Infantilism
(
infantilismus
; lat. infantilis infant, child, from infantis non-speaking) is a clinical syndrome of various origins, characterized by a delay in the development of the body while maintaining the patient’s morphological, physiological and mental characteristics characteristic of an earlier age.
The term was proposed by E. Ch. Lasegue in 1864. A detailed description of the clinical picture of Infantilism belongs to Lorain (PJ Lorain, 1871). Anton (G. Anton, 1908) identified general infantilism (delayed general development) and partial infantilism (a relatively isolated disorder of somatic sexual or mental development), and examined the etiology of the syndrome. Falta (W. Fait a) and Tsondek (N. Zondek, 1929) proposed excluding from the concept of “infantilism” forms of developmental delay in which features of certain endocrine diseases are observed, i.e., the so-called. endocrine forms I. old authors. For example, thyroid I. (Brissot's disease), which develops as a result of decreased function of the thyroid gland and is characterized by delayed growth, mental development and severe symptoms of hypothyroidism, is considered by modern authors as symptoms of hypothyroidism (see). Issues of etiology, clinical picture and treatment of I. were developed by M. Ya. Breitman, A. A. Kisel, D. M. Rossiysky, N. A. Shereshevsky and others.
Etiology
The cause of the development of Infantilism may be chronic diseases in childhood (diseases of the gastrointestinal tract, liver, pancreas, kidneys, cardiovascular and hematopoietic systems, tuberculosis, syphilis, malaria, etc.), diseases and injuries of the brain (especially birth injury). I. may be a manifestation of functional or organic hypothalamic-pituitary insufficiency (total or partial). Chron, intoxication in parents (alcoholism, drug addiction, etc.) and poor material conditions (malnutrition, hypo- and vitamin deficiency) in early childhood are of great importance. In some cases, I. is hereditary.
So-called late infantilism (reversible, or regressive of old authors), occurring in the postpubertal period, at the age of 20-40 years (thyroid, sexual, pituitary) can arise as a result of tumor, traumatic, vascular, infectious-toxic damage to the hypothalamus or pituitary gland, as well as auto-aggressive an immune process that disrupts the functions of the endocrine glands. In men, genital I. is possible due to dysgenesis of the testicles and seminiferous tubules (see Klinefelter syndrome), cryptorchidism (see), as a result of damage or surgical intervention in the posterior part of the urethra in children. When assessing the genesis of late puberty, it is necessary to exclude genetic pathology.
Pathogenesis
Regardless of the etiology, the pathological process that causes a delay in the development of the organism is always mediated by a delay in the development of c. n. With. and insufficient functional activity of one or more endocrine glands with corresponding metabolic disorders. There is always underdevelopment of the organs of the reproductive system - primary (gonadal dysgenesis, Hypergonadotropic hypogonadism) or secondary (hypogonadotropic hypogonadism).
Hormonal deficiency can occur due to primary pathology of the endocrine organs (pituitary gland, thyroid, gonads), but more often it is associated with a violation of the central (hypothalamic) regulation of endocrine functions, which determines the pluriglandular (multiglandular) nature of the disease. The main symptoms of general I. are determined by a violation of the somatotropic and gonadotropic functions of the anterior pituitary gland and hormonal insufficiency, often secondary, of the gonads, as well as a delay in the development of c. n. pp., expressed in the weakness of active inhibition, insufficiency of cortical control over the activity of subcortical centers, the predominance of the first signaling system over the second.
How to deal with infantilism?
It is possible and even necessary to fight infantilism. This is not always an easy or quick process, however, its results can help significantly improve the quality of life of both the person himself and his loved ones.
There are different approaches to solving the problems of infantilism and they are primarily related to its etiology.
If manifestations of infantilism are associated with physiological reasons, then, first of all, it is necessary to consult a doctor who will prescribe competent drug treatment. After which you can contact a psychologist.
If the reasons for the manifestation of personal immaturity are related to psychological factors, then in this case a consultation with a psychologist is necessary. Let's look at this from both sides.
In the case when infantilism manifests itself in a child, consultation with a psychologist is necessary for both the child and his parents. A psychologist will conduct a diagnosis and find out what the main problem is. And a conversation with parents will help you understand where mistakes were made and jointly develop an education system that will help the child develop further without delays. It is quite possible that timely joint psychological consultation will help solve the problem of infantility, and the child’s development will gradually catch up with its peers. The psychologist will help the child learn new adaptive ways of social functioning.
With an adult, the situation is a little more complicated, but everything can be solved. If a person realizes that he has a problem that needs to be solved somehow, then working together with a psychologist can give significant results. The most important thing is not to be shy about seeking help from a qualified specialist and not to be afraid to work on yourself, because this can help significantly improve your quality of life.
But it is worth remembering that you cannot try to save a person from infantilism on your own, if you do not have a psychological education. You can tell him which specialist to contact and support him when he works with a psychologist. But you shouldn’t solve this problem yourself. A competent psychologist will carry out the necessary diagnostics, find out the cause of the disorder and think about how the person can be helped. Only in this case will the help be effective.
Clinical picture
The clinical picture depends on the etiology, damage to one or another system, the degree of developmental delay and the age at which the disease developed. The course of Infantilism (regardless of genesis) is chronic. Exposure to etiological factors in the prepubertal period leads to the development of general I., including sexual and mental I. However, sexual or mental I. can be the main wedge, a manifestation of the syndrome (partial I.).
