Psychogenic disorders of vision in childhood ("visual conversion reactions"): perspectives from adolescence: a research note

How Perceptions of Parents' Parenting Behaviors Pave the Way to Somatic Symptoms: The Mediating Role of Emotion Regulation Among Adults

The purpose of this study was to investigate adult participants' reflections on their parents' parenting behaviors during childhood (parental overprotection and parental rejection), and their current emotion-regulation strategies and somatic symptoms. The study consisted of 627 participants and Somatization subscale of the Symptom Checklist-90-Revised, Difficulties in Emotion Regulation Scale and Short EMBU Children Form were given to the participants. Four different multiple mediation analyses were conducted to test mediator roles of emotion regulation difficulties between perceptions of the parenting behaviors (parental overprotection and rejection) and somatic symptoms among adults. Participants' lack of goals and lack of strategies while dealing with negative emotions mediated the relationship between mother/father rejection and somatic symptoms. However, only participants' lack of strategies while dealing with negative emotions mediated the relationship between mother/father overprotection and somatic symptoms. As a clinical implication, problem-focused coping strategies may assist adults with somatic symptoms. Also, mental health practitioners may focus on perceptions of overprotective and rejecting parental behaviors while formulizing somatic symptoms of the adult patients. Findings, strengths and limitations of this study were discussed in the light of the literature.

Dissociative Visual Loss in Children and Adolescents

Psychogenic vision disorders in children and adolescents are a common disorder primarily encountered by ophthalmologists at the onset because, as with other disorders of dissociation, the presentation suggests a neurologic or other somatic condition. Loss of visual acuity, blurred vision and visual field restriction-often described as tunnel vision-appears to be typical. The onset may be sudden, frequently related to a wide range of stressful life events (school failure, family conflicts, accidents). While the majority of these children quickly recover from their symptoms, a substantial percentage experience persistent symptoms or a fluctuating course. Due to the lack of efficacy studies of specific treatment protocols, diagnostic work-up and treatment suffer from a high degree of uncertainty. Differentiating dissociative visual loss from physical illness requires special expertise. The uncertainty of ophthalmologists and the other specialists involved in dealing with this clinical condition often delays the specialised treatment and may also trigger inadequate therapy with the iatrogenic risk of harming the patient. This article primarily describes the disorder-specific psychiatric diagnostic as well as the somatic differential diagnostic work-up and outlines the therapeutic principles of dissociative visual loss.

A case of psychogenic visual disturbance improved by staying at home after the declaration of a state of emergency in relation to the coronavirus disease

The aim of this study is to report a 7-year-old girl with psychogenic visual disturbance that improved upon staying at home after the declaration of a state of emergency in relation to Coronavirus disease. Her uncorrected visual acuity (UCVA) in the right eye was 0.4 and in the left eye was 0.3. Slit-lamp examination and fundoscopy showed no abnormalities. She had a tight schedule on six days a week due to various lessons. To prevent the spread of infection, her school was closed, and she was not able to attend any lessons. She enjoyed spending time at home. Six months after her initial visit during school closure, her UCVA had improved to 1.2. The situation of staying at home may have had a positive psychological effect after removing factors contributing to her stress.

Conversion Disorder Manifesting as Functional Visual Loss

BACKGROUND

Children with conversion disorder experience neurological symptoms without a definable organic cause. Clinical presentation of conversion disorders is uncommon in the emergency department (ED).

CASE REPORT

An 11-year-old previously healthy girl presented to the ED for management of lobar pneumonia. She developed acute visual loss subsequent to accidental placement of an intra-arterial cannula in her arm. Clinical assessments by the emergency physician, neurology, ophthalmology, and psychiatry services, and negative neuroimaging studies established the diagnosis of functional visual loss as a manifestation of conversion disorder. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Conversion disorder symptoms are often without any specific markers and do not fit standard clinical guidelines. A comprehensive and step-wise evaluation of unusual clinical presentation by multiple specialties and ancillary test results should be considered to rule out organic causes and establish the diagnosis of conversion disorder, as seen in our patient.

