1. Psychosocial factors Children's life is simpler than that of adults, but in the family and school environment, they will also encounter various psychosocial stress factors, such as parents' overprotection or demanding, rude attitude and other inappropriate education methods in family and school, the impact of unexpected life events, and the inability to solve contradictions, which will have a negative impact on children's psychological activities and cause excessive and lasting emotional reactions.
2. Genetic factors Parents pass on their genetic genes to their offspring, who not only inherit their parents' appearance, but also include their personality and emotional response characteristics. The occurrence of the disease is mostly due to children's genetic susceptibility and personality types (such as emotional instability and introverted people), as well as the role of external environment on susceptibility quality. According to reports, the coincidence rate of twins with the same disease is 47%, and the families of children with the same disease account for 16.9%.
3. Children with serious physical diseases in childhood are prone to emotional problems in the process of disease treatment.
(2) Pathogenesis
According to the different symptoms of childhood emotional disorder, the specific description is as follows:
1. Children's parting anxiety
(1) Desire can't be satisfied: According to Freud's psychodynamic theory, when there is psychological conflict in the individual's subconscious, it will be manifested as anxiety, which is caused by the individual's need for desire and the restriction of desire in real life, and is the result of the struggle between "superego" and "id" in the personality structure.
(2) Genetic factors: About 15% parents and siblings of children with anxiety disorder also have anxiety disorder, and the incidence of anxiety disorder in MZ can reach 50%.
(3) Bad parent-child relationship: Bowlby( 1977) thinks that in general, parents should give their children a safe and warm environment, but they should not rely on it. On the other hand, when the parent-child relationship is not good, it shows that on the one hand, it is indifferent and harsh to the children, on the other hand, it makes the children attached to themselves, leaving them in a dilemma.
(4) Life events: Before leaving anxiety, there are often life events as an inducement. Common life events include sudden separation from parents, unfortunate accidents, serious illness or death of relatives, setbacks in kindergartens, etc.
2. Causes of school phobia
(1) Bad parent-child relationship: As early as 1970s, Bowlby had noticed that abnormal parent-child relationship would lead to school phobia. This abnormal parent-child relationship is often manifested as follows: mothers are mostly patients with chronic anxiety disorder and always want to leave their children at home to accompany them; Children are afraid that their parents will encounter misfortune at school, so they ask to stay at home; Children are worried that they will be accidentally injured when they leave home, preferring to stay at home; Mother is worried that her children will have an unfortunate accident in school.
School phobia is closely related to children's parting anxiety, both of which may be the result of poor parent-child relationship. The phenomenon that children with school phobia are unwilling to go to school is more reflected in their unwillingness to be separated from their mothers. The basic problem is the severe anxiety symptoms after separation from mother.
(2) Frustration in learning: Most children with school phobia have good academic performance and strong self-esteem. When they are frustrated or fail in school, their self-esteem is hurt, which leads to strong emotional reactions and painful experiences. Children don't want to face this dilemma and try this painful experience again, so they stay at home by avoiding it. At this time, improper handling by parents will aggravate the severity of symptoms: ① children's behavior is protected and supported at home; (2) Parents adopt a sympathetic attitude towards their children's dissatisfaction and fear; (3) When parents show anxious reaction to their children's going out to school, children's fear of going to school can be strengthened, and school phobia symptoms become stronger and stronger.
3. Etiology of childhood depression
(1) Genetic factors: The importance of genetic factors in the pathogenesis of affective disorder has been recognized by most scholars. Although the genetic research of childhood depression is not as much as that of adult patients, the following three studies also illustrate the importance of heredity: ① Parents of adult patients with depression are more depressed; ② Both longitudinal and horizontal comparative studies found that the proportion of children suffering from depression exceeded expectations; (3) A group of research results show that the proportion of emotional disorders is high among the relatives of depressed children. Among them, Harrington's research group found in 1993 that the lifetime prevalence rate of depressive disorder in relatives of depressed children was nearly twice that of non-depressed control group, suggesting that there is a genetic relationship between childhood depression and adult depression. Akiskal( 1986) reported that the comorbidity rate of emotional disorder MZ was 76%, and that of emotional disorder DZ was only 19%.
(2) Psychosocial factors: There are three views on the influence of psychosocial factors on children's depression: ① The influence of parents on their children. Parents' depression will affect the living environment of their offspring, which will lead to depression symptoms, alienation of parent-child relationship and disharmony of family atmosphere, all of which will lead to children's depression. ② Early acute life events, loss of parents, life difficulties, adversity and susceptibility are the inducing factors of children's depression. Among them, the influence of adversity on children is not only difficulties, but more importantly, parents' attitude towards difficulties and confidence in overcoming them. Weak attitude and lack of self-confidence will promote children's depression. ③ Special life experiences make children suffer from depressive symptoms, such as parents' divorce, natural disasters such as floods and earthquakes, war, being locked in concentration camps, physical abuse, sexual abuse and psychological abuse, which all mean that they play an important role in the pathogenesis of childhood depression.
