Groups of psychosomatic disorders in children. Childhood diseases: psychosomatics

Prerequisites for psychosomatic disorders in children

The emergence of the psychosomatic concept in medicine is associated with the name of psychiatrist Sigmund Freud. His theory of conversion of emotional conflict to somatic function contains the following provisions:

I. The connection between the mental, physical and biological.

II. There is a mental pathogenic agent - affect, affective conflict.

III. There is a mechanism connecting 2 realities - mental and physical, a mechanism of symbolic conversion, which means there is a connection between affective conflict and clinical symptoms (I. V. Kozlova. Irritable bowel syndrome as a psychosomatic problem. Saratov. 2002.)

Sigmund Freud believed that the development of all stages of personality determines sexual development, and its stages are associated with the displacement of erogenous zones - those parts of the body whose stimulation causes pleasure.

Stage I - oral (up to 1 year). The erogenous zone is the mucous membrane of the mouth and lips. The pleasure of eating, thumb sucking leads to the satisfaction of “It”. Under restrictions, the “I” develops. Gluttony, greed, demandingness, and dissatisfaction with everything offered can develop.

Stage II - anal (1-3 years). The erogenous zone is the intestinal mucosa. The child learns to be tidy and learns to comply with the norms of society. The “Super-I” is formed - conscience, internal censorship. Accuracy, hoarding, punctuality, secrecy, and aggressiveness develop.

Stage III - phallic (3-5 years). Passive sexual stage, when sexuality is directed not only at oneself, but also at close adults: boys develop attachment to their mother (Oedipus complex), girls - to their father (Electra complex), overcoming which leads to the intensive formation of the “Super-I” . Self-observation and prudence are born.

Stage IV - latent (5-12 years). Children's sexual experiences are displaced by interest in school and communicating with friends.

Stage V - genital (12-18 years). The biological “It” increases activity. Teenagers fight his aggressive impulses using psychological defense mechanisms.

In the process of growth and development in a constantly changing social environment and activity, a qualitative transformation of the individual occurs.

The transformation of personality outgrows the social situation and leads to its explosion-crisis. Crises are turning points, points on the child development curve that separate one age from another.

Russian psychologist L. S. Vygotsky identified age periodization:

Newborn crisis - infancy (2 months - 1 year) - crisis of 1 year;

Early childhood (1-5 years) - crisis 3 years;

Preschool age (3-7 years) - crisis of 7 years;

School age (8-13 years) - crisis 13 years;

Puberty (14-17 years) - crisis of 17 years.

Under favorable circumstances, crises last relatively short time (several months) and represent stages during which significant developmental changes occur and the child’s psychological traits change dramatically.

Newborn crisis is an intermediate period between intrauterine and extrauterine lifestyles - the child is physically distant from the mother, but is connected to her physiologically, is in a state of inharmony, newborns lack behavior and orientation.

First year crisis. By the age of one year, the child becomes independent from the mother, the “We” situation is destroyed, and psychological separation from the mother gradually occurs.

Crisis 3 years. The child’s psychological functions intensively develop, the beginnings of self-awareness appear: by revising the system social relations, crisis of identifying one’s “I” (according to D. B. Elkonin).

The child separates from adults and tries to establish new, deeper relationships with them. “I myself” is the central new formation of this age period.

Crisis 7 years. Loss of spontaneity, mannerisms (the child pretends to be something, the soul is closed), the appearance of the “bitter candy” symptom (the child does not show that he is feeling unwell). The preschooler withdraws, becomes uncontrollable, and an inner life arises. This is the period of the birth of the social “I” (according to Bozhovich L.I.).

Play is pushed into the background by another activity - studying at school, but the formal transition to learning is delayed, which causes emotional and personal discomfort and negative behavior. At this age, the phenomenon of school maladaptation often develops - the formation of inadequate mechanisms for the child’s adaptation to school in the form of violations of school discipline or behavior, conflict relationships, psychogenic diseases and reactions of increased levels of anxiety, distortions in personal development - a crisis of prepubertal age (period).

Puberty is characterized by intense physical and sexual development. Communication and denial of adults come to the fore during this period.

Adolescents often experience compensation reactions, which manifest themselves in the fact that the child tries to eliminate his own weaknesses:

Emancipation reaction: the desire to escape from the care of adults; non-perception, denial of criticism;

Reaction of grouping with peers - groups are formed according to interests, with a permanent leader;

Movement reaction: hobbies, interests;

The reaction of hypersexuality is an increased interest in the problem of gender relations.

A teenager gets to know himself, which leads to the formation of a physical “I” - an idea of ​​his own attractiveness, a mental “I” - an idea of ​​his mind, abilities, and a behavioral “I”.

Youth (14-17 years old) - the transition from physical maturity to social maturity, inclusion in “adult” life, assimilation of the norms and rules existing in society. This is the time to develop views and beliefs, form a worldview, strive for self-awareness, self-education and self-improvement.

Youth is a period of personality stabilization, but at the same time manifestations of youthful maximalism in assessments and passion in defending one’s point of view.

Thus, each age period in a child’s life has its own characteristics, the consequences of which can become the background for the development of psychosomatic disorders.

In turn, chronic illnesses in a child are a severe mental trauma not only for him, but also for the whole family. The psychological reaction of the patient and family members goes through a number of successive stages.

Shock and disbelief. Regressive behavior, unreasonable fears, denial of the disease are observed; The duration of the stage is from several weeks to several months.

Protest and suffering. There may be feelings of guilt, depression, anger, sadness, mourning for lost health and broken hopes. Young children often perceive illness as a punishment for bad behavior and become bitter when faced with restrictions or treatment caused by it. Teenagers are afraid of becoming helpless or “not like everyone else”; they blame their parents or doctors for everything.

Recovery. At this stage, the child comes to terms with the limitations that the disease causes. Behavior and relationships with others are normalized; self-confidence appears. Denial of the disease is combined with making plans for the future. The family also adapts to new conditions. However, children with chronic illnesses are more likely than healthy children to suffer from emotional disorders. Psychogenic disorders in children are observed more often than in adults, and have a more pronounced somatic nature, due to the still imperfect central nervous regulation of autonomic functions.

Fixation of symptoms is carried out due to the conditioned reflex mechanism.

A feature of childhood is natural emotional and volitional lability, manifested in the form of restlessness and eccentricity. Sometimes there is a hostile and stubborn attitude of children towards adults. Since children are more emotional, they more openly show fear and aggressiveness, and are more suggestible.

Psychopathological manifestations of somatized depression in children

Sleep disorders are considered as a compensatory or adaptive change in response to illness or psychological problems.

20-30% of parents complain of sleep disorders in their children.

A. Ts. Golbin (1979) divides the phenomena of pathological sleep in children into:

Sleep-related stereotypes;

Paroxysmal phenomena during sleep;

Static sleep phenomena;

Complex behavioral and mental phenomena;

Disturbances in the sleep-wake cycle.

Sleep-related stereotypes include:

Swings, which are rhythmic pendulum-like movements of the head and body of varying amplitude from side to side with a frequency of 0.5-2 per second. Oscillations, as a rule, occur before the age of one year with a peak manifestation at 6 months and can disappear at any age;

Beating refers to stereotypies in which the child hits his head on the pillow, raising himself on outstretched arms. Most often, beats occur in children aged 1 year;

Movements of the “shuttle” type consist of rocking the child in the anterior-posterior direction in the “on all fours” position, at the age of 1.5-3 years;

The “folding” phenomenon is understood as the rhythmic raising and lowering of the torso and head from the “supine” position to the “sitting” position. This rare original sleep disorder has been identified in children suffering from somatic (usually allergic) diseases, hyperreactivity, emotional lability and having a burdened perinatal history with symptoms of depression and muscle hypotension in the first months of life;

Thumb sucking occurs in 80% of children, and in 78% it is associated with sleep disorders. It most often occurs in infants under 9 months of age during the sleep phase. There was a slight predominance of thumb sucking in girls and in children from families of a relatively high socio-economic level. Among the reasons for the occurrence of this phenomenon, breastfeeding problems, anxiety or other worries of the child are mentioned; The psychoanalytic school regards thumb sucking as a manifestation of early oral sexuality. Among the psychological consequences for a child associated with thumb sucking are disturbances in family relationships and relationships with peers, the formation of self-awareness;

Masturbation as conscious self-stimulation to obtain sexual arousal is a natural stage of child development. This phenomenon occurs in almost all boys and 25% of girls. Maximum activity falls at the age of 15 years. Masturbation is observed more often when falling asleep and is manifested by tensing the muscles of the thighs, touching the genitals with hands, adopting various positions, rapid breathing, sweating, and screaming. In its expressed form, masturbation is transformed from an evolutionary phenomenon into a pathological phenomenon and can lead to prolonged arousal, disruption of the child’s behavior, disruption of family relationships, relationships with peers and the formation of self-awareness, and the emergence of sexual perversions.

In the development of stereotypies, a significant role is played by violations of the child’s relationship with his parents, the leading one of which is increased attention on the part of the parents to the child (without elements of overprotection).

Among the paroxysmal phenomena in sleep are:

Startles, which are a conditionally pathological phenomenon of sleep, while startles during the period of falling asleep refer to physiological movements that are especially common in adolescence;

Bruxism - grinding of teeth during sleep, occurs at any age with a maximum manifestation of 10-13 years;

Asthmatic attacks in a dream - their peak occurs at several age intervals (2 years, 6-7 years, 10-13 years). The peculiarity of such attacks is their disappearance during wakefulness. These attacks are caused by changes in the sleep-wake biorhythm: children who have these attacks suffer from daytime drowsiness and other paroxysmal sleep disorders (startling, bruxism). Asthmatic attacks during sleep are characteristic of atopic bronchial asthma, however, the characterological characteristics of children suggest the role of conversion (hysterical) mechanisms in the development of an asthmatic attack;

Nyctalgia includes attacks of various locations during sleep. Many somatic diseases are characterized by exacerbation of pain at night (hepatic, intestinal, renal colic), which is due to changes in the central control of pain in different phases of sleep;

Night terrors are a sudden psychomotor agitation with an affect of fear, in which the child does not come into contact with others, and upon awakening does not remember what happened. The duration of the attack is from 30 s to 5 minutes;

Nosebleeds are observed mainly in girls aged 3-6 and 12-14 years;

Paroxysmal vomiting during sleep is typical for children 2-8 years old and, as a rule, accompanies night terrors, asthmatic attacks, and nyctalgia.

Complex behavioral and mental phenomena include sleepwalking, sleep-talking, and nightmares.

Sleepwalking (sleepwalking, somnambulism) is a form of sleep behavior that includes movements, actions and deeds that have the appearance of voluntary and purposeful. More often, sleepwalking is observed at the age of 5-10 years. Developed manifestations of somnambulism are expressed by many hours or many days of vagrancy (“outpatient automatism”). Episodes of sleepwalking are usually amnesic.

Somnambulism is associated with psychopathological syndromes.

Spoken speech occurs in almost all children and manifests itself in various forms - from inarticulate sounds to monologues and songs.

Nightmarish dreams occur in the age periods of 3-7 years and 10-12 years, their content corresponds to the developmental characteristics of the child, the level of his daytime experiences, and they are often symbolic in nature. Reflect the characteristic symptoms of a somatic disease: for example, scenes of suffocation due to congestion in the upper respiratory tract due to a respiratory infection or bronchial asthma, a fire due to disease of the gallbladder and/or liver. Unlike night fears, nightmares are observed during immobility during sleep, their content is completely preserved after awakening.

The differential differences between night fears and nightmares are presented in Table 3. The category of disorders in the sleep-wake cycle includes disorders of falling asleep, waking up, staying awake, sleep inversion and wakefulness. Sleep disorders are common in infancy and are expressed by excessive activity in the evening and at night, and moodiness.

Table 3. Differences between night terrors and nightmares

Etiology of sleep disorders

I. Special conditions for falling asleep: children get used to falling asleep in certain conditions and in the future cannot do without them. Examples include rocking, feeding, and sucking on pacifiers, without which an awakened child cannot fall asleep. Another example is falling asleep in the parents' bed: having woken up in his own crib, the child cannot fall asleep due to the unusual surroundings.

II. An incorrect daily routine (irregular sleep during the day, lack of a clear time for going to bed and waking up) also leads to sleep disturbances.

III. Sleep may be disrupted by lax or inconsistent limits on the child's activities at bedtime.

Awakening disorders consist of incomplete awakening with a strong emotional reaction or a daydream-like state, a state of confusion, as well as difficult awakening without affect.

Violations of wakefulness are manifested by an irresistible desire to sleep at unusual times, the phenomenon of paradoxical drowsiness (excitement or whims of the child when falling asleep).

Narcolepsy is characterized by daytime sleepiness and disturbance of slow-wave sleep. It begins, as a rule, at the age of 15-17 years, less often before puberty.

Clinical features:

Daytime sleepiness mainly occurs when the patient is sitting (in children this symptom is more common than others);

Catalepsy - a sudden decrease in muscle tone upon awakening or excitement;

Hypnagogic hallucinations are visual or auditory hallucinations that occur when falling asleep or waking up;

Sleep paralysis is a paralysis that occurs when falling asleep or waking up (the respiratory muscles are not involved).

The full set of symptoms occurs in approximately 10% of patients. The most common symptoms are daytime sleepiness and catalepsy.

Asthenia

Asthenia (asthenic syndrome, asthenic conditions; is a symptom of a number of diseases, develops with prolonged intoxication, diseases of internal organs.

It is characterized by the appearance of palpitations, weakness, sensations of heat or cold, sweating, dizziness at the slightest emotional and physical stress (or even at rest), the child becomes irritable and capricious. These symptoms are longer and more persistent than with asthenic neurosis. Depressed mood, tearfulness, decreased performance, touchiness, short temper, lack of commitment, violent reactions to minor changes in the external environment (bright light, loud conversation).

Pseudoneurological disorders in children

Pain syndrome

Pain is a central concept in medicine. Diagnosis of this condition is difficult in pediatric practice due to the peculiarities of the psychology of children and their ideas about pain. In 95% of cases, recurrent pain in children is psychogenic in nature.

Below (Table 4) is the evolution of children's ideas about pain depending on age (according to P. G. McGrath, L. McAlpine, 1993).

Table 4. Children's ideas about pain

Since pain is a psychosensory phenomenon, the importance of psychological diagnosis is especially great.

Headache

Headache is a symptom of numerous diseases.

Group I - headaches of an organic nature: skull trauma, inflammatory diseases (meningitis, encephalitis, poliomyelitis), hemorrhages, tumors.

Group II - headaches of an organic nature, not associated with direct damage to the brain (tonsillitis, pneumonia, ARVI, sinusitis, otitis, pathology of the organs of vision).

Group III - headaches of a functional nature (with stress, vascular dystonia, vasomotor headaches, muscle headaches, migraines).

Headaches of vasomotor origin in older children appear after mental or physical stress, excitement, or changes in weather. It is dull in nature, sometimes pulsating, diffuse, without typical localization. Duration - from several hours to several days or weeks. In young children, vasomotor headache is less pronounced, but is more generalized. It is preceded by nausea, vomiting, photophobia (photophobia), pale skin, sweating, swelling of the eyelids, and mood changes.

Muscle headaches are caused by muscle contractions. It is recurrent in nature. It begins with pain in the muscles of the neck, shoulders, and the back of the head, then spreads to the frontal region - the head is “tightened with a bandage.” The duration of such pain ranges from several days to several weeks. Sometimes accompanied by nausea, vomiting, dizziness. Migraine also occurs in childhood.

Etiology of headache

The following etiological factors for migraine are identified:

Hereditary;

Endocrine (in teenage girls before, during or after menstruation - “menstrual migraine”);

Migraine associated with epilepsy;

Allergies can be a provoking factor in the development of migraines.