Sibling-Controlled Study of Parental Bonding, Coping, and Urgent Health-Care Use in Families With Children With Nonepileptic Seizures

Objectives

Pediatric psychogenic nonepileptic seizures (PNES) is a functional somatic symptom condition with significant health-care service burden. While both family and individual factors play an important role in the development and maintenance of PNES, little is known about what predicts urgent health-care use in families with children who have PNES. The aim of the current study was to explore whether child coping and parental bonding styles influence the decision to seek urgent medical care in these families.

Methods

Data were analyzed from youth of age 8-18 years, 47 with PNES, and their 25 sibling controls. Parents provided the number of youth emergency room visits and hospitalizations in the preceding year. Youth completed a questionnaire about their coping styles and a measure about their mothers' and fathers' bonding styles. Using a mixed model with family as a random effect, we regressed urgent health-care use on participant type (youth with PNES or sibling), parental bonding style, and youth coping style, controlling for number of child prescription medications.

Results

Higher urgent health-care use was associated with having PNES, coping via monitoring, and perceiving one's father to be rejecting and overprotective. Lower urgent health-care use was associated with coping via venting and with perceiving one's mother to be caring and overprotective.

Conclusions

This study provides preliminary empirical support for family-based clinical efforts to reduce child urgent health-care use by enhancing effective child coping skills and improving parental response to child impairment and distress in families with youth with PNES.

Somatising in children and adolescents. 2. Management and outcomes

In this paper I outline the assessment, engagement and management of children and adolescents with somatising conditions. The major diagnostic groups, in rough order of prevalence, are adjustment, dissociative (transient and chronic), somatoform and factitious disorders and chronic fatigue. See Eminson (2001) for more detailed descriptions and subtypes.

Somatising in children and adolescents. 1. Clinical presentations and aetiological factors

Somatising disorders, characterised by complaints of unexplained physical symptoms, are common presentations in children and adolescents, both in primary and secondary care settings. They have significant impact on the children themselves and on health care resources: as in adults, there is a wide range of severity and resulting handicaps.

Cognitive-analytical therapy for a patient with functional neurological symptom disorder-conversion disorder (psychogenic myopia): A case study

Functional neurological symptom disorder commonly presents with symptoms and defects of sensory and motor functions. Therefore, it is often mistaken for a medical condition. It is well known that functional neurological symptom disorder more often caused by psychological factors. There are three main approaches namely analytical, cognitive and biological to manage conversion disorder. Any of such approaches can be applied through short-term treatment programs. In this case, study a 12-year-old boy with the diagnosed functional neurological symptom disorder (psychogenic myopia) was put under a cognitive-analytical treatment. The outcome of this treatment modality was proved successful.

Nonorganic visual loss in children

NOVL in children is a relatively common problem for the comprehensive ophthalmologist. Although the etiology and pathophysiology of NOVL are variable, rare cases are because of physical or sexual abuse. Clinical tests can make the diagnosis of NOVL, and nonorganic is our preferred terminology for NOVL. Clinicians should be careful to establish a normal eye examination and prove that the vision is better than claimed before labeling a patient with NOVL. Rarely, the clinical examination is insufficient to establish the diagnosis of NOVL and electrophysiology may be helpful. Reassurance is generally all that is necessary for most children with NOVL, but some patients might benefit from formal psychiatric evaluation. The possibility of nonorganic overlay should also be considered in children with NOVL, and the combination of organic and NOVL is relatively common.

Nonorganic (psychogenic) visual loss in children: a retrospective series

BACKGROUND

Few studies provide follow-up information or systematic investigation of prognostic parameters of nonorganic (psychogenic) visual loss in children.

