Testing the psychogenic vomiting diagnosis. Four pediatric patients
J. Gonzalez-Heydrich, J. A. Kerner Jr and H. Steiner
Department of Psychiatry and Neurology, Stanford University Medical Center, CA.
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.
