Stressors Associated with Dyspnea in Childhood: Patients' Insights and a Case Report

American Journal of Clinical Hypnosis,  Oct 2004  by Anbar, Ran D

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Jane was congratulated on her success, and was given a one week follow-up appointment. Four days later, Jane disclosed to her mother that her stepfather had been sexually abusing her for several years. At that time legal authorities became involved, and Jane was referred to a clinic that specializes in counseling victims of sexual abuse.

Jane's breathing remained normal after her AWP session during three years of follow-up.

Discussion

The patients explained that their dyspnea arose in association with stressful situations, or that it reduced the chances of having to experience an uncomfortable situation. It is unclear whether the dyspnea and associated symptoms arose in order to protect the patients, and/or if the patients found meaning and an advantage in the dyspnea once it occurred, which may have promoted its perpetuation.

Also, it is unclear whether the explanations provided by the patients regarding their symptoms represented true insights as opposed to rationalizations in response to prompting by the pulmonologist. For example, Jane reported that her symptoms arose as a result of her stepfather's involvement with drugs, rather than sexual abuse. Nonetheless, even though her explanation may have been inaccurate or incomplete, she appeared to benefit immediately from reporting a possible cause of her dyspnea. Further, gaining of this insight or the process involved in its acquisition may have been associated with a sufficient increase in confidence that allowed her to disclose her abuse later in the week.

It must be emphasized that the patients described in this report comprise only a subset of patients who reported dyspnea. The reported patients mostly had normal lung function and did not have diagnosed organic illnesses. Therefore, their presentation was consistent with a somatoform disorder (American Psychiatric Association, 1994). Some of the patients in this report may have suffered from conversion disorder, as their unintentional clinically significant symptoms were preceded by Stressors (American Psychiatric Association, 1994). Conversion is thought to allow a somatic symptom to represent a symbolic resolution of an unconscious psychological conflict, reduce anxiety, and serves to keep conflict out of conscious awareness (American Psychiatric Association, 1994). For example, once Jane dealt with her psychological conflict by deciding to trust herself, she no longer required a symbolic resolution, and her symptom resolved. The patients who were exposed to traumatic events (including the loss of grandparents, parental divorce, exposure to a large house fire, near-drowning, and episodes of severe asthma) may have developed dyspnea as part of a Posttraumatic Stress Disorder (American Psychiatric Association, 1994). Patients with possible conversion and posttraumatic stress disorders might benefit from referral to health care providers who specialize in the treatment of these conditions.

The patients were not diagnosed as having a factitious disorder or malingering because their symptoms were judged not to be fabricated, feigned, or intentionally produced (American Psychiatric Association, 1994).