METHODS

A retrospective case series analysis was performed on 58 patients younger than 16 years old who had nonorganic visual loss and underwent at least a 3-month follow-up clinic visit and/or telephone interview between 1992 and 2007 at a single institution in Italy. All patients underwent a full neurologic, ophthalmologic, and orthoptic evaluation. Visual electrophysiologic tests were performed in many patients as part of the evaluation. Neuroimaging was performed and psychiatric referral was made only as needed. We collected data on the age at onset, time to diagnosis of nonorganic visual loss, type and duration of visual symptoms, and concomitant psychologic or psychosocial difficulties.

RESULTS

Visual deficits consisted mostly of reduced visual acuity (76%) and visual field defects (48%). The diagnosis of nonorganic visual loss could be reached with confidence by means of observing inconsistent performance on a wide array of visual function tests, and, in doubtful cases, by means of electrophysiologic investigations. The mean time from onset to diagnosis was 3.1 months. The mean duration of visual symptoms from reported onset to disappearance was 7.4 months. Complete resolution of all visual symptoms occurred in 93% of patients and did so within 12 months of diagnosis in 85% of patients. There was no correlation between the duration of visual symptoms and age at onset, sex, time to diagnosis, type of ocular symptoms, or presence of psychosocial or psychologic difficulties.

CONCLUSIONS

Our study extends the follow-up information and confirms the findings of previous investigators in showing that nonorganic visual loss in children generally resolves spontaneously within 1 year and that no major psychiatric disorders are present or will appear after diagnosis. However, psychosocial stressors are often present and may predispose to this manifestation. There are no obvious predictors of rate of recovery.

Parental overprotection predicts the development of functional somatic symptoms in young adolescents

OBJECTIVE

To examine whether parental overprotection contributes to the development of functional somatic symptoms (FSS) in young adolescents. In addition, we aimed to study whether this potential effect of parental overprotection is mediated by parenting distress and/or moderated by the adolescent's sex.

STUDY DESIGN

FSS were measured in 2230 adolescents (ages 10 to 12 years from the Tracking Adolescents' Individual Lives Survey) by the Somatic Complaints subscale of the Youth Self Report at baseline and at follow-up 2 1/2 years later. Parental overprotection as perceived by the child was assessed by means of the EMBU-C (Swedish acronym for my memories of upbringing-child version). Parents completed the Parenting Stress Index. Linear regression analyses were performed adjusted for FSS at baseline and sex.

RESULTS

Parental overprotection was a predictor of the development of FSS in young adolescents (beta = 0.055, P < .01). Stratified analyses revealed that maternal overprotection was a predictor of the development of FSS in girls (beta = 0.085, P < .02), whereas paternal overprotection was a predictor of the development of FSS in boys (beta = 0.072, P < .01). A small (5.7%) but significant mediating effect of maternal parenting stress in the relationship between parental overprotection and FSS was found.

CONCLUSIONS

Parental overprotection may play a role in the development of FSS in young adolescents.

Medically unexplained symptoms in children and adolescents

A review is presented of the range of medically unexplained symptoms (MUS) in children and adolescents, with an account of the main presentations that are recognised in clinical settings in paediatric and children's mental health services. A summary of both epidemiological and clinical studies of symptoms and their associations is given, followed by a brief overview of aetiological theories and of management interventions.

Childhood experiences and personality traits in patients with motor conversion symptoms

A total of 30 patients with newly diagnosed motor conversion disorder were consecutively investigated by means of a Swedish self-rating inventory designed to assess perceived parental rearing practices (EMBU), and the Karolinska Scale of Personality (KSP). DSM Axis I and II psychopathology was assessed using a Structured Clinical Interview (SCID), and comparisons were made with 30 age- and sex-matched in-patients with motor symptoms due to a neurological disorder. Depression, the presence of a personality disorder and also poor schooling proved to be significantly associated with motor conversion disorder. The index patients perceived a high degree of parental rejection as well as low levels of affection and emotional warmth during childhood, but contrary to most previous studies, childhood physical and/or sexual abuse was not found to be associated with motor conversion disorder.