The clinic is characterized by the presence of paroxysmal headaches, often unilateral, with light intervals, accompanied by nausea and vomiting. Headache of organic origin always appears in early period development of organic pathology, occurs in the morning, is often combined with vomiting, and is not controlled by analgesics. In case of an infectious lesion, the headache is intense, diffuse, constant, and may be accompanied by nausea, vomiting, and convulsions.

Post-traumatic headache occurs immediately after injury and is accompanied by dizziness, increased sensitivity to noise, and sleep disturbances. The nature and location of such pain depend on the type and location of the injury. Headache due to sinusitis appears in the morning and decreases during the day; in case of pathology of the organ of vision, it occurs after several hours of exercise.

Diagnostics

The clinical picture is taken into account. Clinical and instrumental research methods include radiography of the skull and paranasal sinuses, fundus examination, visual acuity, EEG, REG, and computed tomography of the brain.

Dyskinesia

Dyskinesia is a violation of the motor function of the esophagus, stomach, intestines, and gall bladder. Children with dyskinesia are distinguished by the following psychological traits:

Increased anxiety;

Increased aggressiveness, directed in some people outward, in others - towards themselves;

Hysterical and demonstrative features.

Motor impairments are one of the most important ways of expressing emotions (P.K. Anokhin); emotional and mental experiences aggravate motor function disorders. Dyskinesia is clinically manifested by pain in the projection of the organ, dyspepsia (nausea, vomiting, belching - with dyskinesia of the esophagus, stomach; with biliary dyskinesia - bitter belching, vomiting bile; with intestinal dyskinesia - constipation or diarrhea). Esophageal dyskinesia is also characterized by dysphagia (difficulty in swallowing food, attempts to push food through in different ways). Differentiate dyskinesias from organic lesions gastrointestinal tract(inflammatory, erosive-ulcerative, tumor processes) using laboratory and instrumental research methods (fluoroscopic, endoscopic, etc.).

Psychosomatic disorders of the cardiovascular system and pseudorheumatic disorders

Psychosomatic disorders of the cardiovascular system include:

Cardialgia (pain in the heart area);

Arrhythmias (heart rhythm disturbances);

Functional heart diseases;

Cardiac ischemia;

Cardiophobia.

In childhood, functional heart diseases, arrhythmias, cardialgia, and cardiophobia mainly occur.

Various fears, headaches, rage, quarrels and conflicts in children's team influence cardiac activity, which, in turn, is the equivalent of mental and spiritual activity and attitudes. Due to the influence of an external factor, cardiac activity is not realized, a motor reaction occurs and excitement remains in anticipation of the action being performed. In another case, the attitude towards action, repressed from consciousness, leads to tension in the circulatory system. When there is fear or danger, there is a feeling as if the heart begins to beat in the temples, in the throat. In this case, adrenaline is released, causing spasm (constriction) of blood vessels, heart contractions become more frequent, which leads to cardialgia and a feeling of anxiety.

Arrhythmias

Arrhythmia is a disturbance in the rhythm of the heart as a result of pathology in the formation of excitation or its conduction.

Arrhythmias can also occur in healthy children.

Psychosomatic arrhythmias include disturbances in the formation of excitation (tachycardia, extrasystoles). Tachycardia is a common manifestation of psychovegetative disorders. Most often, attacks are provoked by various situations and conflicts (death of parents, grandparents, dog attack). They occur in children who tend to restrain their feelings, tend to suppress them, and protect their emotional world. Tachycardia and extrasystoles, organically caused, intensify during emotional situations and lead to increased suspiciousness and hypochondria.

Cardiophobia

Cardiophobia is the fear of cardiac arrest or disease.

Often occurs in children with neurotic personality development. Such children fix fear on their hearts due to a somatically displaced conflict between impulses to break and protection from an unbearable situation.

Attacks of cardiophobia occur with anxiety and tension, followed by tachycardia, increased blood pressure, deep and rapid breathing, and profuse sweating. The duration of the attack is from 5 minutes. up to 1 hour, the patient’s consciousness, which is very important, is not impaired. But subjectively the patient fears cardiac arrest: Thus, a vicious circle takes place: fear - adrenaline release - rapid heartbeat - fear.

Very often, cardiophobia is accompanied by other phobias: claustrophobia - fear of closed spaces; agoraphobia - fear of open spaces; Bridgephobia - fear of crossing bridges. Such children always stay close to their parents, grandparents, and other adults, whose proximity gives them a sense of peace.

Cardiophobia often affects:

Children growing up without a father;

The only children in the family;

Younger sons who are very attached to their mother.

Effeminacy and affection predispose to neurosis. Habituation does not prepare a person for the difficulties of life. Particularly dangerous is attachment or the alternation of addiction and its abrupt interruption. Situations of separation and feelings of loneliness are important, which can subsequently lead to hostility and fear.

Children suffering from cardiophobia often:

They spare themselves, avoid difficulties;

Not independent;

They try to avoid physical exercise.

Differential diagnosis is carried out with organic heart diseases (congenital defects), mitral valve prolapse - a minor anomaly of the heart (due to the introduction of echocardiography into diagnostics, a currently common pathology can cause cardiophobia).

E. Dunbar and his followers studied the personality traits of psychosomatic patients, as a result of which, in addition to “ulcerative” and “coronary”, the so-called “arthritic” personality was described.

An unresolvable conflict of motives and unresolved stress give rise to a refusal of search behavior, which creates the precondition for the development of psychosomatic reactions.

An “arthritic” personality is characterized by:

Imbalance and lack of poles of softness and hardness;

The desire for dominance and at the same time - for self-sacrifice;

Containment of feelings;

Overconscientiousness, commitment, compliance, a tendency to suppress aggression and hostility (anger and rage);

Supermoral behavior and a tendency to depression;

A pronounced need for physical activity before illness.

Pseudoreumatic disorders (PRD) are manifested by a more or less pronounced articular syndrome (pain in the joints, usually large ones: knees, elbows, ankles, hips; crunching in them when moving, etc.). Unlike rheumatism, with PRR there are no signs of acute inflammation, body temperature is normal, and there are no inflammatory changes in other organs or blood tests. Long-term chronic systemic joint disease, such as rheumatoid arthritis, alters personality development.

L.V. Yakovleva, an employee of the Bashkir State Medical University, examined children with rheumatoid arthritis using various psychological questionnaires and found that sick children:

Phlegmatic;

Distrustful;

Emotionally balanced, restrained;

Prudent;

Reasonable;

Be careful;

Sensitive;

More dependent on others;

They are distinguished by increased self-control;

More adaptable to environmental conditions.

Compared to healthy children they:

More withdrawn and less sociable;

Unhurried;

Calm;

Executives;

Less prone to risk (both boys and girls).

The long course of the disease makes children more:

Practical;

Realistic;

More self-reliant;

Ignoring physical disabilities.

This all indicates the process of mental adaptation to one’s illness.

Psychosomatic disorders of the respiratory and urinary systems

Dyspnea

The function of respiration is to supply the body with oxygen, release carbon dioxide, and maintain homeostasis (constancy of the internal environment of the body). Any emotion - fear, anger, rage, excitement, joy - leads to increased breathing. Horror and sudden shock can cause a short-term cessation of breathing. A pleasant situation and a balanced mood ensure calm breathing. A sigh can sometimes indicate a person’s condition: a sigh when inhaling is “sorrowful”, when exhaling it is “relieved”, as when removing a burden (E. Straus, 1954).

A disease in which shortness of breath is the cardinal symptom is bronchial asthma - a typical psychosomatic disorder.

An “asthmatic” personality is characterized by:

A hidden desire for tenderness, love, support despite all the appearance of aggression;

Increased sensitivity to odors;

Increased reaction to the dishonest behavior of others;

The desire for purity in everything (in behavior, thoughts, everyday life).

Enuresis

Enuresis is involuntary urination, both during night and daytime sleep. Nocturnal enuresis is a complex syndrome that includes involuntary urination during sleep, disruption of sleep processes, changes in motor activity during the day, behavioral disorders, inadequate attitude towards one’s defect, and therapeutic resistance to spontaneous healing.

There are several periods in the development of normal urination in children:

Newborns urinate automatically;

Between the 1st and 2nd years of life, a feeling of a full bladder appears;

By the 3rd year, the ability to hold urine for short periods of time develops when the bladder is full or almost full;

By the age of 4-5 years, children begin to urinate with a full bladder;

At 6-6.5 years old, a child can urinate at any degree of bladder filling.

Causes of enuresis

There are primary and secondary enuresis: primary appears from the day of birth, secondary occurs after a certain period when the child did not wet the bed. The cause of primary enuresis is developmental delay in combination with psychosocial factors; secondary develops due to psychosocial reasons, which include:

Educational defects;

Unfavorable living conditions;

Raising a child outside the family;

Various mental traumas.

Mental trauma can be:

Test at school;

Quarrel with parents or friends;

Changes in life: first separation from parents, for example when entering college kindergarten, school, moving, separation from loved ones (for example, due to parental divorce).

It is important that urinary incontinence represents a problem for the child that mentally suppresses him; a problem that can worsen if not properly cared for.

The child suffers and is ashamed of this, and may hide it from his parents.

He is afraid to go to camp, to go on a hike, fearing that “trouble” will happen to him there and other children will laugh at him.

This is a vicious circle when the disease, worsening the mental state of the child, becomes more and more aggravated as a result.

Among sleep disorders in patients with nocturnal enuresis, it is necessary to highlight disturbances in the process of falling asleep, deep (“dead”) sleep, shuddering, night terrors, and sleep talking.

Types of enuresis

If we consider nocturnal enuresis as a psychoneurotic problem, then the following options can be distinguished:

The asthenoneurotic variant occurs in emotionally labile, easily asthenic children after psychotrauma during age-related crises (3 years, 7 years);

The hysterical variant is observed in gracile, temperamental, artistic girls;

The reactive variant is a form of neurotic enuresis, when a random episode of enuresis causes the child to severe reaction with fixation both on the state of enuresis and on subsequent experiences.

Enuresis in asthenic neurosis and obsessive-compulsive neurosis is characterized by the following clinical features:

Registered rarely, inconsistently and irregularly;

Happens more often at night, less often observed during the day;

Appears after a “dry” period;

Passes in a calm atmosphere;

Children experience it and are upset about their condition;

Sleep is often superficial (many dreams, often nightmarish).

Genetically determined enuresis (pathology of the central nervous system, abnormalities of the urinary system leading to enuresis, decreased secretion or activity at night of the pituitary hormone vasopressin): with this type of enuresis in a child, in addition to urinary incontinence, nocturia also occurs (the predominance of nocturnal enuresis over daytime enuresis).

Enuresis in neurosis-like conditions is characterized by the following clinical features:

Enuresis is regular, almost every night;

Episodes of urinary incontinence are repeated up to several times a night;

The child does not wake up;

Episodes of enuresis become more frequent when tired;

The child “does not worry”, does not get upset;

Enuresis is accompanied by symptoms such as headache, dizziness, fatigue;

Deep sleep (the child does not see or remember dreams; being wet, does not wake up);

An objective examination often reveals a neurogenic bladder.

Neurogenic bladder - a dysfunctional disorder (hyper- or hypo-reflex type), manifested by dysuria (urinary disorder): urination in frequent and small portions, daytime urinary incontinence (hyper-reflex bladder), paradoxical ischuria (urine comes out in drops), rare urination - hypo-reflex bladder.

Diagnosis of enuresis

In case of enuresis, a comprehensive planned clinical and instrumental examination should be carried out:

General urine test (three times);

Cumulative tests (urinalysis, according to Nechiporenko, Addis-Kakovsky);

Bacteriological urine analysis (to exclude microbial inflammation in the urinary system);

Study of spontaneous rhythm of diuresis;

Functional tests (Zimnitsky, Reberg tests);

Ultrasound, excretory urography, voiding cystourethrography, cystoscopy to exclude developmental anomalies;

Neurological examination - examination by a neuropathologist, REP, ECHO-ES, EEG, psychological testing.

According to W. Franzak (1969), the most valuable diagnostic methods for studying patients with enuresis are voiding cystourethrography and psychological testing.

Psychosomatic disorders of the digestive system

Appetite disorders

Appetite disorders are common in psychosomatics, especially in adolescence.

Appetite disorders include:

Anorexia;

Bulimia;

Obesity.

Anorexia nervosa

Anorexia is a painful condition that manifests itself in refusal to eat. It occurs in adolescence, mainly in girls, and is associated with the desire to lose weight and become graceful. At the origins of this disorder is teenage conflict regarding one’s appearance.

The personal characteristics of this pathology are associated with the peculiarity of puberty of such girls: they are not ready for their maturity - they have a hard time experiencing physical maturation (the onset of menstruation and the growth of the mammary glands), they consider it alien to themselves, which leads, in turn, to the desire to lead an ascetic image life. Such girls are very vulnerable.

Real changes in body shape, typical of puberty, coincide with the emergence of dissatisfaction with their own appearance: teenagers do not like either their “recovered figure” as a whole or its individual parts: “round cheeks”, “fat belly”, “rounded hips”. Ideas of this kind can be combined with the presence of ideas about other imaginary or extremely overestimated flaws in appearance (the shape of the nose, ears, lips). The defining moment in the formation of such ideas is most often the patient’s discrepancy, in his own opinion, with some “ideal” - a literary hero or a person from his immediate environment, which is combined with the desire to imitate him in everything, first of all - to be like him.

The second stage of anorexia nervosa begins with an active desire to correct appearance and ends with a decrease in body weight by 20-50% of the original, accompanied by the development of somatic and neuroendocrine disorders, in particular the cessation of menstruation.

They try to achieve weight loss through a strict diet, active sports, artificially induced vomiting, gastric lavage, etc.

Patients resort to artificial vomiting and gastric lavage after they, unable to resist, immediately eat a lot of food. It is typical that in this case the room is filled with bags and jars of vomit in order to compare them with the volume of food eaten.

Artificially induced vomiting is inextricably linked with attacks of bulimia (gluttony), which is an irresistible hunger and lack of a feeling of satiety; At the same time, adolescents can absorb very large amounts of food, often even inedible. A distinctive feature of such patients is the desire to “feed” loved ones, especially younger brothers and sisters.

Active methods of losing weight have already been described previously. Passive methods include coffee abuse, smoking and the use of diuretics.

The third stage of anorexia nervosa is characterized by a sharp decrease in body weight and associated complications - somatic and endocrine: amenorrhea (absence of menstruation), deficiency states (deficiency of basic food, elements, proteins, fats, carbohydrates, vitamins, microelements); anemia, hair loss, brittle nails, tooth decay, skin diseases, secondary infection due to the presence of immunodeficiency. Mental disorders develop, including fear of gaining weight, which leads to further weight loss. Obsessive phenomena are noted: obsessive fear of food, anticipation of a feeling of extreme hunger, counting the calories contained in the food eaten. At later stages, selfishness and excessive demands are added to these mental disorders: sick teenagers become “tyrants” in their own families.

Thus, the leading place in the clinical picture is occupied by asthenic syndrome, adynamia (a significant decrease in physical activity) and exhaustion, loss of a critical attitude towards one’s condition. Being exhausted, patients still stubbornly refuse to eat.

An increase in cachexia (exhaustion) leads to water and electrolyte changes, which can cause death and require immediate hospitalization.

The fourth stage is removal from the state of cachexia.

Bulimia

Bulimia - “bull, wolfish appetite.” These are repeated bouts (episodes) of quickly eating large amounts of food (bingeing), more common in teenage girls.

Features of these attacks:

They are carried out completely alone (in front of witnesses, actions are interrupted and shyly hidden);

Patients prepare for the absorption of food by making large purchases or even stealing;

Thoughts about food occupy great place in the lives of these patients;

Family, interpersonal and professional problems fade into the background.

