思春期の心身症(ライフサイクルと心身症)

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At first the importance of differential diagnosis of adolescent psychosomatic diseases from other psychiatric disorders with somatic symptoms was pointed out. Adolescence, like infancy and the terminal stage of life, is the period in which the distance between body and mind is very close, and it is likely that psychosomatic symptoms can develop, even when a certain disorder is not diagnosed as psychosomatic disease (PSD). A correct diagnosis can lead to a correct therapy. If this principle is not applied, there will be a danger of producing iatrogenic diseases. Then, what can the core state of PSD be? For the purpose of clarifying the characteristics of adolescent PSD, the author presented a case of a twelve year old junior high school boy who developed psychogenic fever and consequently was unable to go to school. The conclusions led from this case are as follows : 1. He showed no marked anxieties and conflicts. Neither did he show preoccupation and apprehension with symptoms as in the case of hypochondriasis and obsessional neuroses. Rather, he was overwhelmed by the symptom and maladaptive to the given situations. Thus when free from symptoms, he was never worried about eyes of other friends in going to school. This was quite different from the so-called school refusal in which the patient shows tension and worry. 2. He was very poor at emotional communication to the therapist and showed hardly any deepenig and widening of relationship. He was never hurt by the therapist's words or behaviors in the course of psychotherapy unless some therapeutic change occurred. 3. Clinical history tended to be simple, because he did not oscillate emotionally with the circumstances. In the beginning, he gave an impression that he had a physical disease. 4. However, when his aggression was ventilated, that is, with the breakdown of his defence organization, the world of his fantasy began to appear. This was different from day dream, but it was the world of idol singers and famous baseball players with some colour of reality attached. 5. This was the world which he found it easy to share with his contemporaries. This meant his establishment of the world of contemporary, as well as his independence of the generation of his father, and separation from his parents. This state which the author describes might be quite similar to the so-called alexithymia. But the author wishes to keep the attitude that this state is of different quality from the concept of alexithymia which has the biological basis, because the present patient did not show the concrete thinking and overadaptation. This state characterized by adolescent PSD can be thought to have the genetic factor in the development of pre-adolescence or early adolescence which has the advent of puberty, as well as distortions of parent-child relationship of early childhood. The author thought that the disturbance of delicate and difficult processes of transforming unconscious sensation of body functioning into fantasy in these periods was important. In addition, the author pointed out the importance of taking consideration into the level of personality in the practice of psychosomatic medicine for adolescents.
1994-03-01

思春期の心身症(ライフサイクルと心身症)

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