Kratky-Dunitz M, Scheer P J
Psychosomatische Abteilung, Universitäts-Kinderklinik Graz.
Monatsschr Kinderheilkd. 1988 Sep;136(9):630-5.
37 children (aged 4 1/2-15 1/2 years) with encopresis were seen at the psychosomatic outpatient unit of the university children's hospital of Graz in the course of two years, comprising 1.8% of all our outpatients of that time (n = 2037). They had been referred to us by pediatricians general practitioners, welfare institutions and the local children's surgical hospital. Based an our observations and data-analysis of this heterogenic group we would like to suggest a subdivision of the new classification group of "elimination disorders" (307.70/307.60 DSM III-R) into three main subgroups; according to the use of the fifth digit in the DSM III-R (e.g. mood disorders 296.xx) we define: 307.71: primary infantile encopresis (group I); 307.72: primary reactive encopresis (group II a); 307.73: secondary reactive encopresis (group II b); 307.74: late "neurotic" encopresis (group III); 307.70: not otherwise specified NOS. Moreover, we hope to draw attention to the specific psychodynamics of this functional disorder, since we believe this to be a fundamental prerequisite for any successful therapeutic intervention.
在两年时间里,格拉茨大学儿童医院身心科门诊共接待了37名患有大便失禁的儿童(年龄在4岁半至15岁半之间),占当时所有门诊患者的1.8%(n = 2037)。他们是由儿科医生、全科医生、福利机构和当地儿童外科医院转介到我们这里的。基于对这个异质性群体的观察和数据分析,我们建议将“排泄障碍”这一新分类组(DSM III-R 307.70/307.60)细分为三个主要亚组;根据DSM III-R中第五位数字的用法(例如情绪障碍296.xx),我们定义:307.71:原发性幼儿大便失禁(第一组);307.72:原发性反应性大便失禁(第二组a);307.73:继发性反应性大便失禁(第二组b);307.74:晚期“神经症性”大便失禁(第三组);307.70:未另行说明(NOS)。此外,我们希望引起人们对这种功能性障碍特殊心理动力学的关注,因为我们认为这是任何成功治疗干预的基本前提。