Very often, bulimia becomes chronic. From anorexia (in which attacks of gluttony can also occur), bulimia is distinguished by attacks of precisely “bull, wolfish appetite”; Patients with bulimia usually have normal or overweight bodies.

An attack of bulimia consists of abundant and rapid consumption of high-calorie, filling foods (butter, sausage, sweets, flour products), followed by vomiting, which teenage girls induce on themselves.

The personality structure of a person suffering from bulimia is characterized by the following features:

Tendency to dramatize;

Extroversion;

Tendency to bad habits, addiction (alcohol, nicotine, drugs).

Factors that provoke bulimia:

Boredom, feeling of inner emptiness;

Increased requirements for modern girls (girls) - they must improve their qualifications, express themselves professionally, study diligently;

Inflated demands on appearance due to the increased number of beauty contests and fashion magazines.

Inflated criteria and requirements for the modern ideal of female beauty;

Stressful situations: separation from parents, their divorce, quarrel with friends, unrequited love, problems at school (school failure, heavy workload, conflicts with teachers).

Eating, according to patients, comforts, brightens up loneliness, improves mood, and quenches the bitterness associated with stressful situations.

Obesity

The personality structure of obese children and adolescents is characterized by:

Attachment (such children have a hard time withstanding separation and are dependent on their parents, especially their mother);

Impulsivity.

Provoking factors:

Loss of a love object: leaving the parental home, death or divorce of parents;

Children often react with increased appetite to the birth of a younger child;

Negative emotions: fear, anger, feeling of loneliness;

Dangers and expectations: war, preparation for exams.

Nausea and vomiting

Nausea and vomiting are manifestations of dyspepsia. The causes of dyspepsia are impaired gastric motility, duodeno-gastric reflux (reflux of the contents of the duodenum into the stomach), and slower elimination of food from the stomach. The course is chronic, the clinic includes complaints of a feeling of pressure in the epigastric region, nausea and vomiting after eating any foods, but there may be intolerance to vegetables and fats.

Personality structure includes:

Passivity;

Dependency, especially on the mother;

Tendency to depression.

Provoking factors:

Stressful situations, conflicts;

Mental and mental overload.

Diagnostics

In order to exclude organic pathology of the stomach and duodenum, an FGDS is performed; in case of pathology of the pancreas, gallbladder and liver, an ultrasound is performed. Laboratory tests are carried out: blood tests (general and biochemical), coprogram, assessment of the exocrine (enzymatic, digestive function) of the pancreas.

Irritable bowel syndrome (IBS)

IBS is a biopsychosocial functional disorder of the intestine, the basis of which is the interaction of two main mechanisms: psychosocial adaptation and sensorimotor dysfunction, i.e., there are disturbances in visceral sensitivity and motor activity of the colon. In 1988 in Rome, the International Group for the Study of Functional Pathology of the Gastrointestinal Tract first approved the term “irritable bowel syndrome.”

There are 3 variants of the course of IBS:

With a predominance of abdominal pain and flatulence;

With a predominance of diarrhea;

With a predominance of constipation.

Stressful situations change the motility of the sigmoid colon, reduce the absorption of water, potassium, chlorine, and sodium ions. Stress turns the absorption function into an excretory function. Children with intestinal dyskinesias are distinguished by the following psychological traits:

Symptoms of depression and anxiety predominate (melancholy, despondency, lethargy, mood lability);

Hysteria;

Phobias-fears (defacophobia - fear of involuntary passage of gases and feces, thanatophobia - fear of death).

In addition, such children are distinguished by:

I. If you are prone to constipation:

Fear of loss;

Power, desire for leadership, dominance (over mother).

II. With a tendency to diarrhea (“nothing is retained”):

Infancy;

The desire to give and do good.

Differential diagnosis is carried out: with organic intestinal diseases (Crohn's disease, chronic ulcerative colitis, tumors), which are accompanied by weight loss, blood in the stool, changes in other organs and in blood tests (anemia, increased ESR, leukocytosis) during instrumental studies ; with infectious diseases (intestinal infections, helminthiases (helminthic infestations), protozoan infestations (amoebiasis, giardiasis).

Psychosomatic disorders in dermatology

The skin performs many functions: protective, thermoregulating, vitamin-forming; in addition, it acts as a receptor field reflecting the state of the gastrointestinal tract, endocrine and nervous systems.

The skin performs many psychological functions:

It is the boundary between a person and the environment, between “I” and “you”;

It is an organ of contact, a bridge to the environment;

It is an organ for expressing emotions: worries, fears, fear, joy, shame;

It is an organ with a unique aesthetic function;

It is one of the sense organs (sensation of heat, cold, pain, burning, etc.).

The skin expresses emotions: it “turns red” with shame, “turns pale” with some other experiences, and becomes “goosey” with fear and cold. A person who steadfastly accepts the biases of fate, who is calm and indifferent, is often called “thick-skinned.” Very often, stressful situations are the trigger for the development or exacerbation of dermatitis.

Psychosomatic skin pathology

Psychosomatic in nature can be: atopic dermatitis (a clear manifestation of food allergies, occurs with itching, various skin rashes, enlarged lymph nodes); perioral dermatitis, which is characterized by inflammation of the perioral area (around the mouth) with redness, rash, peeling and itching; alopecia (local or total baldness); urticaria - an acute allergic reaction, manifested by severe itching and the appearance of blisters of various sizes; angioedema (Quincke's edema) is an acute allergic reaction manifested by swelling of the face, hands and feet, in severe cases- up to diffuse edema (anasarca). In the personality structure, emotional attachment to other people, excessive expectations, worries, the desire to show and present oneself in a female form are important, which can be combined into one concept - “exhibitionism”. The cause of urticaria and Quincke's edema is allergic factors (food, household, animal, plant, medicinal, etc.). The causes of perioral dermatitis are bacterial and fungal infections, cosmetics. The personality structure is dominated by efficiency and distrust of people of the opposite sex.

Delay in physical and speech development(ZFR and ZRR)

Reasons: chronic stress, separation from parents, refusal to eat or extreme pickiness in food, due to the characteristics of the relationship with parents (for some - abandonment, for others - overprotection). For psychogenic PBS characteristic feature is that underweight precedes undergrowth. After eliminating the causative factors and carrying out therapeutic measures, an increase in body weight is noted; the child becomes more sociable.

Behavior problems and sexual deviations (deviations)

Peculiarities of personality structure - character accentuations - arise under the influence of congenital factors and as a result of improper upbringing and can lead to deviations in behavior and sexual deviations.

Behavioral disorders in children and adolescents

Types of character accentuations

The following accentuations are distinguished:

I. Unstable type - weak-willed teenagers who go with the flow. From early school age, it is noticeable that they have no particular desire to learn, but have a strong craving for entertainment. Their interests, relationships with people, knowledge - everything is random and superficial. They live in the present, without plans for the future. They are always ready to follow the strong, everything bad seems to stick to them. They easily make oaths and promises and just as easily break them. Often such teenagers begin to have sex early, although not because of “fatal passion” or “crazy infatuation,” but because they mindlessly follow the leader. For company, they begin to drink, smoke, and use drugs, although they have no craving for such entertainment.

According to psychologists, it is useless to read moral teachings; firm power, strict control, and exactingness are needed. It is important to protect them from bad influences and accustom them to work. The task is not easy, but continuous effort in favorable cases allows you to achieve what you want.

II. Conformal type, characterized by increased suggestibility. Such a teenager is able to work, be disciplined, and can become interested in some subject or activity, but not on his own, but only following the leader or parents. If he is led by a negative leader, then there will be no trouble. Therefore, it is very important that parents, if they have not yet lost authority and influence, using all possible forms of influence, and not just forceful pressure, help him follow a straight path, without retreating or turning aside. Later they will be rewarded a hundredfold - the young man (girl) will begin to live by his own mind.

III. The hyperthymic type is oversocial and overactive. He is a leader and this is very important to him. These guys are fearless, cheerful, always the center of attention, and easy to get to know. They fall in love and just as easily part with the subject of their hobbies and affections. In company and for company, they will do anything, including committing crimes. Their ingenuity, intelligence, and energy are often wasted on trifles, on fun, pranks, and sometimes on more serious and dangerous pranks.

These guys are erotic and, enjoying the success of their peers, often lead a promiscuous sex life, starting it very early.

You cannot deal harshly and straightforwardly with hyperthymic teenagers. You cannot put pressure on them, especially in the presence of their peers, show distrust of their words and actions, or strictly control them. It is important to interest them in some exciting and vibrant activity, an interesting, difficult assignment, and from time to time to spur their waning interest.

IV. Explosive accentuation is very peculiar. This type of guy is familiar to teachers. They mature physically early, are strong, stubborn, assertive and go straight to their goals. However, sometimes they show almost bestial cunning: hiding, they wait long and patiently for the opportunity when they can achieve what they want. They are punctual, practical, vindictive, do not forgive betrayal and punish it quite cruelly. Such guys can take their anger out on the first person they come across, but as a rule, they hit the weak ones. Such guys go in for sports, prefer boxing, wrestling, karate, and avoid anything that is harmful to health or could lead to trouble or punishment.

With proper upbringing, these types can achieve a lot, become respected people, caring family men. Adults should be emphatically fair about the actions of such a teenager - approve the good ones, firmly and decisively reject the bad ones. It is important to inform him as early as possible about the legal consequences of unwanted behavior and the adverse effects on the body bad habits, early sexual life. This is exactly the case when such information can determine a person’s fate.

V. Hypererotic type - highly sexual. Such teenagers worry parents and teachers with their cravings and interest in sexual relationships. As a rule, this type is formed as a result of guys’ fixation on an awakening sexual desire. They talk a lot, fantasize about this topic, are interested in “porn” and bring corresponding postcards and manuscripts to school. Sometimes they incite erotic moods and interest in sex in the classroom. Here it is important to captivate the children with some idea, to find an interest that can supplant sexual aspirations. And at the same time where irony, where severe reprimand, where a serious rebuke can be used to cool the ardor of young cynics. Moreover, basically they are guys like guys - they study normally, they are quite active.

Behavioral problems in children and adolescents

Consequences from problem behavior can range from minor deviations to serious or even tragic offenses, both for the teenager himself and for his environment.

Behavioral problems can be divided into behavioral problems, school refusal, antisocial behavior, alcoholism, drug addiction and substance abuse, lack of attention combined with hyperactivity.

Behavioral problems

I. Problems associated with satisfying physiological needs - refusal to eat, sleep disturbances, etc.

II. Eating disorders - anorexia, bulimia nervosa - are described in the corresponding section.

A perverted appetite is a dissatisfaction of emotional needs, a deficiency of micronutrients, and possibly a mental illness. Occurs in children 1.5-5 years old.

III. Aggressive-resistant behavior (outbursts of anger, aggressiveness towards peers).

IV. Problems associated with the need to separate the child from his usual environment (separation or loss of parents, fears, shyness).

V. Obsessive fears (fear of animals, darkness, death, agoraphobia - fear of open space, claustrophobia - fear of enclosed spaces). Persistent, inexplicable fear of objects (oxyphobia - fear of sharp objects), phenomena, activities or situations.

VI. Anxiety is persistent anxiety that lasts at least 1 month and is manifested by at least 4 symptoms:

Unreasonable anxiety about the future;

Constantly thinking about your past behavior;

Excessive preoccupation with one's achievements;

Unfounded somatic complaints;

Need for consolation;

Shyness;

Feeling of tension, trembling, restlessness;

Autonomic disorders.

VII. Hyperactivity.

VIII. Bad habits: thumb sucking, nail biting, smoking in teenagers.

School refusal

Reasons for not attending school:

Associated with fears (fear of leaving parents, feeling of insecurity, school phobia with specific fears), are more common in children with good academic performance;

Secondary reasons: indifference to lessons, preference for home comfort - more often among low-achieving students.

Antisocial behavior

Antisocial behavior - deceit, pugnacity, absenteeism from school, theft, etc. The diagnosis is made when episodes are repeated several times over a period of 6 months.

Alcoholism, drug addiction, substance abuse

Educational defect. As a rule, these are children with low self-esteem, feelings of inferiority, and a high level of aggressiveness.

Stages of alcohol and drug use:

Experimental;

For fun;

Creating problems (personality changes occur);

Development of addiction.

Attention deficit with hyperactivity disorder

Symptoms: Inattention, hyperactivity, and increased impulsivity for 6 months, and symptoms must be developmentally appropriate, manifest in a variety of situations, and lead to significant social impairment and decreased school performance.

Forms of pathological hyperactivity:

With a predominance of inattention;

With a predominance of hyperactive-impulsive reactions;

Mixed form.

In parallel, there are oppositional disorders (30-60%), specific developmental disorders (20-60%) - motor, speech and others; increased level of anxiety (20-30%); mild dementia (3-10%).

Treatment of psychosomatic disorders in children

General principles of traditional therapypsychosomatic disorders

Drug therapy includes:

Sedative or tonic therapy. Preparations of plant origin are used (valerian, motherwort, lemon balm, passionflower - for sedative purposes; lemongrass, eleutherococcus - as tonics). Tranquilizers (diazepam, elenium) are also used for sedative purposes in small dosages;

For improvement metabolic processes nootropics (phenibut, glycine) are used in the nervous system, especially in the brain;

Since dyskinesias are a common manifestation of psychosomatic disorders, normokinetics (peristil, motilium) are used;

Analgesics, anti-inflammatory drugs.

Psychotherapy

Psychotherapy is a targeted method of influencing the patient, his pathological somatic and mental state.

The following types of psychotherapy are used to treat psychosomatic disorders:

Psychotherapeutic conversation;

Supportive psychotherapy;

Dynamic psychotherapy;

Psychotherapy based on depth psychology;

Psychoanalysis;

Analytical group psychotherapy;

Family psychotherapy;

Behavioral psychotherapy;

Body-centered techniques;

Suggestive and exercise techniques;

Inpatient psychotherapy;

Self-help groups.

Psychotherapeutic conversation

To establish contact between a doctor and a sick child, you can use a number of rules.

A one-time conversation is sometimes enough. The first conversation is decisive, because it determines whether the doctor will be able to establish contact with the child in the future and explain to him accessible form essence of the disease. It is necessary to obtain information from the child about complaints and his emotional state. The conversation is not only about complaints and mood, but also about the child’s understanding of the life situation in which he finds himself.

An important step is to clarify whether the conflict and the patient’s participation in it remain “outside” or whether he can present it stage-wise.

The patient must independently participate in the discussion, that is, be the object of learning. It is necessary to discuss the patient’s lifestyle (especially in cases of appetite disorder, pain syndrome), since difficulties and mental conflicts are often associated with an incorrect lifestyle and violation of the regime. Sufficient time should be allocated to the conversation. The psychotherapeutic conversation is supported by the prescription of drug therapy.

Psychotherapeutic conversations are indicated for acute diseases that have analytically reliable grounds and a psychosomatic basis. Duration - from 25 to 60 minutes. The purpose of the conversation is to achieve the patient’s understanding that he himself can overcome the disease.

Supportive psychotherapy

Supportive psychotherapy - psychotherapeutic management. This method consists of working through one’s behavior and difficulties in real life, preferably together with one’s parents and relatives, and is indicated for patients with a weak “I”, as well as for drug addiction and borderline psychoses.

Dynamic psychotherapy

It consists of linking conflicts with living conditions in the past and understanding one’s own mistakes, allowing one to support one’s “I.” Indicated for somatized depression.

Psychotherapy based on depth psychology

A type of psychotherapy that is divided into a core of conflicts that at first seem insurmountable. After a partial resolution of the conflict, a way out of it becomes possible.

Psychoanalysis

It is carried out in the form of frequent sessions (3-4 hours a week) using certain ceremonies and rituals: the patient is invited to freely express everything that comes to his mind. The doctor stands behind the patient and concentrates on his story.

