Psychosomatic Medicine 11:200-210 (1949)
© 1949 American Psychosomatic Society

Physiologic and Psychologic Interrelationships in Diabetes in Children

¹ Departments of Psychiatry and Pediatrics, College of Physicians and Surgeons, Columbia University

This study is based on psychiatric observation of 37 diabetic children. No uniform psychologic picture could be discovered. Although the families tended to relate the onset of diabetes to upsetting events, only in exceptional cases was there real evidence of such a relationship. The psychologic structure of the families showed great variety. It was found that these existing attitudes were of great importance for the course of treatment. This point is illustrated by 8 selected case histories. The findings were compared to observations on obese children, in whom a characteristic psychologic picture could be described, which in turn was related to a typical family frame. These observations, particularly the marked difference between the picture in diabetes and obesity, seems to be of more general importance.

There has been a tendency in psychosomatic research to focus on the association of certain basic personality traits with certain organic illnesses. In this orientation the illness may be likened to a neurotic symptom expressing unconscious conflicts and needs. Failure to establish such central relationship has been attributed to inadequate technic. The opinion has been expressed that only intensive psychoanalytic studies could reveal the fundamental interrelationships.

In the study of obese children, common psychologic characteristics could be readily recognized and were found to be intrinsically interrelated with the development of obesity. One might say that obesity is a way of life and, though resented as an embarrassing handicap, serves the function of giving the security of size. No psychologic factors of such central importance were recognized in diabetic children studied by the same technic. Diabetes enforces a certain way of life to which a child and his family will react according to pre-existing yet unspecific patterns. Diabetes seems to reinforce existing problems. From the comparison of obesity and diabetes in childhood one might conclude that physical changes and psychologic reaction are integrated on different levels and in different ways in different somatic disorders