Content area
Full Text
INTRODUCTION
Psychogenic vomiting has been defined as persistent regurgitation of previously swallowed food in the absence of organic pathology (Toister, Condon, Worley, and Faradic, 1975). The presence of this disorder in childhood, particularly among infants, may have severe physical consequences including dehydration, malnutrition and lowered resistance to disease if significant amounts of food are lost repeatedly (Sajwaj, Libet, and Agras, 1974). In addition, those children who have reached school age may experience negative social consequences involving peer ridicule and rejection. While adults charged with the responsibility of caring for psychogenic vomiters express concern over their welfare, the annoying, unpleasant nature of the behavior may interfere with the quality of the interaction between the children and their caretakers.
Etiology
The syndrome of recurrent vomiting has presented a difficult problem in both diagnosis and treatment in pediatrie practice, and no definite cause can be identified (Reinhart, Evans, and McFadden, 1977). Organic causes are seldom found, even in those rare cases where diagnostic laparotomies have been performed in the hope of finding a correctable lesion. In observing groups of children who exhibitrecurrent vomiting, some clinicians have noted severe psychological problems in many of the children and their families, leading to the claim that the disorder may have a psychogenic basis (Hammond, 1974; Reinhart, et al., 1977). The psychosomatic explanation for recurrent vomiting states that a child may have" a physiological predisposition to develop this particular disorder when certain actual or perceived environmental conditions are present. These conditions may involve a chronically anxious parent who tends to label the child as weak and vulnerable, and a triggering situation such as an actual illness in which the parental reaction to vomiting is one of oversolicitous concern, attention and sympathy. In this situation, the parent reinforces the child's "sick role" behavior, increasing the likelihood that the child will respond to future stress situations in a similar manner. While the etiology of persistent vomiting is not entirely clear, attention to psychological and social factors is extremely important.
Prognosis
Psychogenic vomiting does not appear to be a benign condition that a child will outgrow easily in the absence of appropriate treatment (Reinhart, 1977). The literature cites numerous cases in which the syndrome appears remarkably resistant to change, even with the patient involved in...