External factors fade into the background. The goal of treatment: re-experiencing and regression of childhood experiences revealed in free associations and dreams. During treatment, it is necessary to restore children's emotional attitudes towards their parents.

Analytical Group Psychotherapy (AGPT)

There are outpatient and inpatient antihypertensive therapy. Group psychotherapy is carried out 1-2 times a week for 1 to 3 years with an optimal number of participants of 6-8 people. The advantage of the method: as part of a group, patients begin to feel motivated about themselves and are interested in communicating with others. Group psychotherapy makes it possible to transfer experiences not only to the psychotherapist, but also to other patients. Indications for antihypertensive therapy are functional syndromes, bronchial asthma, anorexia nervosa.

Family psychotherapy

Family circumstances can cause and maintain psychosomatic disorders.

In family psychotherapy, the conversation is conducted not only with the patient, but also with his family members. The decisive thing here is that the goal of treatment is not the individual, but the system of family relationships as a whole, which needs to be understood and changed.

For example, in case of severe dependence, an even closer merging of family members should be recommended, resulting in the acquisition of self-confidence based on the family.

Behavioral psychotherapy

In this type of psychotherapy, illness is considered as a learned form of behavior. The essence of psychotherapy, its core, is behavior analysis. The patient in ideas or in reality (in life) is led to the elimination of a traumatic situation. Problem behavior is suppressed by ignoring it. Self-reinforcement is important: the patient, in order to achieve a certain goal of behavior, i.e., suppressing incorrect behavior, rewards himself with positive reinforcement (praise).

Such methods of self-control give the patient a sense of self-worth, responsibility for one’s behavior, and give the patient activity.

IN last years in psychosomatic medicine, the technique of creating biological feedback is used with great success.

With the help of biological feedback, the patient learns to modify somatic processes through direct reverse instructions in the direction he or others need.

This technique is effective in the treatment of arrhythmias, high blood pressure, headaches, and migraines.

Hypnosis

Hypnosis is a treatment by suggestion. With the help of hypnosis, acute functional symptoms are eliminated: vomiting, diarrhea (diarrhea), attacks of bronchial asthma. During hypnosis, the patient's consciousness is narrowed, completely deprived of will and controlled by the doctor.

Autogenic training (AGT), one of the active methods of collective-individual psychotherapy, also relies on hypnotic suggestion. AGT is carried out through methods of self-persuasion and self-education; it is an intellectual and volitional process that rationally rebuilds the personality.

AGT fosters self-reliance, a sense of responsibility, initiative, and independence in the patient. AGT achieves its goals indirectly - through conditioned physiological reactions caused by words and ideas associated with these words.

First a thought appears, then words spoken in a whisper or mentally. A thought always causes a response - movement, action.

The combination of repeated self-hypnosis with repeated figurative representations in the chosen position leads through conditioned reflex connections of the nervous system to responsible specific physiological reactions; As a result, a person develops a feeling of calm, relaxation, warmth, free breathing, and an improved appetite.

Body-centered techniques

This method of psychotherapy is carried out through bodily self-perception to tension-relieving exercises based on AGT.

At the first stage (2-3 months), the patient is taught to experience a state of peace, feelings of heaviness and warmth, which he can then evoke in himself throughout the day. The second stage leads to general bodily and mental relaxation, spiritual self-immersion. Body-centered techniques also include functional release, which allows you to relieve tension and change self-perception. The patient must feel certain parts of the body and bring them into internal connection with other parts of the body. At the same time, tension and alienation are overcome, and the goal of treatment is to find yourself through your body. Concentrative movement therapy uses body awareness, movement and joint exercises with other patients (leading someone and being followed, touching someone and allowing them to touch you).

The last two methods are indicated for functional psychosomatosis and somatic syndromes.

Suggestive and exercise techniques

Focused on performing certain exercises as directed by the doctor. The techniques influence the external and internal behavior of the patient; special formulations and positive statements provide him with mental support and promote internal balance. Indicated in the treatment of headaches and other types of pain syndrome.

Inpatient psychotherapy

During treatment in a hospital, image therapy techniques and concentration movement therapy are used.

Self help groups

Self-help groups are aimed at communication between patients (discussing the mental and social consequences associated with their illness), as well as improving cooperation with the doctor; In such groups, when talking with “comrades in misfortune”, patients quickly find a solution to their problem, become more independent and mature. It is useful to create self-help groups for psychosomatic disorders such as appetite disorders, especially obesity, alcoholism and drug addiction.

Physiotherapy, balneotherapy and spa therapy

Physiotherapy (PT)

Physiotherapy - treatment physical factors. PT has a reflex, local anti-inflammatory effect, improves organ functions, metabolism and microcirculation, and is used for the administration of drugs (sedatives, tonics, analgesics).

General contraindications to the use of physiotherapy in children are diseases of the cardiovascular system in the stage of decompensation, blood diseases, epilepsy, and malignant neoplasms.

Features of PT in childhood

I. Psychotherapeutic preparation of the child is necessary (affectionate attitude, toys, presence of the mother). The course of electrical procedures begins with imaginary effects.

II. Taking into account the anatomical and physiological characteristics of children of different ages (presented in Table 5), PT is carried out in lower dosages than for adults.

III. Procedures that cause pain should be avoided, and the possibility of intolerance to procedures (especially electrotherapy) should be taken into account.

IV. Conditions must be created for the child to rest after the procedures.

V. When carrying out procedures, it is necessary to monitor the child’s behavior and facial expressions.

Table 5. Anatomical and physiological characteristics of the child’s body that are important for physiotherapy

General rules for carrying out TF

Contraindications to PT are the following diseases associated with psychosomatosis: stage III malnutrition, active pulmonary tuberculosis, diseases of the cardiovascular system in the stage of decompensation, blood diseases, epilepsy, malignant neoplasms.

To carry out physical procedures, appropriate sanitary and hygienic conditions (temperature, lighting, ventilation) must be created in compliance with safety regulations.

PT is prescribed after diagnosis, if there are indications for the use of physical methods of treatment and there are no contraindications.

The procedures should not coincide with the maximum digestive process, so they are carried out no earlier than 1 hour after a meal and end 30 minutes before a meal.

Hydro- and balneotherapy

Hydrotherapy (HT) is hydrotherapy using fresh water of varying temperatures.

Balneotherapy (BT) is treatment using mineral waters.

Hydrotherapy has been known since ancient times. Cold water has a general tonic and stimulating effect; warm - anti-inflammatory and metabolism-normalizing effect; hot - diaphoretic and metabolism-increasing effect. Water at an indifferent temperature (34-37 °C) has a sedative effect.

Hydrotherapy includes the use of baths, showers, swimming, dousing, rubbing, wrapping, therapeutic exercises in water (hydrokinesitherapy) and underwater shower-massage.

The action of the shower is based on thermal and mechanical irritation of the skin and mucous membranes: impacts of water, flow of drops and jets. Positive influence have hydroaeroions formed during procedures. Showers have a tonic effect on the central nervous system, improve trophic and reparative processes. Showers are especially indicated for children with functional disorders.

Balneotherapy includes the external use of mineral waters in the form of baths, for intracavitary procedures and drinking treatment.

The therapeutic effect of baths consists of the influence of temperature, hydrostatic, mechanical and chemical factors.

Carbon dioxide baths affect the circulatory, respiratory and metabolic systems.

Salts (chloride, iodine-bromine) have an analgesic and calming effect.

Nitrogens provide a sedative and analgesic effect.

Hydrogen sulfide baths restore the balance of nervous processes and the immune system.

Radon baths have a calming and analgesic effect.

Spa therapy (CT)

Resort therapy (CT) - treatment using natural remedies (favorable climate, mineral waters, therapeutic mud).

Based on the nature of natural remedies, resorts are divided into three groups:

Balneological (with the main healing factor in the form of mineral waters used in the form of baths, showers, swimming, drinking, inhalation, etc.);

Mud using silt (salt lake mud), sapropel (silt mud of fresh lakes), peat mud in the form of applications and tampons;

Climatic using healing features determined by the geographical location of the area, its relief, vegetation and altitude above sea level with treatment with air and sun baths, as well as swimming.

Contraindications to spa therapy: all diseases in the acute phase, anomalies requiring surgical intervention, tumors, infectious diseases.

General principles of alternative therapy

Non-traditional therapy includes reflexology - treatment by influencing biologically active points located on the surface of the patient's body.

The basis of reflexology is the reflex principle, as a result of which the physiological protective mechanisms of the central and autonomic nervous system are activated, normalizing the regulation of organs and systems and relieving pain.

Methods of influencing biologically active points:

With needles - acupuncture (IRT);

Acupressure;

Magnetopuncture.

For psychosomatic disorders, they influence biologically active points - analgesic, sedative, tonic, restorative, points of the five elements - wood, fire, earth, metal and water.

Therapeutic approaches for certain types of psychosomatic disorders

Sleep-wake rhythm disorders

I. Stereotypes and paroxysms:

Drug therapy - antipsychotics at night;

Psychotherapy - music therapy, hypnotherapy, psychoanalysis;

Herbal medicine - galvanic collar, general electrophoresis with calcium and bromine;

Hydro- and balneotherapy - oxygen and pine baths;

Spa therapy - Riga seaside resorts;

Non-traditional therapy: points for acupuncture - He-gu, Wen-yayu; use of a magnetic puncture applicator (bracelet) on the wrist.

II. Cephalgia and night migraine:

Drug therapy - diacarb 30-80 mg/kg per day, beta-blockers in the inter-attack period, ergot preparations during an attack;

Alternative therapy: analgesia points can be used (see section “Pain syndrome and headache”).

III. Night terrors:

Drug therapy - tranquilizers;

Non-traditional therapy: acupuncture: Shou-wu-li, Shen-men, Yang-xi (fire), Li-dui, Wen-yu.

IV. Sleep apnea:

Drug therapy: xanthines (theophyllines), anticonvulsants;

Alternative therapy: points for acupuncture: Hou-xi, Shao-shats, Ju-chu.

Asthenia

Drug therapy:

Stage I - tranquilizers (Elenium, Seduxen, phenazepam);

Stage II - stimulants: a) biostimulants of plant and animal origin (schisandra chinensis, eleutherococcus, pantocrine, pantogam); b) nootropics.

Rational contact psychotherapy.

Herbal medicine: electrosleep (pulse current with a frequency of up to 100 Hz), electrophoresis on the collar area with a 5% solution of calcium chloride or a 1% solution of caffeine.

Hydro- and balneotherapy:

Stage I - heat baths (20 °C) for two weeks;

Stage II - carbon dioxide baths;

Showers: circular, needle, contrast, jet, Charcot (for older children), underwater shower-massage;

Baths: oxygen, pearl, salt-pine, sodium chloride, carbon dioxide baths with rubbing and dousing;

Spa therapy: Darasun, Kislovodsk, Pyatigorsk, Anapa, Lake Shiro, Staraya Russa, Feodosia;

Alternative therapy: points for acupuncture: Wen-liu, He-gu, Shou-san-li, Qu-chi, Tzu-san-li.

Pain syndrome

Drug therapy:

I. Non-opioid analgesics, non-steroidal anti-inflammatory drugs: ibuprofen 4-10 mg/kg every 6 hours orally, indomethacin 0.5-2 mg/kg every 8-12 hours, diclofenac (Voltaren) 0.3-0.5 mg/kg per day, pironsican 0.3-0.5 mg/kg after 8 hours.

II. Opioid analgesics - morphine, promedol.

III. Antidepressants - amitriptyline 0.1-0.2 mg/kg (single dose).

Psychotherapy: hypnosis, progressive muscle relaxation, game types of psychotherapy.

Herbal medicine: electrophoresis with analgesics, anesthetics, antispasmodics (0.1% papaverine solution, 5% magnesium sulfate solution, 5% novocaine solution).

Hydro- and balneotherapy: baths with water at an indifferent temperature (34-37 ° C), warm water.

Alternative therapy: acupuncture brings the greatest effect. Use the points Kun-Tsui (pain point), Le Que, Tai Yuan (earth), Yu Chi (fire), Jing Qu (metal), Shao Shan (wood), San Jian (wood), He -gu, Wen-liu (pain point), Bing-feng, Da-zhong, Xi-men, Yin-si.

Headache

Drug therapy:

I. Analgesics (symptomatic therapy).

II. When intracranial pressure increases, dehydration agents are used: Diacarb according to the regimen - 5 mg/kg once a day, 3 days a week: the first week - 5 mg/kg once a day; second week - 5 mg/kg 2 times a week; third week - 5 mg/kg once a week.

III. Tranquilizers.

IV. For migraines - salicylates + caffeine (salicylates are not used for children under three years of age).

V. Ergot preparations: ergotamine or ergotamine + caffeine.

Psychotherapy: proper daily routine and instilling confidence in recovery.

Non-traditional therapy: for headaches, in addition to acupuncture, you can use auricular therapy (use of magnetic clips) at points 7 (neck), 49 (forehead), 47 and 48 (analgesia points).

For pain syndrome, you can also use pedo-puncture - treatment using special insoles.

Dyskinesia

For any form of dyskinesia, diet matters. Diet No. 5 is used: mechanically and chemically gentle food (steamed, boiled or pureed). Dishes with extractive substances are excluded - spices, marinades, smoked meats, strong mushroom, fish, meat broths, fatty foods, cold and carbonated drinks.

Hypertensive form:

Peace, dry heat on the right hypochondrium (to relieve spasm of the gallbladder sphincter);

After relieving spasm and pain - tubes, according to Demyanov;

Waters of medium mineralization (sodium sulfate and magnesium) - 3 ml/kg;

Herbal remedies: elecampane, St. John's wort, peppermint.

Hypotonic form:

Diet No. 5 with plant fiber;

Cholecystokinetics (drugs that promote the secretion of bile, stimulating contraction of the gallbladder);

20-25% solution of magnesium sulfate;

Holenzyme;

Olimethine;

Holagol;

Normokinetics: motilium, peristyl.

Psychotherapy: hypnosis, relaxation, autogenic training, rational and suggestive psychotherapy should be aimed primarily at eliminating anxiety and phobias (fears).

Herbal medicine: for hypertensive form - galvanization, faradization, diadynamic currents, magnetotherapy, ultrasound on the right hypochondrium, ozokerite or paraffin applications; in the hypotonic form - electrophoresis with magnesium sulfate, sinusoidal modulated points.

Hydro- and balneotherapy: pine and pearl baths, rain, fan and circular showers, sauna.

For the hypertonic form, carbon dioxide, pine and pearl baths are used, as well as showers - jet, rain, fan and circular. Mineral waters of medium mineralization (sulfate-sodium and magnesium) 3 ml/kg per day orally.

For the hypotonic form, mineral waters with high mineralization and a significant content of gas, sulfates or chlorides are used (Essentuki No. 17, Arzni).

Spa therapy: Darasun, Kislovodsk, Pyatigorsk, Shivanda, Shmakovka - for the hypertensive form of disorders, and for the hypotonic form - Arzni, Borjomi, Goryachy Klyuch, Jermuk, Essentuki, Zheleznovodsk, Mineralnye Vody, Nalchik, Truskavets.

Non-traditional therapy: for hypertensive form (pain syndrome), it is possible to use magnetic clips on analgesia points (points 47, 48) and therapeutic insoles.

Cardialgia, functional heart murmur, arrhythmias

Diet: you should limit the consumption of salt, salty foods, exclude products with extractive substances, seasonings (smoked meats, canned foods), coffee, strong tea. The use of sedative herbal remedies (motherwort, valerian, oregano, lemon balm, hawthorn) is allowed.

