小児科の特殊性からみた心身症治療の考え方(心身症の発症機序・病態に応じた新たな治療技法の展開)

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There are following characteristics in PSD in childhood. 1. Because children are in the midst of growing and developing, they complain rather general symptoms such as general malaise in PSD, while adults complain somatic changes or functional disorders of some particular organs like as gastric ulcer or angina. Since these symptoms may shift each other, it may be difficult to make exact distinction between somatic factors and psychological factors. For instance, headache, abdominal pain or general malaise may be the first symptoms of the children who can not attend school but they may also be the symptoms of the children with diabetes mellitus or hepatitis. 2. One of the characteristics of children is a poor verbal communication. In other words, they may resemble alexithymic patients who have difficulties in expressing emotions in words, and for whom dynamic psychotherapy cannot be effective. Therefore, psychotherapy in childhood is necessarily different from that conducted with usual adults with PSD. However, they can express their feelings much better through the process of drawings. About 800 patients have visited us for various psychological problems until now. They have left behind several hundreds of pictures that have led the author to believe that drawing tests are the best possible way to understand these young patients. The parents can understand their loneliness or distress through the products, and patients can reveal their anger or concealed aggression and be released from them during the process of drawing. 3. People around children may be convinced of normal developmental phenomena as abnormal. For instance, some parents may overestimate the behavior of their child in the gang age and thus protect or meddle him excessively. In that case it is important to remove the parent's anxiety. 4. The children who are tender, good and over adapted are liable to suffer from PSD. However, we may misunderstand their behavior because their way of thinking or acting is different from those of adults. Sometimes they play the role of a scapegoat or a peace maker of the family system. For instance, where there is continuing marital strife, he may intervene on behalf of one or the other of warring partner or defuse the conflict by behaving badly or having some symptoms. In that case it is necessary to pay attention not only to the symptoms of the child but to the system of the family. There are many implications in symptoms in children with psychological problems. Knowing their feelings or emotions is most important for a therapeutical involvement, therefore we should make efforts to stand on the children's view point and to understand the meaning of their symptoms in an appropriate manner. The author has explained the above by presenting some cases.
1995-01-01

小児科の特殊性からみた心身症治療の考え方(心身症の発症機序・病態に応じた新たな治療技法の展開)

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