ENCOPRESIS IN THE CHILD - A BIDISCIPLINARY REASSESSMENT OF THE CONCEPT AND ITS TREATMENT

Childhood encopresis is a complex, progressive, polyfactorial symptom. It evokes dysfunctioning art three levels relational, parental and in fantile. The psychosomatic anamnesis of encopretic children reveals th e intergenerational viscissitudes which appear in the negotiation of a n educational,familial containment. More specifically, it emphasizes t he misadventures which occur in the conquest of a moderate balance bet ween auto-erotic cathexis and objectal cathexis during the oral and la ter the anal stages. By following this epistemologically federating de velopmental arts, the authors propose original, structural guideposts which underline the psychopathological diversity of encopresis and ope n the debate concerning which therapeutic indications are appropriate in each case. The results of a multi-centered study of 54 children, re cruted in pediatrics, sheds light on this structural disparity. Encopr esis is reactional in 3.7% of the cases, displays a neurotic polarity in 11% of the children, a psychosomatic aspect for 62.9% of them, and is a combined form for 22.4%. Auto-erotic subversion which is inherent in the symptom in the mixed and psychosomatic forms carries a risk of increasing self-calming addiction which lends a depressive valency to these cases. Recognition of this frequent tendency which may have ser ious consequences for the child's future should cause pediatricians an d psychotherapists to mobilize themselves and not to trivialize encopr esis. The clinical and theoretical position of the authors as regards encopresis refuses both the fanatical position of those who profess a uniquely organic etiology and of those who profess a uniquely psychoge nic explanation. Their collaborative work involving a gastro-pediatric ian and a psychologist is a plea in favor of pluridisciplinary therape utic complimentarity.