaks about plasticity, the flexibility of cognitive-communicative processes. Low-level B, on the contrary, indicates a negative internal atmosphere of the family, the negative influence of the macro environment, rigidity and such traits as distrust, suspicion, high egocentrism, intransigence, impatience, etc., and, in most cases, is a mirror image of the characters of the parents.
In children with neurosis, neurotic and somatoform disorders, in comparison with peers, there are one or more conflicts in the microenvironment or too much dependence on relatives, especially symbiosis with the mother. In the macro environment, such children are difficult to establish a contact (even and immediate adequate communication). At the same time, they often become unnecessarily subordinate in the group, suggestible, and lack of initiative. After establishing contact with peers, hyperactive, inconsistent, hardly show patience and friendliness. In the behavior of children of younger groups, elements of auto- and hetero-aggression can manifest, in adults, demonstrative (conversion) behavior with elements of subordination to the requirements of the macroenvironment.
In adolescents: the need to obey the requirements of the macro environment is difficult to form and there are many problems in adapting and shaping the creation of social benefits. Social adaptation, ideologies of existence are formed in the form of idealism, incl. individualism or egocentric “withdrawal into oneself.”
In the future, the gap between the ability and the desire to realize one's “high ideals, goals”, to protect oneself (self-preservation instinct), to defend one’s opinion, to differentiate positive life principles, etc.
At the same time, the presence of neurotic development of the personality constantly pursues them throughout their life. They become dissatisfied, dissatisfied with themselves and often carry this discontent to their relatives.
The crisis of self-awareness, lack of criticism is further transformed into an inadequate self-consciousness of the world. Self-awareness of one's own inferiority - the dissociation between the meaning of life and values, the feeling of one's own worthlessness. In adulthood, 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 the parents and the attention of society to healthy and sick children.
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