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[A child whose parents denied her psychiatric care]
1Medisch Centrum Leeuwarden-Noord, afd. Kindergeneeskunde, Postbus 2310, 8901 JH Leeuwarden. tjalling.de.vries@znb.nl
Nederlands Tijdschrift Voor Geneeskunde
|February 27, 2003
Summary
Medically unexplained symptoms in a teen, including a palpable abdominal tumor, resolved with nutritional support and behavioral therapy, highlighting conversion disorder. Parental refusal of psychiatric care complicated treatment and posed risks.
Area of Science:
- Pediatric Psychology
- Child Neurology
- Psychosomatic Medicine
Background:
- Conversion disorder can manifest with severe, medically unexplained physical symptoms in children and adolescents.
- Parental denial or resistance to psychiatric evaluation poses significant challenges in diagnosing and managing these complex cases.
Observation:
- A 15-year-old female presented with an abdominal tumor and failure to thrive, exhibiting symptoms like blindness and paralysis following a childhood accident.
- Extensive medical workup revealed no organic cause for the symptoms or the apparent tumor.
- The patient's severe underweight (32 kg) and abdominal mass resolved with nasogastric tube feeding and behavioral therapy.
Findings:
- The abdominal tumor disappeared, and the patient's weight normalized after nutritional intervention and behavioral therapy.
- Conversion disorder was diagnosed, but the parents vehemently rejected this psychiatric diagnosis, hindering further care.
- This case underscores the potential for severe somatic manifestations of psychological distress in youth.
Implications:
- Early identification of conversion disorder and parental psychological factors is crucial for effective intervention.
- Failure to address underlying psychological issues in children presenting with unexplained somatic symptoms can lead to detrimental health outcomes.
- Physicians must navigate parental resistance to psychiatric diagnoses while advocating for the child's comprehensive well-being.