Drug therapy: for arrhythmias, antiarrhythmic drugs are used; for functional heart murmur - cardiotrophics (improving metabolism in the myocardium), riboxin, potassium orotate (0.01-0.02 mg/kg in 2-3 doses), panangin (1/4-1/2-1 tablet per depending on age 3 times a day). A mandatory measure is the rehabilitation of chronic foci of infection (treatment of tonsillitis, sinusitis).

Psychotherapy: it is necessary to create a positive emotional environment, communicate with nature, water (walking, hiking, swimming).

Herbal medicine: for arrhythmias, it is possible to use reflex techniques.

Hydro- and balneotherapy: pine and oxygen baths are used.

Spa therapy: local sanatoriums, sanatoriums of the Republic of Belarus.

Non-traditional therapy: MPA (magnetic bracelet), pedopuncture (use of therapeutic insoles) and acupuncture of pain points are used.

Pseudoreumatic disorders

Diet: you should limit the consumption of foods containing purines (chocolate, fatty meats, fish, broths), and also exclude extractive substances (seasonings and smoked foods) in case of predisposition to metabolic disorders (for example, purine metabolism).

Drug therapy: for pain and inflammatory changes in the joints, nonsteroidal anti-inflammatory drugs (paracetamol, brufen, ibuprofen, diclofenac sodium, piroxican, ortofen) are prescribed.

Herbal medicine: electrophoresis with novocaine solution, inductotherapy, paraffin-ozokerite applications are used.

Hydro- and balneotherapy: 4 types of baths are used - carbon dioxide, hydrogen sulfide, sand and mud.

Non-traditional therapy: points for acupuncture - Jian-zhen, Fei-yang, Zhong-zhu, Zhou-liao, as well as the use of MPA (magnetic bracelet) and pedo-puncture (therapeutic insoles).

Shortness of breath (with bronchial asthma)

The diet is prescribed if there is an allergy to a particular product.

Drug therapy:

To relieve an attack: short-acting bronchodilators (salbutamol, atrovent, berodual, berotec);

For basic therapy (aimed at preventing attacks): mast membrane stabilizers (intal, zaditen);

Beta-2 adrenergic agonists;

Combination drugs (Ditek, Intal Plus);

Leukotriene receptor agonists (a new stage in the treatment of bronchial asthma - singular, acolate);

Glucocorticoids (becotide, aldecine, budesonide, pulmicort, flixotide);

Long-acting theophyllines (theotard, theonek, theodur);

Mucolytics (lazolvan, bromhexine).

Psychotherapy: a method of volitional elimination of deep breathing (Buteyko method).

Herbal medicine: general ultraviolet irradiation, galvanic collar with calcium, diathermy on the spleen area, paraffin-ozokerite applications, aeroion therapy, electrosleep.

Hydro- and balneotherapy: Gauff baths, sauna.

Health resort therapy: resorts of the Crimea (Feodosia, Yalta, Evpatoria), the Black Sea coast of the Caucasus (Anapa), mountain resorts (Kislovodsk, Nalchik, Teberda). The most preferred time of year is late spring, summer, early autumn. Duration - 1.5 months.

Non-traditional therapy: acupuncture has a sedative, antispasmodic effect, and increases the duration of remission. Acupuncture points:

Zhong fu - along the upper edge of the second rib;

Kun-tsui;

Tai-yuan (earth);

Yuji (fire);

Shao-shan (tree);

Shan-yang (metal);

San-jian (tree);

Xia-lian.

Dysuria (enuresis)

Regular - until 17.00;

Dry salt-free - at 18.00;

Sleepy product - for the night.

Drug therapy:

Tonics (belladonna, belladonna preparations);

Drugs that improve metabolic and bioenergetic processes in the nervous system (nootropics): nootropil 20-80 mg/kg per day, picamilon 1.5-5 mg/kg per day, encephabol (pyriditol) 50-100 mg/kg ( single dose; course - 2-3 months, 1 time per day);

Amino acids (glycine for 1-1.5 months);

Preparations that improve tissue trophism: B vitamins (B 6, B 1, B 15), A, E; potassium orotate; carnitine (for 1 month).

For special forms of enuresis (genetically caused against the background of neurogenic bladder dysfunction), an analogue of vasopressin (adiuretin SD) is used - 2-3 drops on the nasal septum 1 time a day before bedtime; The minimum course duration is 5-6 days, the maximum dose is 6-10 drops for 4-6 weeks.

Psychotherapy: psychoeducational techniques - a strategy for reinforcing behavior favorable to health; conversational psychotherapy - a child cannot be punished, put on diapers at night, he must live an ordinary life.

Herbal medicine: electrosleep, electrophoresis (iontophoresis) with atropine, aminophylline, papaverine, diadynamic stimulation, sinusoidal modulated currents, magnetotherapy, ultrasound, laser therapy (low-intensity irradiation with a helium-neon laser over the womb).

Hydro- and balneotherapy: pine baths (37-38 °C) with sea salt (have a tonic effect for hypo-reflex bladder); ozokerite applications to the bladder area or to the lumbosacral region.

Spa therapy: resorts of the Southern Coast of Crimea.

Non-traditional therapy: points for acupuncture: Chi-tse, Xi-lian; magnetic auricular puncture using magnetic clips on Than-mon points; pedopuncture.

Appetite disorders (anorexia, perverted appetite)

Drug therapy:

Stage I - nonspecific therapy aimed at improving the somatic condition and restoring body weight (cardiovascular drugs, vitamins, drugs that normalize digestion); nutrition is balanced, rational, fractional, in small portions;

Stage II - specific therapy aimed at the disease as a whole (psychotropic, antiemetics).

Psychotherapy:

I. Rational - explanation of the need for treatment, the failure of treatment without a doctor, adequate adaptation in a team, identification of inclinations and abilities, the desire to realize them.

II. Suggestive - suggestion in a state of hypnosis or wakefulness.

III. Autogenic training - eliminating tension and discomfort.

IV. Group - to increase the patient’s concern for the nutrition of other children, when eating together, to encourage each other to eat, to share experiences. Working with parents, adequate attitude towards sick children and ensuring effective cooperation.

Herbal medicine: electrosleep, galvanic collar, general electrophoresis with calcium and bromine.

Hydro- and balneotherapy: pine, nitrogen, radon baths (used for older children) with water at an indifferent temperature (34-37 ° C).

Spa therapy: Pyatigorsk, Nalchik.

Alternative therapy: reflexology points - Neiting (water) and sedative points - Da-ling and Xiao-hai.

Constipation and diarrhea

Drug therapy:

When anxiety and sleep disturbances predominate, short-course tranquilizers are used;

If depression predominates, take antidepressants in small dosages. Gastroenterologists and psychiatrists currently recommend fevarin (for children over 8 years old, 50-150 mg per day);

To relieve pain, dicetel is prescribed (also reduces flatulence), loperamide (children over 8 years old, 2-8 mg per day);

For constipation - herbal laxatives (senna herb, senade, bisacodyl, regulax, mucofalk, forlax);

For diarrhea - smecta (children under 1 year - 1 sachet per day, up to 2 years - 2 sachets per day, 3 years and older - 3 sachets per day), Forlax, Almagel, phosphalugel, Maalox;

In case of increased gas formation in the intestines (flatulence), escumizan is prescribed.

Psychotherapy: hypnosis, relaxation, autogenic training, as well as rational and suggestive therapy are used.

Psychotherapy should be aimed at reducing anxiety, mitigating conflicts, involving the patient in the treatment process and giving it personal meaning.

Phytotherapy:

Constipation: ultraviolet irradiation, electrophoresis with novocaine, papaverine, no-shpa - in the presence of pain, paraffin and ozokerite applications to the intestinal area, inductotherapy, DMV therapy;

Diarrhea: SMT therapy, inductotherapy, galvanization.

Hydro- and balneotherapy: for constipation, use pine and salt baths (36-37 ° C for 4-6 minutes), as well as swimming; for diarrhea, cold baths with indifferent water (34-37 ° C) and medicinal showers are used.

Resort therapy: Borjomi, Goryachy Klyuch, Jermuk, Essentuki, Zheleznovodsk, Pyatigorsk, Truskavets. The course of treatment is 4-6 weeks.

Alternative therapy: points for acupuncture:

For any stool disorders - Li-dui (metal), Yin-bai (wood), Tzu-San-li (earth);

For constipation - Fu-ai, Jie-si (fire), Nei-gin (water).

The use of a magnetic bracelet and therapeutic insoles is also shown.

Alphabetical index

Abdominal pain syndrome

Active movements. Coordination of movements

Analytical and synthetic activity of the cerebral cortex

Anorexia

Asthenic disorders

Pain syndrome

Brachialgia and anterior scalene syndrome

Bronchial asthma

Vaginismus

Dysgamy options

Variants of mental disorders in different groups

Variants of psychosomatic diseases

Variants of psychosomatic disorders

The relationship between negative emotions and psychopathological states of the body

The relationship between mental and somatic diseases

Types of menstrual irregularities

Types of psychosomatic disorders possible during pregnancy and after childbirth

Types of psychosomatic disorders

Types of enuresis

The influence of the patient’s personality on the formation of cardioneurosis

The influence of a person’s mood on the occurrence and course of the disease

The influence of the patient’s behavior and attitude towards his illness on its development

The influence of mental state on somatic

The influence of somatic diseases on existing psychoses

The influence of fears on the personality and behavior of the patient

The influence of stress on the development of skin diseases

Appetite development and factors influencing it

Age dependence of somatized depression

Hypotheses for the occurrence of psychosomatic diseases

Headache

Homeopathic remedies

Diagnostics

Diagnosis of somatized depression

Dysuria (enuresis)

Dysgamy

Dyskinesia

Differential diagnosis

Differential diagnosis

Dependence of sensitivity disorders on the distribution of radicular innervation

Constipation and diarrhea

The importance of psychosomatic pathology in modern medical practice

Individuality of the occurrence and expression of emotions

Hypochondria

Historical evolution of the concept of somatized depression

Historical approach to understanding psychosomatics

Coronary heart disease (CHD) with unchanged coronary vessels

Yoga therapy

Cardialgia

Cardialgia with hysteria

Cardialgia, functional heart murmur, arrhythmias

Cardiophobia

Classification of cardialgia

Classification of experiences of fear and anxiety

Clinical picture

Clinical manifestations of somatized depression

Clinical sexological examination

Mood swings

Cerebral cortex and autonomic nervous system

Treatment of abdominal pain syndrome

Treatment of mental illness using artificially induced febrile states

Treatment of psychosomatic disorders in diseases of the cardiovascular system

Facial sympathalgia

Masks of somatized depression

Drug therapy

The place of psychogenic cardioneuroses in modern medical practice

Mechanisms of masked depression

Prescribing psychotropic drugs

The most common forms of cardiophobia

The most common causes of dysgamy

Sensory impairment

Appetite disturbances in various diseases

Menstrual irregularities

Behavioral disorders in children and adolescents

CNS disorders in surgical patients

Sensory disorders

Neuralgia and neuritis

Neuralgia of the occipital and spinal nerves

Neuralgia of the geniculate ganglion

Neuralgia of the pterygopalatine ganglion and nasociliary nerve

Sciatic neuralgia and lumbar pain

Trigeminal neuralgia

Neuralgia of the lingual and glossopharyngeal nerves

Facial neuritis

Neurodynamic mechanisms of somatic manifestations of emotional instability

Neuromorphological changes in psychosomatic disorders

Anorexia nervosa

Nonspecific mental reactions to diseases of the digestive system

General principles of alternative therapy

General principles of traditional therapy for psychosomatic disorders

General information about symptoms of psychosomatic disorders

Shortness of breath (with bronchial asthma)

Obesity

Organ neuroses

Main classes of psychotropic drugs

Basic methods of psychotherapy

Features of the clinical picture

Features of sexual intercourse in men and women

Features of diarrhea. Main causes of diarrhea

Features of psychogenic angina

Acute abdominal pain

Pathogenesis of psychosomatic diseases

Pathogenesis of psychosomatic disorders

Pathophysiological mechanisms of nausea and vomiting

Indications for prescribing herbal medicines and methods of their use

Polyneuritis and polyradiculoneuritis

Sexual coldness of a woman (frigidity)

Gender characteristics of sexual reactions

The concept of psychosomatics in modern medicine

Premature ejaculation

Principles of personality formation and its influence on the emergence and course of psychosomatic pathology

Causes of development of cardioneuroses

Causes of enuresis

Progressive paralysis

Prevention of psychosomatic diseases

Inhibition processes in the cerebral cortex

Manifestations of the patient's fears

Pseudoreumatic disorders

Mental disorders during gynecological operations

Mental disorders in skin diseases

Mental disorders in syphilitic brain damage (cerebral syphilis and progressive paralysis)

Mental disorders in AIDS

Psychogenic skin diseases

Psychogenic heart rhythm disorders (arrhythmias)

Psychogenic sexual disorders in women

Psychogenic sexual disorders in men

Psychopathological disorders in acute surgical diseases

Psychopathological symptoms of hypochondria

Psychosomatic and somatopsychic interactions and illness

Psychosomatic disorders in diseases of the urinary system

Psychosomatic disorders in peptic ulcer disease

Psychosomatic disorders not related to pregnancy

Psychosomatic disorders during pregnancy

Psychosomatic disorders in inflammatory diseases of the digestive system

Psychosomatic disorders in intestinal diseases

Psychosomatic disorders in liver diseases

Psychosomatic disorders in malignant neoplasms

Psychosomatic approach to the diagnosis of somatic diseases

Psychotherapy

Pathways for transmission of nerve impulses

Development of psychogenic arrhythmias

Prevalence of psychosomatic disorders

Appetite disorders

Appetite disorders (anorexia, perverted appetite)

Male potency disorders

Sleep-wake rhythm disorders

The body's response to stressful situations

The role of a psychiatrist in the treatment of psychosomatic patients

The role of sexual disorders in the occurrence of somatic and mental illnesses

Sexual reactions

Symptomatic neurotic disorders

Irritable bowel syndrome (IBS)

Syndromes of confusion

Synkinesis

System of “errors and corrections”, “model of the required future”

Somatic symptoms of hypochondria

Spastic and flaccid paralysis

Specific psychosomatic disorders in diseases of the digestive system

Fear and cancerophobia

The essence of pain syndrome

The essence of masked depression

The essence of sexual function

Therapeutic approaches for certain types of psychosomatic disorders

Course of psychogenic skin diseases

Types of nervous system

Nausea and vomiting

Factors contributing to nausea and vomiting

Factors contributing to the development of psychosomatic pathology in different age groups

Pharmacological and endocrine effects on the cerebral hemispheres. Functional pathology of the cerebral hemispheres

Physiotherapy, balneotherapy and spa therapy

Phytotherapy

Phobic and hypochondriacal manifestations

Functional disorders in organ neuroses

Characterological (psychopathic) disorders

Cystalgia

Emotions and motivations

Negative and positive emotions, their impact on human health

Emotional instability and suspiciousness as a cause of disease

Etiology of psychosomatic diseases

Etiology of sleep disorders

Text taken from a psychological site http://www.myword.ru

Psychosomatics has been studied for quite some time, and numerous studies have been conducted. It was found that diseases due to psychosomatics develop not only in adults, but also in very young children. Moreover, it does not matter whether the child is raised in a very good environment or in dysfunctional families. In most cases, psychosomatics manifests itself at a very superficial level, but sometimes the reasons for this are hidden very deeply and are difficult to detect; in these cases, it is imperative to contact specialists.

Very often, when illnesses occur in children, parents are very worried and perceive it as a test. Mom and dad visit doctors with enviable regularity, follow all the recommendations exactly, carefully monitor the child’s nutrition and warmth, and do not go to crowded places so that their beloved child does not become infected with infectious diseases. However, sometimes a child gets sick as if he had been hexed, nothing helps. With the wave of an eye, he catches various diseases, and nothing can be done about it.

