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: The term 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 and pains, anorexia, etc.
Diagnosis usually rests on exclusion of organic cause, absence or 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 (d/d Factitious illnesses).
Treatment is non-specific during acute phase except exclusion of organic/concomitant illnesses, while psychotherapy is necessary on recovery to prevent recurrence.
Munchausen by proxy syndrome is a form of child abuse; characterized by illnesses fabricated in children by their parents, usually mother, in order to get medical attention. These babies are repeated brought for medical consultations with non-existing illnesses, multitude of complaints or problems induced by parents themselves, e.g. bruises, hematuria, fever, vomiting, etc. and some parents even alter the laboratory samples or
temperature measurements of the child to substantiate their complaints.
Important ecological factors include disturbed family, mentally unstable mother or unwanted child.
Clinically, these children present with large spectrum of unexplained symptoms, e.g. fever, vomiting, diarrhea, seizures, hematuria, etc.
Diagnostic indicators include: (a) exotic and wide- spectrum of complaints, (b) discordant physical examination, (c) extremely anxious or unconcerned mothe,
(d) history of multiple medical consultations (Doctor shopping), (e) poor response to rational therapy, and (f) absence of symptoms on separation from parents.
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