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Testing the Psychogenic Vomiting Diagnosis: Four Pediatric Patients

Testing the Psychogenic Vomiting Diagnosis: Four Pediatric Patients Abstract • We treated four patients with chronic vomiting during childhood in whom a tentative diagnosis of psychogenic vomiting was made after an extensive evaluation. In each case, the diagnosis was reconsidered during the course of treatment, as observations about the patients and their response to interventions accumulated. In three instances, these observations did not fit those expected if the diagnosis of psychogenic vomiting was correct. This led to a reexamination of the organic evaluation and the discovery of an undiagnosed organic contribution to the vomiting. In the fourth patient, gastric emptying studies confirmed that there was a strong psychological contribution to the vomiting, and helped to more carefully define this contribution. Family and individual psychotherapy and treatment were aided by the greater clarity in diagnosis. (AJDC. 1991;145:913-916) References 1. Malagelada JR, Camilleri M. Unexplained vomiting: a diagnostic challenge . Ann Intern Med . 1984;101:211-218.Crossref 2. Hill WH. Psychogenic vomiting . Gut . 1968;9:348-352.Crossref 3. Clarke DJ, Salmons PH, Harrison T. Psychogenic vomiting among female Asian migrants to the United Kingdom . Int J Soc Psychiatry . 1988;34:221-229.Crossref 4. Leibovich MA. Psychogenic vomiting . Psychother Psychosom . 1973;22:263-268.Crossref 5. Reinhart JB. Disorders of the gastrointestinal tract in children: consultation-liaison experience . Psychiatr Clin North Am . 1982;5:387-397. 6. Rosenthal RH, Webb WL, Wruble LD. Diagnosis and management of persistent psychogenic vomiting . Psychosomatics . 1980;21:722-730. 7. Wruble LD, Rosenthal RH, Webb WL. Psychogenic vomiting: a review . Am J Gastroenterol . 1982;77:318-321. 8. Stacher G. Differentialdiagnose psychosomatischer Schluckstorungen . Wien Klin Wochenschr . 1986;98:658-663. 9. Abell TL, Kim CH, Malagelada JR. Idiopathic cyclic nausea and vomiting: a disorder of gastrointestinal motility? Mayo Clin Proc . 1988;63:1169-1175.Crossref 10. Camilleri M. Organic basis for symptoms in functional gastrointestinal disease? Mayo Clin Proc . 1988;63:1256-1257.Crossref 11. Smart HL, Atkinson M. Abnormal vagal function in irritable bowel syndrome . Lancet . 1987;2:475-478.Crossref 12. Camilleri M, Fealey RD. Idiopathic autonomic denervation (AD): an unrecognized cause of dysmotility in patients with apparently functional bowel disorders . Gastroenterology . 1988;95:858. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Testing the Psychogenic Vomiting Diagnosis: Four Pediatric Patients

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1991.02160080091026
Publisher site
See Article on Publisher Site

Abstract

Abstract • We treated four patients with chronic vomiting during childhood in whom a tentative diagnosis of psychogenic vomiting was made after an extensive evaluation. In each case, the diagnosis was reconsidered during the course of treatment, as observations about the patients and their response to interventions accumulated. In three instances, these observations did not fit those expected if the diagnosis of psychogenic vomiting was correct. This led to a reexamination of the organic evaluation and the discovery of an undiagnosed organic contribution to the vomiting. In the fourth patient, gastric emptying studies confirmed that there was a strong psychological contribution to the vomiting, and helped to more carefully define this contribution. Family and individual psychotherapy and treatment were aided by the greater clarity in diagnosis. (AJDC. 1991;145:913-916) References 1. Malagelada JR, Camilleri M. Unexplained vomiting: a diagnostic challenge . Ann Intern Med . 1984;101:211-218.Crossref 2. Hill WH. Psychogenic vomiting . Gut . 1968;9:348-352.Crossref 3. Clarke DJ, Salmons PH, Harrison T. Psychogenic vomiting among female Asian migrants to the United Kingdom . Int J Soc Psychiatry . 1988;34:221-229.Crossref 4. Leibovich MA. Psychogenic vomiting . Psychother Psychosom . 1973;22:263-268.Crossref 5. Reinhart JB. Disorders of the gastrointestinal tract in children: consultation-liaison experience . Psychiatr Clin North Am . 1982;5:387-397. 6. Rosenthal RH, Webb WL, Wruble LD. Diagnosis and management of persistent psychogenic vomiting . Psychosomatics . 1980;21:722-730. 7. Wruble LD, Rosenthal RH, Webb WL. Psychogenic vomiting: a review . Am J Gastroenterol . 1982;77:318-321. 8. Stacher G. Differentialdiagnose psychosomatischer Schluckstorungen . Wien Klin Wochenschr . 1986;98:658-663. 9. Abell TL, Kim CH, Malagelada JR. Idiopathic cyclic nausea and vomiting: a disorder of gastrointestinal motility? Mayo Clin Proc . 1988;63:1169-1175.Crossref 10. Camilleri M. Organic basis for symptoms in functional gastrointestinal disease? Mayo Clin Proc . 1988;63:1256-1257.Crossref 11. Smart HL, Atkinson M. Abnormal vagal function in irritable bowel syndrome . Lancet . 1987;2:475-478.Crossref 12. Camilleri M, Fealey RD. Idiopathic autonomic denervation (AD): an unrecognized cause of dysmotility in patients with apparently functional bowel disorders . Gastroenterology . 1988;95:858.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Aug 1, 1991

References