Such parents should definitely know that psychosomatics may be possible causes of diseases. This usually happens in cases where specialists and doctors cannot find serious reasons for endless diseases. There are no pathologies, but the child is still sick. He is treated, takes medicine, recovers and begins a normal life. But... It only lasts a couple of weeks, and then the disease comes again. Here you need to seriously think about psychosomatic disorders, and health deteriorates due to mental reasons, and not just physiology.

In this case, the pediatrician will be of little help; you should definitely go for a consultation with a psychologist. It is these specialists who identify and eliminate mental disorders. Nowadays the big problem is the psychosomatics of childhood diseases. Children who have problems with the gastrointestinal tract, cardiovascular system, urinary tract, bronchial asthma, diabetes, allergic reactions are constantly sick.

Their number is getting larger and larger, and the medical examination is very high quality, but doctors cannot do anything about it. That is why it is necessary to identify the psychological problems of the occurrence of diseases in order to eliminate them as soon as possible.

Adults also often experience illnesses that can be caused by psychosomatics. Moreover, the roots of the disorder usually lie in childhood. A person may not even remember the reasons for psychological instability; they have ambiguous emotional reactions. In adolescence, psychological problems are already gaining full force.

Statistics show that half of children suffer from vegetative-vascular dystonia, they also have unstable blood pressure, diseases of the gastrointestinal tract and gastritis. In adolescence, diseases such as atherosclerosis, which previously were exclusively age-related, are often detected. Why are children so susceptible to psychosomatic diseases? It's worth trying to figure this out.

Causes of psychosomatics

Not all children are able to cope with negative information and experiences, they have nowhere to put negative emotions, they feel mental discomfort. Kids do not always understand what is really happening to them; they cannot tell what emotions they are experiencing at the moment. Only teenagers can already consciously perceive the surrounding reality, try to understand their psychological problems Oh.

Young children feel extremely pressured and dissatisfied with life, but they cannot explain or do anything about it. They don't complain because they don't know how to describe the problem. Also, children are not able to relieve psychological stress. This is why children often experience psychosomatic disorders. The depressed state begins to actively affect physical state health. This is expressed in the acquisition chronic disease, which gradually eats the unfortunate child from the inside, does not allow him to live in peace and rejoice.

Also, sometimes short-term illnesses may occur; the child may not even be aware of their causes. Painful symptoms appear only then. When the baby begins to think about his problem and cannot cope with it. Most mothers have gone through such situations when the child categorically refuses to go to kindergarten, he cries and is capricious in the morning. If this behavior does not help, and he still has to go to the garden, he begins to invent other reasons for refusal. He tells his mother that his throat and head, stomach and leg hurt.

Sometimes a child simply pretends and tries to manipulate his parents, but if the baby actually develops a cough and runny nose, fever, vomiting and nausea, then a psychosomatic illness is already developing. It is necessary to take into account social, psychological and somatic factors when a child is predisposed to psychosomatics.

Somatic factors

Such factors are certain characteristics of the child and the impact on him in early childhood, his predisposition to certain types of diseases. Such factors may be:

• genetics and predisposition to certain diseases;
• complications during the mother’s pregnancy or illness while carrying a child, injuries and infections at a time when the formation of the baby’s internal organs occurs;
• disorders of the nervous and central system;
• staphylococcus immediately after the birth of the baby;
• hormonal imbalance or deviations in biochemistry after the birth of a toddler.

When a child is influenced by the factors described above, his health deteriorates. Psychosomatic diseases appear in those organs that are most weakened.

If it were not for the mental disorder, the disease might never have manifested itself at all. That is why experts are convinced that despite the fact that somatic factors are of great importance, it is mental factors that play a large role. A person should feel comfortable at home, adapt well to a team, a child should feel normal in kindergarten and school, and feel equal to others.

Psychosomatics in early childhood

Research carried out in the field of medical psychosomatics shows that signs of certain diseases can be established in the child himself. early age. Sometimes this even happens while the fetus is developing in the woman's stomach. Many are sure that such assumptions have no basis, because the baby in the stomach cannot yet experience emotions and experiences.

However, everything here is quite complicated. A mother who experiences certain emotions during pregnancy is susceptible to irritation and negativity, and this influences the child and his physical health. It is almost impossible to determine for sure whether diseases can already occur during pregnancy or whether they appear after the birth of the baby. But no one dares to deny such a connection. During the research, those children who were considered unwanted were examined. The expectant mother considered pregnancy unnecessary and was perceived negatively by the woman; her life plans were destroyed.

Such children already at the time of birth suffered from a wide variety of diseases and disorders. It could be bronchitis, asthma, gastrointestinal ulcer, allergic reactions, dystrophy, persistent respiratory diseases. That is, the unborn child tried to destroy himself on his own, so as not to disturb anyone. In order for the formation of the fetus to proceed normally, the expectant mother needs to be well disposed, the woman needs to be supported by her spouse, close and dear people. All negative emotions have big influence on the formation of the baby, so it is worth helping the expectant mother stay in good location spirit. If this is not done, then immediately after the birth of the baby he will develop various diseases.

Even if a mother dreams of giving birth to a baby, she pays attention to how others treat her. If she does not feel love and understanding, then she begins to show not very good emotions, which affect the unborn baby. All this applies not only to the period of bearing a child. The emotional state of the mother greatly influences the child during the first months of life. After birth, the baby becomes a separate person from his parents, but he maintains a close connection with them. The mother symbolizes the baby’s external world; it is through her that he perceives the surrounding reality, looks at the reaction and learns to show his own. All the mother’s worries and worries are passed on to the child.

When preventing psychosomatics, you need to try to provide the most comfortable emotional conditions in the house, to limit the mother from worries, because the child absorbs everything like a sponge. That is why it is necessary for the expectant mother to be positive before and after the birth of the baby. This is what can protect the baby from psychosomatic diseases.

Asthma and psychosomatics in children

The characteristics of the causes of bronchial asthma due to psychosomatics can be very different. They need to be described in more detail. If the mother immediately after the birth of the baby does not pay enough attention to him, then the child may develop bronchial asthma. Sometimes it happens that the disease manifests itself closer to five years of age. It is imperative to think about the relationship between parents and their children in order to determine the cause of the disease. It is likely that mom and dad demand too much from their child, they have a strong influence on him, and he cannot realize himself.

As a result, the baby is unable to express his own emotions, suppresses feelings and intentions, which causes periodic suffocation, because he really cannot breathe. When raising a child in a dysfunctional family, poor conditions, the child suffers greatly from lack of attention, and therefore tries in every way to change the situation. All this provokes the occurrence of diseases with the respiratory system. Psychosomatics is one of the main factors in the development of child diseases.

Elimination of psychosomatics

In order to eliminate diseases or alleviate them, it is necessary to get rid of the psychosomatic causes that caused the development of diseases of the respiratory organs. That's why it's worth:

• visit a psychotherapist;
• undergo acupuncture;
• undergo climatotherapy.

It is necessary to increase the child’s resistance to stressful situations; sedative medications, motherwort tincture and valerian will help with this.

Psychotherapy and asthma

Psychotherapy should be carried out in order to increase the child's life opportunities and strength. It is imperative to eliminate emotional disorders and form optimal behavior and reactions to various stressful situations. Typically, those patients who have bronchial asthma are quite withdrawn and shy, they do not know how to express themselves and restrain their emotions, they constantly feel the negative and refuse to accept the positive.

Asthmatics constantly express denial, repress emotions and regress. For such children, group classes and trainings under the guidance of an experienced psychologist are excellent. The groups practice breathing exercises, autogenic training and functional relaxation. It means a lot what kind of relationship a child has in the family and what kind of atmosphere there is. It is imperative for the spouses to improve their relationship with each other, because the child feels any negativity.

Statistical data

Typically, bronchial asthma occurs in childhood around five years of age. Psychologists have long noticed that in most cases this disease is observed in boys, because the demands placed on them are often excessive, they are brought up in strict rules. Many may well get rid of the disease in adolescence, when they begin to open up and spill out emotions.

Psychosomatics in bronchial asthma plays a decisive role. This must be taken into account. You should react normally to stressful situations, forget about mistakes and troubles. You should engage in self-improvement, open up to others and communicate as much as possible.

The cause of illness in children is psychosomatics

Many diseases can be hereditary, but if children grow up in unfavorable conditions, then most of the diseases are psychosomatic. The child’s personality, his ability to adapt in a team and school, various stressful situations - all these are psychosomatic problems. Psychosomatics manifests itself due to some reasons that can be placed in the table:

• improper upbringing and bad atmosphere in the family;
• nervous state of parents and tense atmosphere;
• bad family relationships;
• unbearable study load, the child has no free time;
• excessive demands on the child;
• parents do not perceive the child as a separate person, his individuality;
• parents force the child to be better than he really is;

Psychosomatic problems and disorders can be seen even in newly born babies, schoolchildren or teenagers. And in before school age they become the most noticeable. Children cannot cope with numerous difficulties, they have to establish relationships with the team and teachers, they cannot cope with this and react negatively to them. As a result, various diseases appear.

Infantile children grow up in dysfunctional families with improper upbringing. They are unable to refuse to attend school, because they are forced to listen to the opinions of their parents and fulfill their demands. Every child knows perfectly well what self-esteem and pride are, but he cannot firmly defend his beliefs, so he begins to get sick. As the baby grows up, they begin to devote less time to him, but demand more and more. Nobody notices how the child experiences this, and no one wants to do it.

Children become lonely, they believe that they cannot achieve anything. That they are not loved and appreciated, they suffer greatly from this. Often a child is humiliated by everyone around him, but no one sees it. Psychosomatics are often observed in those children from whom their parents demand too much. Children try with all their might to do everything possible to meet expectations; peers for them are not friends, but rivals. They begin to suffer from high self-esteem, end up feeling envious of others, and have a negative attitude towards those who achieve greater success. As a result, such children often suffer from gastrointestinal diseases. They get stomach ulcers.

Children try to fight hard to succeed and become better than others, but they begin to suffer from numerous diseases. The body sends signals to such children, but they do not understand this and continue to fight a ridiculous struggle. The child becomes overly touchy and cries constantly, he does not feel well physically, he begins to have a headache, and he cannot sleep at night. The body cannot cope with constant nervous tension.

Children begin to strongly conflict with everyone around them, demand the impossible, and parents strive to obey their flawless and sick child. Emotional rejection of something forms a child’s low self-esteem, but he is not going to accept it. He understands his inferiority, but shows protests and cruelty. Children try in every way to show that they are the best, but they do not have enough opportunities for this. They do not understand the signals of their own body, they lack the instinct of self-preservation.

At school, children try to achieve the impossible, show perseverance, but only develop various diseases due to overload of the nervous system. Psychosomatic diseases also manifest themselves when parents demand success from their child. He naturally obeys and tries to do everything to meet the expectations of his parents. However, in this way the child has no childhood, he cannot play and have fun with friends, he communicates only with serious people.

If a child is strong, then he is able to become successful, but if not, then he acquires a huge number of diseases. Already in kindergarten, such a child is very nervous and irritable, his sleep is disturbed. Such children suffer from vegetative-vascular dystonia, diseases of the gastrointestinal tract and pressure surges. Very often psychosomatics begins with parental provocation. If mom and dad are too suspicious and anxious, then the children become exactly the same. They start to doubt own strength, expect failure, cannot trust others and parents, and experience fear.

The child tries to succeed, but constantly doubts his abilities, and in the end he fails. These children often have heart disease and many others. Children with psychosomatic disorders get sick with enviable consistency. Moreover, diseases arise so suddenly that it is sometimes impossible to understand what is bothering the child today. Parents constantly take their child to specialists and carry out everything possible diagnostics, use different methods treatment, but nothing helps.

The situation is getting worse, but pathologies are simply not detected. When a person tries to find a disease, it definitely appears. If a child is constantly sick, then you should definitely consult a psychologist and figure out what’s troubling you. little man. Then maybe health will return to normal if psychosomatics are eliminated.

Fragment of a lecture on the topic - child psychosomatics

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How to remove psychological blocks, fears and pressures yourself What is psychosomatics of diseases and how to treat with it

The prerequisites for the occurrence of such disorders are individual psychological characteristics of personality and character and the state of vegetative homeostasis. Those most susceptible to the development of psychosomatic disorders are those with a weak type of response to external stimuli. These may be persons with asthenic, psychasthenic, hypochondriacal personality traits.
The relevance of the need to identify psychosomatic disorders is dictated by statistical data from specialists from different countries of the civilized world (Remschmidt, Karvassarsky, etc.). According to their generalized data, 22% of patients who go to doctors with numerous and various complaints about their physical illness have psychosomatic disorders.

Psychosomatic disorders

Psychosomatic disorders are understood as psychogenically caused symptoms and syndromes in the somatic sphere, namely, disorders of the functional systems of internal organs and other areas.

In medical clinical psychology, there are several basic models of the formation of psychosomatic disorders:
1) psycho-physiological model, founded by I.P. Pavlov and called “experimental neurosis”, which is based on the strengthening of conditioned unconditioned reflexes and failure of adaptation;
2) Alexander’s psychodynamic model, who defined psychosomatic disorders as “ autonomic neurosis“, while its symptoms can manifest themselves as physiological vegetative accompaniment of an emotional state;
3) Pezeshkian, one of the founders of psychosomatic medicine, believed that a person is able to speak through the speech of his organs, since at this moment he has no other ways of processing his experiences;
4) the socio-psychosomatic model (Delius) states that psychosomatic illness is the result of improper development of relations between the individual and social structures, and most importantly, it is the incorrect solution to one’s individual problems.
In the mechanism of formation of psychosomatic disorders, the factor of autonomic dysfunction plays an important role, which can become a “predisposition” in the clinical picture of a psychosomatic disease.

Criteria for psychosomatic disorders

Criteria for psychological diagnosis of psychosomatic disorders:
– the patient has multiple and various complaints about symptoms from internal organs or other systems, for which no adequate explanation for the presence of a somatic disease has been found;
– ignoring the advice of doctors in terms of the patient’s absence of illness, his endless search for other doctors or paramedics who would confirm that he has serious illness;
– obvious disruption of family and social functioning associated with somatic symptoms and behavioral characteristics of the patient;
– active self-medication with many unnecessary examinations and use various drugs on the advice of other people, but not specialists whom the patient usually does not trust.
It is necessary to distinguish the psychological characteristics of a patient with psychosomatic disorders - he creates his own individual concept of the internal picture of the disease and considers it the only correct and indisputable one.
Moreover, unlike the “hypochondriac”, where he, mainly mentally, considers himself sick, the “psychosomatic” actually experiences unpleasant and sometimes painful sensations from his internal organs and other “sick” systems.
In medical clinical psychology, the following main groups of psychosomatic disorders are considered:
– conversion or dissociative disorders;
– functional syndromes or somatized, somatoform disorders, “organ neuroses.”

Conversion and dissociative disorders

The concept of “conversion” was introduced into the clinic by S. Freud back in 1894. By this term he understood the transition, the conversion of mental negative energy to the psychosomatic level. At the same time, attention is drawn to the discrepancy between the psychotrauma and the patient’s motives with the severity of the patient’s symptoms. Subsequently, when such disorders were considered only within the framework of hysterical symptoms, they were defined as “flight into illness” from a frustrating situation. However, the transition of psychologically negative energy to the motor or somatic level is much more complex in its mechanism. Features of personal response, stability of motivation, and the presence of the patient’s highly valuable conviction in making the right choice own internal picture of the disease, sometimes deeply hidden intrapersonal conflict, passive-defensive personality type and much more.
Conversion disorders can manifest themselves in various forms: motor disturbances, sensory disturbances, dysfunction of analytical systems (hearing, vision). All these disorders are psychogenic, and the blockade of functions does not depend on the will of the patient. Perhaps the patient’s behavior seems demonstrative, but it is clearly not deliberate, these are subconscious violations.