From the psychological mechanism, learned helplessness is the main psychological mechanism of depression. Helplessness often brings people the expectation of waiting, and hopeless waiting will lead to depression and negative cognitive activities, which are negative for themselves, their future and the world around them.
(3) Psychobiochemical abnormality: At present, it is basically the same hypothesis that the monoamine neurotransmitter system in children with depression is low, which is caused by two reasons: First, all drugs that can exhaust monoamine neurotransmitters in the synaptic gap (between nerve cells) of the central nervous system can cause depressive symptoms. Secondly, so far, effective antidepressants, especially tricyclic antidepressants, improve the level of neurotransmitters in synaptic cleft by inhibiting the recycling of neurotransmitters, thus achieving the purpose of eliminating symptoms.
In fact, we can also see the mental and biochemical abnormalities of depression from some biomarkers, such as positive dexamethasone inhibition test and abnormal sleep EEG. The younger the onset age of children, the greater the instability of biomarkers.
4. Etiology of obsessive-compulsive disorder in children
(1) Basal ganglion dysfunction: In the study of mental diseases, the findings obtained by means of CT, PET, neurotransmitters and neuroendocrine show that the symptoms of obsessive-compulsive disorder are closely related to the dysfunction of frontal lobe-basal ganglion circuit.
In clinical practice, clinicians will have such experiences: ① The compulsive motor convulsion and ritual behavior of children with Parkinson's disease after encephalitis are similar to the "do or not do" behavior of patients with obsessive-compulsive disorder. ② Tourette's syndrome is a disease caused by basal ganglia dysfunction, and the number of children and adolescents with Tourette's syndrome and dance-like dyskinesia is obviously increasing. ③ Rheumatic chorea is due to the immune response of basal ganglia to hemolytic streptococcus, which presents uncontrollable and aimless dyskinesia at the onset. Chapman( 1958) reported 8 cases of rheumatic chorea and 4 cases had obsessive-compulsive symptoms. ④ Obsessive-compulsive symptoms can appear in the onset of many diseases, such as rheumatic chorea, Huntington's chorea, Wilson's disease, idiopathic Parkinson's disease and Tourette's syndrome after encephalitis. , are manifestations of basal ganglia dysfunction.
Rapoport( 199 1) scanned 10 children with obsessive-compulsive disorder and 10 healthy control children, and found that caudate nucleus, an important part of the basal ganglia of obsessive-compulsive children, was significantly smaller than that of normal children.
Researchers from the National Institute of Mental Health and the University of California, Los Angeles used PET technology to study the local glucose metabolism rate in the head of patients with obsessive-compulsive disorder. It was found that the glucose metabolism rate of the frontal lobe, cingulate gyrus and caudate nucleus in patients with obsessive-compulsive disorder increased significantly, suggesting that the frontal lobe-basal ganglia pathway was abnormal.
(2) Abnormal neurotransmitters: At present, commonly used anti-obsessive-compulsive drugs such as chlorpromazine and fluoxetine are selective 5-HT reuptake inhibitors, which can effectively block the recovery of 5-HT neurotransmitters by presynaptic cells, suggesting that 5-HT function is insufficient or the level of 5-HT is decreased in obsessive-compulsive disorder.
Some researchers have observed that children with obsessive-compulsive disorder have hyperactivity of dopaminergic neurotransmitters, which is very similar to the "compulsive concept" and "compulsive ritual action" when psychostimulants (amphetamine and methylphenidate) are overused.
(3) Neuroendocrine abnormalities: Flemish (1988) found that the number of men with obsessive-compulsive disorder was less than that of women, with mild symptoms. The increase of symptoms of obsessive-compulsive disorder before puberty, the increase of compulsive thinking and ritual movements before menstruation, and the emergence of obsessive-compulsive disorder after delivery all indicate that neuroendocrine changes play a certain role in the pathogenesis of obsessive-compulsive disorder.
(4) Psychological factors: Psychoanalysis believes that the symptoms of children's obsessive-compulsive disorder are rooted in the anal period, which is the period when children receive toilet training. Parents ask their children to obey, but the child's unconstrained contradiction causes conflicts in the child's mind, which leads to hostility of the child and makes the development of sexual psychology fixed or partially fixed at this stage. Obsessive-compulsive symptoms are the external manifestations of inner conflicts in this period.
(5) Personality characteristics of parents: As early as 1962, Kanner realized that most children with obsessive-compulsive disorder live in a family with "over-perfect parents", and their parents have the personality characteristics of following the rules, pursuing perfection step by step, and not being good at changing.