Childhood experiences of a client with multiple personality.
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The findings in nine studies of abused children indicate a need for mental health treatment of emotional problems that may result from the abuse experience.
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The various childhood problems that are often subsumed under the heading of "hyperactivity" occur in various combinations and, apparently, for various reasons. The designation does not define a homogeneous group of children, does not consistently point to a common cause, and has treatment implications only in the sense that multiple simultaneous approaches must typically be considered. Stimulant drugs, which seem frequently to be used for control of so-called hyperactivity, are an inadequate treatment when used alone, have a number of poorly studied effects, some of which are apparently negative, and may obscure problems other than the hyperactivity itself, which then may be ignored. There is some evidence now available that classroom learning does not improve with drug treatment despite common assumptions to the contrary.
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The literature on adjustment disorder in children and adolescents is reviewed to evaluate the empirical and conceptual basis of this disorder as defined in DSM-III-R, and to determine whether revisions, are indicated in DSM-IV. Existing studies suggest that adjustment disorder is a disorder of high prevalence in all settings, which carries significant morbidity and poor outcome in children and adolescents. Problems identified with the DSM-III-R definition include low reliability, the predominance of mixed rather than discrete symptom presentations in children and adolescents, and the persistence of symptoms in excess of 6 months in a significant number of cases.
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A general review of psychological reactions to a disaster situation in four groups of people is presented. Adult reactions (and management thereof) vary according to the phase of the disaster, viz (i) the pre-impact phase characterized by underactivity, development of anxiety symptoms or involvement in adaptive activities; (ii) the warning phase typically manifested by overactivity; (iii) the impact phase characterized by bewilderment, confusion or hysteria; (iv) the turmoil-recoil phase manifesting in emotional expression relating to the immediate past; and (v) the emotionally wounded or post-traumatic phase featuring reconstructive activity with some elements of anger and resentment. Reactions in children are usually transitory but may be influenced by parental psychopathology, separation anxiety or previous emotional disturbances. Typical adult reactions seen in the elderly may be compounded by what has been termed a high sense of deprivation. Relief workers are exposed to psychic stress in the form of greater responsibilities and role identification and many also show delayed reactions to the death and destruction observed.
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.
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This paper outlines basic elements used in treatment of suicidal preadolescents, namely, having current knowledge of suicidal behavior, understanding a therapist's reactions to a suicidal child, intervening to decrease risk factors, developing a network of people who are involved with a child, and establishing follow-up contacts.
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During the past decade personality development of abused children has been studied by several investigators. A comparative overview of the results allows to name a number of symptoms which appear to be characteristic. The symptomatology expresses an ongoing conflict between resistance and resignation by restlessness, aggressivity and withdrawal on the one hand, and by low self esteem, pseudo-adult behavior and perfectionism on the other. The psychological consequences are the result not only of parental personality and aggression but also of social conditions and of factors which are inherent to the child. Treatment needs to include all three pathogenetic areas.
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