Let's consider the most common motor conversion disorders functional system.

Motor stupor

Motor stupor is a complete immobility of the patient with loss of expressive speech (answering questions). Such disorders most often occur in stressful situations (disasters or evidence of them, acute psychological trauma, grief, fear of the unknown).
An example of such a condition can be a case from practice.

Yura M., 12 years old, fell ill suddenly. Before his illness, the boy grew up as a calm, sociable, but somewhat fearful child. He studied well at school and successfully studied piano at a music school.
The psychogenic situation before the illness developed as follows: at the insistence of the doctors, Yura was placed in the ENT department for tonsillectomy. After the operation, he was in pain and scared, as “blood was oozing from my mouth, and I was afraid to die.” He began to cry and call the nurse, but on the operating day she, naturally, was very busy and did not come right away. Yura's fear grew, he began to scream, which worried the nurse, and she forbade him to cry and demanded that he lie still, otherwise there could be bad consequences. The boy stopped crying and “froze.”
7 months have passed since then, and Yura remained motionless, although at night, during sleep, he moved quite freely in bed. He didn’t talk to anyone, he ate from his mother’s hands. During his illness, he changed several clinics, where he was transported in a lying position on a stretcher. However, no neurological disorders were identified.
For the last 2 months he has been treated in a psychiatric hospital with a diagnosis of psychogenic conversion stupor. Then, at the insistence of his parents, he was discharged home in a state of slight improvement (he began to sit up in bed, his speech was restored).
In the spring, his father took him outside and sat him in a sliding chair. The boy enjoyed watching the children play, became more active, and cheered up.
One day, children nearby were playing with a ball and accidentally threw it into Yura’s lap. He caught the ball with his hands and threw it back, laughing. He was glad that he could move. Since then, the motor sphere has gradually begun to recover. Within a month, movements in the arms, legs, and torso returned. Yura quickly learned to walk and run.
And so, almost 10 months after the onset of the illness, Yura returned to a full life: he continued his studies at school and successfully studied at a music school. However, over the next two years, when meeting with doctors, Yura seemed to be replaced: his movements became slow and uncertain, his gait clumsy, he spoke after a pause, slowly drawing out his words. In everyday life, the boy was absolutely healthy.

Psychogenic paralysis is manifested by a violation of complex and purposeful motor acts and voluntary movements. But these disorders of the motor functional system do not fit into the picture of a neurological disorder according to innervation.

Case Study. The girl Masha, 12 years old, was very worried about her parents’ divorce, after which her mother left the family and went abroad with her new husband. Masha, of her own free will, stayed with her father. For a couple of years they lived with their father amicably, in complete harmony. Rare meetings with their mother did not disturb their prosperous life. However, 2 years after the divorce, my father met a woman with whom Masha established a warm and trusting relationship. That was until the father announced his marriage to this woman.
Masha was very upset by this; she intended to live with her father until she became an adult. Masha’s mood and attitude changed - she became irritable, was rude to her father and his fiancee, often cried, and in every way showed active protest to her father’s marriage. About a month after these events, father was called to school and his attention was drawn to the fact that excellent student Masha began to study poorly, especially in written subjects. The girl refused to do written assignments, stating that it became difficult for her to write, “writing cramps her hand.” To her father’s questions, Masha answered that when she tried to write, her fingers went numb, they didn’t listen to her and couldn’t write the necessary letters and numbers.
When examining the girl by a neurologist, it turned out that when Masha takes a pen or pencil in either hand, the hand seems to “numb” and becomes rigid. The fingers do not straighten on their own, although the girl makes vain attempts to use them in writing. Over time, the same phenomena were repeated with her toes, which prevented her from putting on shoes and socks. No changes were detected in the nervous system. Passive flexion and extension of the fingers and toes, performed by the doctor, was easy, but voluntary movements were blocked.
After psychotherapy sessions, Masha’s condition improved, she calmed down, reconciled with her father’s marriage, and voluntary motor acts were completely restored.

Astasia-abasia

Astasia-abasia is the inability to sit, stand and walk independently, maintaining balance, while maintaining the ability to make other voluntary, purposeful complex movements.

Let us give an example of a psychogenic disorder of this type.
Kira I., 16 years old, came to the clinic with complaints that she could not independently maintain balance when walking or standing.
From the history of the development of this condition it is known that the family consists of 3 people: father, mother and girl. By nature, Kira is calm, balanced, sociable, she studies well and has no problems. Except...her own family, where there are constant scandals between father and mother, which greatly upsets the girl. During these conflicts, parents try to “win” her to their side.
One day Kira fell ill with ARVI with a low fever and catarrhal symptoms. Three days after the temperature returned to normal, the mother, returning from work, discovered that the girl, at the insistence of her father, was still in bed, and there were a lot of things and garbage around. The mother was indignant and demanded that the girl get out of bed and clean up after herself. But the father, who came in at that time, began to be indignant at the mother’s demands, shouted, claimed that the girl was still weak and seriously ill. At her mother’s insistent demand, Kira got out of bed and staggered. The father screamed terribly, seeing this as a manifestation of the girl’s serious illness. Although the doctor had discharged the girl to school the day before and considered her healthy.
Since then, Kira began to complain that it was difficult for her to stand and walk on her own because she “couldn’t feel her legs” and couldn’t maintain her balance. The father made active attempts to establish a diagnosis and treatment for the girl and began to contact specialists in various fields. At the same time, neurologists from different clinics did not find any abnormalities in the neurological status. Kira moved very quickly on all fours.
Over the next two years, the father, having lost faith in the competence of doctors, began to treat her on his own: using alternative medicine methods and physical exercises. Kira rode a bicycle very well on her own, but continued to stand and walk with the help of her father. There was still a tense psychological situation at home.
One day, when Kira was once again riding a bicycle along the side of the road, a huge truck was rushing towards her. The girl got scared, threw her bike and quickly ran along the sidewalk. Since then she has been able to walk and run normally.
Six months later, she again visited the doctor, where her father brought her with other complaints. Kira began to refuse food. In a separate conversation with the doctor, the girl asked to be spared her father’s excessive care, otherwise she would leave the house.
A psychotherapeutic conversation with my father did not give the desired results.
The mother filed for divorce and exchange of the apartment. Since then, Kira lived with her mother and made no complaints about her illnesses.

As can be seen from the above example, psychosomatic disorders in the presence of a psychogenic situation that is significant for the patient can change - from motor disorders to somatized symptoms.

Hearing and vision disorders

Disorders of the organs of hearing and vision can also be psychogenic if the child is in a chronic frustrating situation. This can be psychogenic blindness, complete or partial, and psychogenic deafness.

Example from practice. The boy Zhenya, 10 years old, was very reluctant to study piano. The teacher and parents scolded him more than once for his negligence and poor preparation for classes. But Zhenya couldn’t sit still, she really wanted to play with the guys in the yard.
And then one day Zhenya complained of worsening vision; he does not see or distinguish musical notes. A check of the visual apparatus by an ophthalmologist showed normal vision in both eyes.
But the ophthalmologist drew attention to the fact that Zhenya sees ordinary letters and numbers well, but not musical symbols or similar drawings.
A psychotherapeutic conversation was held with Zhenya and his parents, as a result of which it was revealed that the boy had a complex complex of aversion not only to reading notes, but also to listening to musical phrases. Musical studies were suspended for a while, and then stopped altogether, especially since Zhenya did not have sufficient abilities to become a future musician.

Sensitivity disorders of a psychogenic nature often occur after stress and are manifested by loss of sensations (rather than true sensitivity) in the form of “socks” and “gloves”. Neurological examination does not reveal any innervation type sensitivity disorders. Moreover, when attention is distracted, these phenomena disappear, and reactions to pain are natural.
Medical clinical psychologists suggest paying attention to the psychological characteristics of patients with conversion disorders.

Symptoms in patients with conversion disorders

They are characterized by (Remschmidt, Karvassarsky):
– symptoms have their own goals and content, they can be associated with a provoking situation;
– symptoms are sometimes demonstrative (“look what a serious illness I have”);
– there is a significant contradiction between the severity of the symptoms and the person’s behavior: he remains inactive in getting rid of his illness;
– the final landmarks are obvious to people, but not to the patient himself.

The somatized, somatoform type of psychosomatic disorders is a psychogenically caused violation of the functional regulatory systems of various internal organs.

From the standpoint of medical clinical psychology, alexithymia is the basis of somatoform disorders. The term “alexithymia” was coined by Sitheos in 1973, which literally meant “without words for feelings.”

Alexithymia

Alexithymia is a psychological characteristic that determines the following characteristics of an individual (B.D. Karvassarsky):
1. Difficulty in distinguishing between feelings and bodily sensations;
2. Difficulty in describing and identifying one’s own feelings;
3. Reduced ability to fantasize, limited symbolization;
4. Focus more on external events than on internal experiences.
According to N.V. Khaitovich’s definition, “alexithymia is an individual’s limited ability to perceive his own feelings and emotions, their adequate verbalization and expressive transmission.”
From the point of view of the concept of alexithymia, the inability of an individual to regulate and modulate emotions that cause him suffering mental level lead to increased physiological reactions from internal organs, especially in stressful situations (Taylor, Karvassarsky).
If we consider childhood, then, according to the basic concepts of developmental psychology, the presence of alexithymic manifestations in the child’s psyche may be associated with variants of insufficient maturation of the above-mentioned components of mental response to external conditions.
In adolescence, due to psychophysiological characteristics, difficulties arise in identifying “oneself” and own feelings, emotional instability, rigidity of teenage motivations and lack of experience. These features of the adolescent psyche, according to developmental psychology, may also be a predisposition for the occurrence of alexithymic manifestations.
In addition, in childhood and adolescence, the state of the autonomic nervous system as an autonomous regulator of the functions of internal organs also plays a role in the mechanisms of formation of somatization disorders.

Somatization, somatoform disorders

Somatized, somatoform disorders are characterized by the presence of multiple, recurring and often changing somatic symptoms that can relate to any part of the body or internal organ system (G. Heminghausen).
Such disorders are well known to pediatricians and family doctors.
Somatization disorders in childhood and adolescence are psychogenically caused symptoms that manifest themselves functional disorders regulation various organs and systems: cardiovascular, respiratory, gastrointestinal, urinary, thermoregulation and sleep regulation systems. A special place is occupied by pain syndrome and its psychological design.

In childhood, especially infancy, somatization disorders of the gastrointestinal tract, thermoregulation and sleep disorders are most common. These disorders manifest themselves in infants with a neuropathic constitution, which is based on autonomic dysregulation of the functioning of internal organs. At the same time, minor conditions of physiological or psychogenic discomfort can lead to the appearance of symptoms of somatization disorders.
For example, “intestinal colic” usually occurs before the age of 3-4 months and is known to manifest itself as spasms along the intestines. This, naturally, worries the baby and his parents very much. Cases are considered when the warm hands of the mother and a sung song neutralize these painful sensations, and the child calms down. And, conversely, the forced absence of the mother is a stressful situation for the baby, and similar phenomena are repeated and intensified. The described cases of the positive emotional influence of the mother appear only if there is complete agreement in the “mother-child” relationship system, and the mother “understands” her child, his needs and emotional condition.
IN infancy Frequent regurgitation, sometimes profuse, may also be observed, which accompanies the child’s emotional anxiety.
A child with a neuropathic constitution is also characterized by thermoregulation disorders, sleep disturbances, etc. Moreover, these manifestations can be provoked by various factors: disruption of sleep patterns, an unfamiliar smell, the presence of many people who want to “snuggle the nice baby,” especially in the absence of the mother, whom the baby perceives as a “talisman,” etc.
In preschool age, somatization disorder of the gastrointestinal tract can manifest itself in the form of habitual vomiting.

Let's give an example from practice.
Lyusya S., 5 years old. The child’s mother came to see him about his recurring vomiting every morning. The girl, the only child in the family, grew up selfish, spoiled, and whiny. She was raised in a family of 3 people: mother, father and daughter. Due to her parents being busy at work, Lucy was mostly with her grandmother and felt psychologically comfortable.
When the girl was 4.5 years old, her grandmother fell ill and was unable to care for Lyusya. The girl was sent to kindergarten, where she was greeted kindly. But the girl was not used to being in a group of children, did not know how to establish contact with them on her own, and refused to attend kindergarten. However, the parents had no choice, and Lucy was forced to attend kindergarten. After about 2-3 months, Lucy started vomiting on the way to kindergarten. An examination by specialists did not reveal any organic changes in the girl’s internal organs. And the vomiting continued and turned into “habitual vomiting.”
After consulting a psychologist, conducting play psychotherapy, psychological correction In the system of relations between the girl and the children, the vomiting stopped.

At school age, psychogenic symptoms from the gastrointestinal tract may also appear. For example, a feeling of nausea before a test at school, if the student is not sure of a successful assessment.
Flatulence and “irritable bowel syndrome” can have a psychogenic provocation against the background of autonomic dysregulation in a passive type of person. This is one of the forms of somatized response to the situation.

Let's give an example from practice.
Igor L., 15 years old. By nature, calm, shy, timid, somewhat insecure, he fell in love with a classmate. For a long time he hesitated to ask her out, but at the same time he blushed, sweated, and had difficulty pronouncing short phrases. And finally, it happened! The girl turned out to be “spiritier” and invited Igor on a date. He prepared carefully, slept poorly at night, and was worried. But the meeting was interesting and emotionally intense, if not for one unpleasant circumstance. During the conversation, Igor’s stomach began to “seem.” In his words: “The intestines and rectum were especially noisy - they were literally singing.” It seemed to Igor that the girl heard these sounds, and he naturally tried to move away from her. The girl did not like this behavior of the fan, and she left the date. Subsequently, any meeting between Igor and the girl was accompanied by more or less intense manifestations of this type. Examination of the intestines and rectum revealed no organic changes. Seeing a psychotherapist helped the boy get rid of this “suffering.”

The psychotherapy carried out increased the boy’s self-esteem, taught him to overcome psychologically difficult situations and helped him remove the internal complex of his own inferiority.
Everyone knows that in a situation of stress, in addition to motor sphere, the functional system of the gastrointestinal tract may also react. This somatized reaction can manifest itself in different ways: constipation and diarrhea (“bear disease”), anorexia and bulimia, and other forms.
Somatic disorders of the urinary system can also be observed in children.
For example, a boy partially urinates during a lesson with a strict teacher. These manifestations intensified after the teacher in a stern voice forbade him to go to the toilet when necessary during class. This led to the appearance of psychogenically caused daytime enuresis, and the boy had to be homeschooled.
Let's pay attention to next case and the doctor’s tactics in helping the child.

Masha, 4.5 years old. An intelligent, sociable girl was raised at home under the supervision of her grandmother. They lived on the 4th floor of a five-story building without an elevator.
One day at the end of October, Masha and her grandmother were getting ready to go for a walk. The grandmother, who had difficulty climbing the stairs, reminded the girl that before going for a walk she must go to the toilet. To which Masha answered negatively, because she saw a friend on the street and was in a hurry to see her. The grandmother and granddaughter went outside, and literally 15 minutes later Masha needed to go to the toilet and urgently urinate. Naturally, the grandmother returned to the apartment with her and angrily sent her to the toilet. However, Masha was unable to urinate, despite all the efforts of the girl and grandmother, “the urine did not come out.” The girl's parents were called and took her to the clinic, where she was examined by a urologist, but found no organic abnormalities. However, the urine “didn’t come out.” I had to do a catheterization. Since then, catheterization of the bladder was repeated several times over the course of 2 days. An examination by a neurologist also did not reveal any organic changes in the innervation of the girl’s urinary system. Since then, the girl began to actively resist visiting the clinic. A doctor invited to the house had a conversation with Masha. Then they played with the naked doll in the bathtub under running water. We managed to persuade the girl to bathe with the doll. And when Masha went into the bathroom, warm water poured onto her pubic area - urine began to flow reflexively. After several sessions of reflex urination, Masha began to urinate voluntarily, which she was incredibly happy about.

