Psychological aspects of recurrent diabetic ketoacidosis in preadolescent boys
Nathan, S.W.
American Journal of PsychoTherapy 39(2): 193-205
1985
ISSN/ISBN: 0002-9564 PMID: 3925798 Document Number: 260921
This paper examines the psychotherapeutic treatment of 2 preadolescent boys who presented with recurrent episodes of diabetic ketoacidosis (DKA). The DKA episode is interpreted as a developmentally primitive pathway for the expression of affect in patients who tend to be alexithymic and are unable to cognitively differentiate among various emotional states. Problems with separation-individuation, gender identity and self-esteem suggest failure in mastery of developmental tasks originating in Mahler's rapprochement period. Often passive, frightened, silent and angry, these challenging patients initially respond best to a play-oriented approach that encourages the motor expression of feelings previously discharged via metabolic pathways. Once externalized, these feelings are available for discussion. The ultimate goal of psychotherapy is to help the patient learn to differentiate among various feeling states, to develop a capacity for the symbolic expression of feelings via language and play, and to become sensitized to physiological signs of disequilibrium that warn of impending DKA episodes. Collaborative treatment of family members and at times residential placement are important adjuncts to psychotherapeutic intervention.