bubble_chart Overview

Emotional disorders are primarily caused by psychological factors such as certain mental stimuli or inappropriate family education, leading to abnormal emotional expressions that cause distress to the affected child or impair their social adaptation.

bubble_chart Epidemiology

According to a survey in Shanghai (1984) involving 3,000 preschool children, the incidence of various emotional problems was 17.66%. In child psychiatric clinics in Nanjing and Beijing, emotional disorders accounted for 21% and 11.6% of cases, respectively, with a higher prevalence among girls than boys. The prevalence of emotional disorders was also higher in urban children compared to rural areas.

bubble_chart Etiology

There are many causes, with genetic predisposition playing a significant role in the onset. Children who are timid, sensitive, or overly dependent during early childhood are prone to emotional disorders. Family factors and poor parenting approaches—such as excessive protection, overly strict demands, or harsh attitudes—can also contribute to emotional disorders in children. Experiencing psychological trauma in early childhood, leading to deep emotional distress, is another common cause. Physical illness, excessive stress, fatigue, or an overwhelming academic workload can also influence the onset of the condition.

bubble_chart Clinical Manifestations

The main types of childhood emotional disorders are as follows:

1. **Separation Anxiety Disorder** This mostly occurs in preschool children. The main manifestations include excessive anxiety, panic, and unease when separated from their loved ones. The child may worry that their loved ones might suffer an accident or fear they will not return, leading to demands to stay at home and reluctance to attend school. If forced to go to school, the child may complain of headaches, abdominal pain, etc., but no abnormal signs are found upon examination.

2. **Phobia Disorder of Childhood** This refers to excessive fear of ordinary objects or situations in daily life, where the intense emotional reaction far exceeds the actual level of danger. Despite reassurance and explanations, the fear persists, even leading to avoidance or withdrawal that interferes with daily activities. During episodes of panic, symptoms such as pallor, palpitations, sweating, frequent urination, and dilated pupils may occur.

Another type involves a strong fear of school, where the child vehemently refuses to attend, skips school for long periods, and exhibits significant anxiety and fear about going to school. They often claim to be ill, though no illness can be identified. However, they can study at home without displaying other behavioral issues. This phenomenon is called **school phobia**, commonly seen in school-aged children, more frequently in girls than boys. The causes may include fear of school-related situations, academic failure, boredom with learning, or fear of separation from the mother.

3. **Social Sensitivity Disorder** Mostly seen in children aged 5–7, this disorder manifests as excessive sensitivity, nervousness, fear, timidity, shyness, and withdrawal when interacting with their surroundings. As a result, they avoid unfamiliar environments and fear separation from their mothers.

4. **Child Obsession (Childhood OCD)** This is relatively common and involves repetitive, rigid obsessive thoughts or compulsive actions, such as excessive handwashing, repeatedly checking one's behavior, meaningless counting, arranging items in order, or obsessively recalling recent actions or dwelling on trivial matters. The child is aware these thoughts and actions are unnecessary and meaningless but cannot control them.

5. **Child Hysteria** Common in adolescents, more frequently in girls than boys. Factors such as family discord, inappropriate parenting methods, excessive indulgence, or overprotection can predispose children to hysteria. Children from low cultural or socioeconomic backgrounds or those influenced by superstitious beliefs are also more susceptible. The clinical manifestations are similar to adult hysteria, divided into two types: - **Somatic Symptom Disorder**: Non-organic motor, sensory, or autonomic symptoms, known as conversion reactions. - **Dissociative Reaction**: Episodes of clouded consciousness, emotional outbursts, or abnormal behavior, with normal functioning between episodes. As the child grows older, the symptoms increasingly resemble those of adult hysteria.

Diagnosing hysteria requires a detailed history and examination to determine the underlying cause. Due to the varied and often pseudo-physical or neurological symptoms, hysteria is easily misdiagnosed, especially when physical illness coexists with psychological factors.

6. Child depression is a condition that occurs during childhood, characterized by persistent unpleasant mood, low spirits, sadness and crying, reduced interest, decreased activity, sluggishness, reticence, insomnia, and loss of appetite as core symptoms. A few cases may be accompanied by other undesirable behaviors. This condition mostly occurs during adolescence, and the disease cause remains unclear, possibly resulting from multiple factors including genetic factors, generation and transformation metabolic defects, and environmental factors. The diagnostic criteria for child depression, as proposed by Weinberg, can be broadly summarized into the following four points:

(1) Poor mood and low self-evaluation.

(2) Two or more of the following 8 symptoms: ① aggressive behavior; ② sleep disturbance; ③ reduced contact with others; ④ unwillingness to attend school; ⑤ decline in academic performance; ⑥ somatic complaints; ⑦ lack of energy; ⑧ changes in appetite and/or weight.

(3) These symptoms indicate a change in the child's behavior compared to usual.

(4) Symptoms persist for at least one week or more.

bubble_chart Treatment Measures

Based on the factors related to the child's illness and the characteristics of the symptoms, psychotherapy can be adopted, including behavioral therapy, play therapy, and suggestive therapy. Patient education and guidance should be provided to help the child overcome emotional barriers, establish a brave, strong, and healthy character, and encourage them to actively participate in group activities to improve their mood, enhance social interactions, and help them better adapt to their environment. At the same time, parents should be assisted in educating their children correctly and improving the family environment to reduce adverse psychological effects on the child.

For drug treatment, medications can be selected based on the main symptoms. For anxiety and fear symptoms, anti-anxiety drugs such as diazepam or nitrazepam can be taken, or small doses of tricyclic antidepressants such as doxepin or amitriptyline can be used. Clomipramine has good effects on childhood obsessive-compulsive disorder and depression. For those with hysterical emotional outbursts or impulsive crying, hydroxyzine, small doses of haloperidol, or chlorpromazine can be administered.