Psychiatry and Clinical Psychopharmacology

Psychogenic vomiting treated with psychotherapy: case report

Psychiatry and Clinical Psychopharmacology 2014; 24: Supplement S244-S245
Read: 601 Published: 17 February 2021

An 8-year-old schoolboy (grade 3) was referred to our outpatient clinic with “frequent vomiting”. In his history, it was found out that he was vomiting when he ate much or his mother insisted to eat or he felt a hard object in his mouth during eating or parents asked to do something. Eight months ago, number of vomiting episodes was increased, when he learned that his mother received therapy for pregnancy and he began to want sleeping with mother. He was vomiting when his demands were not fulfilled; thus, his parents were trying to meet his demands. He could have vomiting during travel by coach. He was so much concerned about his physical appearance, because his friends were sending up him, as he was weak and şapped-ear. The patient had no concern regarding weight gain and he was experiencing distress about vomiting. The patient was assessed at general pediatrics outpatient clinic first where evaluations directing organic causes were performed. No organic disorder or complication was detected. Thus, the patient was referred to us by the consideration that vomiting episodes could have a psychological etiology. The patient underwent psychoeducation with a diagnosis of psychogenic vomiting. Damages and complications related to vomiting were discussed in the therapy by using Socratic questioning technique. During therapies, information about time he vomited was obtained and the patient and parents were informed about measures that should be taken and behavioral tasks were given. The patient left follow-up visits by his own decision, as all symptoms were relieved after 2 sessions of therapy. By telephone interview, it was confirmed that his wellbeing was persisting. Firstly, organic disorders and complications secondary to vomiting should have to be excluded in cases presented with vomiting. Then, eating disorders including anorexia nervosa, bulimia nervosa and rumination disorder and neurological disorders such as migraine should have to be excluded. In our case, evaluations directing organic reasons were performed first and no organic disorder or a complication was detected. As concerns regarding weight gain was lacking and the patient experienced distress about vomiting and family relationships were good, we moved away from the diagnosis of other eating disorders. Usually, vomiting episodes secondary to depression and anxiety disorder can be observed in patients with psychogenic vomiting. However, there was no diagnosis of depression or anxiety disorder fulfilling DSM criteria in our patient. Psychogenic vomiting with onset at younger age, which cause challenge to patient and his/her parent, is a disorder that can be rapidly resolved by psychotherapy when precise reason is established and reasons established is not
 

EISSN 2475-0581