Somatization disorders from the outside respiratory system may manifest themselves in the form of hyperventilation syndrome (frequent breathing without physical need), psychogenic cough, “imaginary bronchial asthma” and others.

Let's give an example from practice.
Ulyana, 15 years old. At the insistence of her mother, she contacted the pulmonology department with complaints about constant attacks suffocation. Before that, she lived in a small town and was unsuccessfully treated for bronchial asthma for 2 years. They lived together with their mother; the father died when the girl was 3 years old. The girl had average abilities; her studies were difficult for her. However, Ulyana was uncritical of her capabilities, had inflated self-esteem and lack of a real opportunity for self-realization at the level she desired. Moreover, she was extremely passive.
Since the girl fell ill, her father’s relatives have provided funds for treatment. In the department, the pulmonologist did not find any obvious symptoms of bronchial asthma during a physical and instrumental examination.
The medical staff drew attention to the fact that any situation in the ward that was not in favor of the girl led to the provocation of an “asthma” attack. Auscultation at the time of the attack revealed no changes in the lungs. But the girl and mother continued to insist on a serious illness. At their insistent request, Ulyana received a referral to a rehabilitation center in Solotvino.
At the beginning of treatment, according to her words, the attacks stopped. But then, after a conflict with the nanny, they resumed again. The mother's fixation on the girl's illness supported and provoked attacks of suffocation and fear of the possibility of suffocating from lack of air.
Over time, Ulyana stopped studying even at home, declaring that the sight of notebooks and books leads to seizures. That is, the personality “entered” into illness, and arose pathological development Personalities of the passive-defensive type with manifestations of alexithymia.

It should be noted that a psychosomatic radical is also present in the mechanism of true bronchial asthma. For example, confidence in immediate help from others or having the necessary medicine at hand will help protect a patient from the onset of another attack.
A psychogenic cough can occur in a child after a mild ARVI, when the somatic manifestations have already passed, but the cough remains and manifests itself in a difficult situation (test work, conflicts in the family and school).

Violation of thermoregulation

Thermoregulation disorders - an increase or decrease in body temperature under the influence of traumatic circumstances can be observed in children and adolescents. If you have a constant low-grade fever that cannot be explained by an organic disease of the internal organs or the hypothalamic region, it is advisable to contact a medical psychologist. Its tasks include: the study of the psychological characteristics of the individual, his reactions in frustrating situations, as well as the identification of intrapersonal conflict in the patient, and in adolescents - the presence of an internal picture of the disease, an alesithymic radical.
Somatization disorders of the cardiovascular system manifest themselves in the form of “heart neurosis”, hyperkinetic heart syndrome, psychogenic paroxysmal tachycardia and other heart rhythm disturbances. These disorders are well known to doctors and are widely presented in relevant publications (N.V. Khaitovich, G. Remshmidt).
Pain syndrome and its psychosomatic aspects are one of the central problems in biology, medicine, and psychology.
According to P.K. Anokhin’s definition, “pain is a unique mental state of a person, caused by a set of physiological processes of the central nervous system, brought to life by some super-strong or destructive stimulus.” Painful sensation occurs under the influence of external stimuli and is a warning about danger threatening a person.
However, the doctor cannot always judge objective characteristics pain and all its parameters. This is due to the fact that pain is a subjective sensation, which depends not only on the intensity and quality of the stimulus that caused it, but also on the individual’s psychological personal reaction to the painful sensation.

Psychological factors

Of the psychological factors that have a great influence on the experience of pain, the following are the main ones (B.D. Karvassarsky):
– diverting the patient’s attention from the outside world and focusing it on the pain sensation and anticipation of it;
– characteristics of the patient’s personality, resistance and endurance to pain or delicacy and intolerance to pain;
– various emotional states in stressful situations can block pain sensations (post-traumatic shock);
– social and moral attitudes and orientation of a person’s life values, which can determine his attitude towards pain.
An example of the fact that in a pain syndrome, in addition to physiological mechanisms, there are psychological factors, are various forms of psychalgia.

Psychalgia

Psychalgia is a feeling of pain in various parts body (head, limbs, back), which arises and intensifies under the influence of a traumatic situation and can disappear on its own after its cessation.

"Phantom" pain

“Phantom” pain is pain in a non-existent part of the body or organ; it also has a psychosomatic mechanism.
Psychalgia and phantom pain are successfully treated with hypnotherapy or another type of psychotherapeutic intervention that is more suitable for the patient. In children and adolescents, psychalgia is a common phenomenon that occurs in a situation of frustration and can linger for a long time due to the principle of pathologically strengthened connections. This connection can be broken by using psychotherapy that is adequate for the patient’s personality.

If you want to know more, read:

1. Anokhin P.K. – Key issues of the theory of functional systems. M., Science. 1980.
2. Karvassarsky B.D. – Textbook of psychotherapy. Peter. St. Petersburg 2002.
3. Mendelevich V.D. – Clinical and medical psychology. M. Medpress-inform. 2002.
4. Renmschmidt G. – Child and adolescent psychiatry. M., Eksmo-press. 2001.
5. Developmental psychology. – Ed. M. Martsinkovskaya. M., Academy. 2001.
6. Textbook - clinical psychology. – Ed. Karvassarsky B.D. 2nd ed. St. Petersburg Peter. 2006.
7. Khaitovich M.V., Maydannik V.G., Kovalova O.V. – Psychotherapy in pediatrics. Kyiv. Aspect-polygraph. 2003.
8. Heminghausen K. – Somatoform disorders. In the book. "Child and Adolescent Psychiatry." M., Eksmo-press. 2001. p. 334 – 338.

Not so long ago, official medicine was skeptical about attempts to explain some diseases by psychological problems. Today, more and more doctors recognize the existence of psychosomatics.

Psychosomatic diseases - what is it?

You can often hear from parents: “Aren’t you ashamed? Good girls/boys don't behave like that! Stop being capricious, you can't swear. Why are you crying like a girl?” Of course, there are children who do not accept these prohibitions, but many learn the rules, interpreting them in their own way. The main conclusion they make is simple: “I will not express my dissatisfaction, show emotions, and then my mother will be happy and begin to love me.” Often, this position leads to serious psychological and behavioral problems that children deal with long after they become adults. And sometimes suppressed emotions turn into physical illnesses. This is what they call psychosomatics .

The term “psychosomatics” itself will soon turn 200 years old; in 1818 it was coined by the German physician Johann Christian August Heinroth. Since then, there has been a lot of controversy around this concept, but now there is a special direction in medicine and psychology that studies the relationship between diseases and the human psyche.

How are psychosomatic diseases formed?

Psychosomatic problems arise when a child fails to meet his needs. Then a constant “negative” emotional arousal is formed. It is reflected in bodily sensations, and sometimes in pathological process. After all, there is a direct connection between emotions and physiology. The expression of negative emotions is: increased blood pressure and pulse rate, increased breathing, changes in secretory and motor activity digestive tract, change in bladder tone, tension skeletal muscles, increasing blood clotting. Remember how you feel, for example, when you are afraid or worried. Heaviness in the stomach and nausea, fever, sweat appears on the forehead, hands become wet, sometimes even tremble. In general, quite a lot of tangible and quite unpleasant manifestations arise. The same thing happens in a child. And so time after time.

But the fact is that emotions, like energy, do not come from nowhere and do not go to nowhere. In other words, being unexpressed, they are “stored” inside the body, and with constant repetition of a traumatic situation, they accumulate and cause illness. That is, the internal conflict, without resolution, is transformed into certain physiological symptoms.

Thus, the child partially gets rid of emotional discomfort. Thanks to the transfer from the mental to the physiological, the exciting situation is resolved, anxiety and restlessness subside.

As a rule, this happens unconsciously, and it can be difficult to understand what exactly is causing the sudden illness. But sometimes situations arise when the causes of a child’s sudden illness are obvious. For example, often serious problems health problems arise during a divorce, when the child finds himself in the midst of a parental conflict. Of course, this happens against a background of stress, but the subconscious message may be: “If I get sick, my parents will take care of me and stop quarreling.” I must say that usually this really works; a child’s illness can unite parents and distract them from sorting things out. Thus, the child receives some relaxation, as well as guaranteed care and love from loved ones.

Concerning external manifestations, then it could be like acute reactions and long-term illnesses. Usually adults treat them only with medication, but “for some reason” they come back again and again.

By the way, in Europe it has long been customary to conduct psychotherapy with a child in case of recurring chronic somatic manifestations to resolve the conflicts that he “squashes” into his body. There are even special small psychosomatic clinics that provide such treatment. But such a practice is not yet widespread in our country.

At what age can psychosomatic illness occur?

There are studies that suggest that psychosomatic diseases can develop in infants and even develop in the embryo while in the womb. In recent years, there have been reports that unwanted children have, in addition to psychological problems, various somatic disorders. Among them are dystrophy at birth, high frequency respiratory diseases, bronchitis, pneumonia, enuresis, neurodermatitis, stomach ulcers. In this regard, researchers even talk about the possible influence of intense unvoiced maternal thoughts during pregnancy on the occurrence of psychosomatic problems in the child.

For the normal formation of the fetus, the emotional state of the expectant mother, the attitude of her husband and the people around her are very important. Any emotional imbalance of a woman during this period (resentment, jealousy, feeling that she is not loved) can cause one or another pathology in the child.

True, it is still difficult to say whether these diseases originate only in the prenatal period or whether the rejection of the child after birth is decisive. However, most often, these two points are interconnected. If the pregnancy was not desired, if the woman was afraid of the onset of labor, doubted whether she needed a child, then after the birth of the baby she most likely will not be too positive. At least at first. Although, there are quite frequent cases when, upon seeing her child, a woman immediately fell in love with him.

By the way, when a baby is born, he formally becomes a separate organism from his mother. But in fact, a very strong connection remains between the baby and the mother, so all the worries and fears of the mother are immediately transferred to the baby. Thus, it is obvious that positive emotions and the psychological attitude of parents are very important both during pregnancy and after the birth of the baby.

But not only “neglected” children can experience psychosomatic problems. Sometimes children and caring parents get sick. It would seem, where can a baby in a full-fledged family get similar symptoms?

Each psychosomatic disease is the body’s way of “drawing attention” to some problem that could not be resolved or talked about, which is especially important in the case of children. It is most often difficult for any child to tell their parents about their problem; it is difficult to explain it. In some cases, a child, especially a younger one, cannot understand what happened to him or why he feels bad. At this stage, the baby’s body enters into a “dialogue” with the parents, trying to attract the attention of adults, producing painful symptoms that are difficult to treat.

Also, the cause of somatic diseases can be the lack of a daily routine and necessary conditions for play and independent activity, neglect of the child’s interests, lack of affection, understanding, jealousy and envy of younger children, experience of natural distance from the mother. But it’s interesting that over-concern can have the same effect. In addition, a pronounced dependence on one of the family members or the lack of a unified approach to the upbringing process can become a stress factor. Often problems arise after the child goes to nursery, kindergarten or school. A child’s inability to adapt to a new environment, establish relationships, or cope with the academic load - all this can cause health problems. And if nothing is done, then as you grow older the situation can only get worse.

The most common psychosomatic diseases

The spectrum of such diseases is quite diverse and affects various body systems. Psychosomatic diseases are traditionally classified as bronchial asthma, diseases of the gastrointestinal tract(peptic ulcer, gastritis and ulcerative colitis), thyroid dysfunction, neurodermatitis, enuresis, anemia.

IN Lately Researchers are increasingly saying that psychosomatic nature is also diabetes type 1, allergies and cancer.

Moreover, the nature of the occurrence of all these diseases can be explained by tracing the connection with the problems that exist in the child’s life. The main idea of ​​this classification is that a person does not get sick by something random. Each specific symptom symbolically represents what his experiences were associated with. For example, psychosomatic visual and hearing impairments can be associated with a reluctance to see and hear what is happening around.

There is an assumption that autism also has psychosomatic “roots”. Thus, the child unconsciously chooses to become self-absorbed in order to escape from reality.

Of course everything listed diseases and their psychological explanation is rather conventional; we are talking here rather about a general trend. Obviously, in each specific case it is necessary to study in detail the situation in the child’s life, and only after that suggest treatment.

Methods and principles of treatment

Each psychosomatic disease is specific, so work with it can only be done on an individual basis. First of all, of course, you need to make sure that the disease is psychosomatic. Observe the child - when and how he begins to feel unwell. Perhaps your stomach hurts every time before a test, and your head hurts after a showdown at school or at home. It is important to understand that psychosomatics is not a method of simulation. We are talking about a disease that requires treatment.

The conclusion that a child truly has a psychosomatic disorder can only be made after a thorough medical examination. At the same time, consult a psychologist who deals with psychosomatic diseases. It will help determine the cause, that is, identify the “traumatic event.” This is the most important thing in psychotherapeutic work with such diseases.

The problem can then be solved using various methods specifically selected for each child. Sometimes it is enough to listen to what the child wants and feels, treat him more attentively, try to create a friendly and trusting atmosphere at home, and eliminate the experiences that torment him. In the case of entering kindergarten, a “gradual immersion” may be necessary, for example, you can start with 1-2 hours in the kindergarten, gradually increasing the time so that the child can adapt.

However, parents are not always able to cope with the problem on their own. Moreover, some diseases take a long time to develop (sometimes even over several generations), and it is almost impossible to do without treatment. Sometimes it may be necessary to psychologically study the problems of not only the child, but also the parents, in order to eliminate intrapersonal conflicts underlying the disease. As a rule, after this the symptoms go away.

Often asthma, allergic diseases, many gastrointestinal disorders, enuresis, and skin diseases are amenable to psychotherapy. Drug therapy, not supported by psychotherapy, does not give such a lasting result, the symptoms constantly return, the disease occurs again and again. This happens because during treatment the conflicts themselves are practically not affected; on the contrary, the child gets what he wants and continues to fall into somatic states again and again. Then the conflict “grows” with more and more new layers, which, of course, complicates its resolution.

Therefore, it is important to start dealing with psychosomatic problems as quickly as possible - from the moment when you have a suspicion that this is not only a matter of the child’s poor health. Moreover, an integrated approach is important: some specialists appoint and control drug treatment, while others deal with the child’s psychological difficulties. Here it is necessary to maintain a reasonable and delicate balance between medical and psychological assistance. Then the problem will find its solution, and the treatment will have a lasting effect.

Here's how some health problems are explained from a psychosomatic point of view:

Asthma, bronchitis, Quincke's edema– fear of losing the love of parents, disorientation in relationships with significant people, hypersensitivity to bad relationships.
Colds, herpes– depression, fear, anxiety, neuroses associated with social contacts (in kindergarten or school).
Fainting– suppression of the flight response.
Chronic cough- a hidden expression of aggression, unspoken protest.
Gastritis– depression due to the inability to achieve what you want.
Duodenal ulcer– loss of security, increased responsibility, changes.
Hyperthyroidism (increased function thyroid gland) – readiness for action and responsibility, suppressed by fear.
Childhood eczema– the mother experiences feelings of guilt towards the child, overprotection.
Neurodermatitis– irritability, high readiness for experiences, affects, a feeling of dependence on stronger individuals.
Teak– increased tension due to the high demands of parents.
Otitis– subconscious avoidance of conflicts in the family.
Enuresis– regression due to fear of growing up, return to a safe intrauterine state, problems with taking responsibility for one’s behavior and body.

Veronika Kazantseva, psychologist-educator, clinical psychologist of the Semeynaya network of medical clinics
magazine for parents “Raising a Child”, July-August 2013