Based on the principle of correspondence of the appearance, structure and size of the body to a certain period of normal development, M. Ya. Breitman (1949) distinguishes three forms: 1) I. in the narrow sense of the word - preservation of signs of infancy, 2) puerilism (lat. puer boy ) - preservation of the signs of the pre-pubertal period, 3) juvenileism (lat. juvenilis juvenile) - preservation of the signs of adolescence. Some authors highlight embryonicism - the preservation of embryonic characteristics (in premature babies).
General infantilism
The most striking symptom of general infantilism is retardation of height and weight while maintaining child-like body proportions: the body does not acquire the appearance and sexual development of an adult. According to D. G. Rokhlin (1931), with I., in contrast to pituitary dwarfism (see), we are talking only about insufficient growth (140-149 cm). Characterized by fragility of the skeletal structure (often bone age lags behind true age), thin skin that is not tender for age. Typically there is a sharp lag in the development of the external and internal genital organs; Secondary sexual characteristics are usually absent, sometimes weakly expressed. On the part of the internal organs, the greatest hypoplasia is found in the cardiovascular system (narrow aorta, drip heart), blood pressure is often lowered. There is often a delay in intellectual development.
Sexual infantilism in women
Sexual infantilism in women is expressed in the underdevelopment of the reproductive system (partial). The main wedge syndrome is hypogenitalism (see Hypogonadism): delayed development of the external and internal genital organs, the mammary glands and other secondary sexual characteristics are undeveloped or poorly developed, the menstrual cycle is disrupted (see) according to the type of oligo-, opsomenorrhea, possible dysfunctional uterine bleeding (see), amenorrhea (see), infertility (see) or spontaneous abortion (see).
A gynecological examination reveals insufficient development of the clitoris, labia majora and minora, a narrow, short vagina, insufficient depth of the vaginal vaults, and a thin vaginal mucosa with mild folding. The cervix is elongated and conical. The body of the uterus is reduced in size, located high in the pelvis, and often tilted to the side. Sometimes only the uterus is underdeveloped with good development of the external genitalia and a completely female general physique. Sexual I. can be combined with general obesity or exhaustion. With sexual intercourse, there is constant pain in the sacral area, a feeling of pressure in the depths of the pelvis, pain during sexual intercourse, and decreased libido.
Body features depend on the genesis of I. Thus, growth can be low with gonadal agenesis of the Shereshevsky-Turner syndrome type (see Turner syndrome), normal or high with other syndromes. With the congenital form of hypogonadism, acrocyanosis, sometimes bedwetting and lack of smell are often observed.
Sexual infantilism in men.
Delayed sexual development in men is observed less frequently than in women; in men it is more often combined with general I. With short stature, there is an almost complete absence of secondary sex characteristics and underdevelopment of the genital organs. Patients look younger than their age, have a fragile physique, and retain a high-pitched voice; hair on the face, pubis and armpits is weak or completely absent. The penis is conical in shape with transient phimosis (see). The scrotum is underdeveloped and depigmented. The testicles are small and have a jelly-like consistency. The prostate gland is so small that it is usually not detected by palpation. Sexual desire, spontaneous and adequate erections (see) and emissions (see) are absent. Sometimes erections occur, but with a small penis, sexual intercourse is difficult.
Partial Infantilism
- predominant underdevelopment of the genital organs - can be observed with clearly defined forms of primary and secondary hypogonadism. Wedge, the picture of partial I. is determined by the form of hypogonadism that underlies it.
Mental infantilism
Lasegue wrote that people suffering from mental illness remain “children for life”; Lauren noted that the disorders that make up mental illness relate more to the entire constitution than to individual systems of the body.
Mild signs of mental illness can also occur in normal physical conditions. development. In patol, cases, the features of mental I. are due to the variety of etiol and pathogenetic factors, the conditions under which it manifests itself.
Various classifications of forms of mental I. have been proposed. A distinction is made between endogenous and exogenous I.; congenital and acquired I., “pure” constitutional I., associated with certain types of psychopathy; I., observed in endocrine diseases; I. for organic brain lesions; I., associated with somatic diseases or damage to individual organs (liver, kidneys, cardiovascular system); I., associated with mental illness (schizophrenia, epilepsy, etc.), as well as psychogenically caused infantilization under the influence of improper, pampering upbringing.
G. E. Sukhareva distinguishes harmonious, disharmonious and organic infantilism. V.V. Kovalev distinguishes between simple, or uncomplicated, and complicated mental illness; complicated I. includes cerebrasthenic, neuropathic, disproportionate (a combination of mental I. with partial physical acceleration), as well as mental I. in combination with severe underdevelopment of the emotional-volitional sphere. It is also proposed to distinguish between partial and total mental I.; I. as immaturity that exists throughout life, I. as a manifestation of delayed maturation, which is overcome with age.
Wedge, the picture of mental I. can be conditionally divided into the most general symptoms and into signs associated with the characteristics of the nosological affiliation. In the picture of general I., the features of childishness are equally manifested in both the physical and mental make-up of the patient (psychophysical I.), while both signs of immaturity are harmoniously combined. In infantile children, not only is there a lag in height and weight, but they also retain body proportions, features of facial expressions, gestures and psychomotor skills characteristic of an earlier age. In the mental makeup, the immaturity of the emotional-volitional sphere comes to the fore; with relative preservation of intellectual development, thinking is characterized by concreteness, immaturity of judgments, a predominance of superficial associations and weakness of abstract thinking. The ability for intellectual tension and concentration of attention is weakly expressed, rapid fatigue occurs from activities that require volitional effort, with tirelessness in games. There is instability of interests, a constant desire for change, a special desire for new sensations and impressions (“sensory thirst”). Characterized by spontaneity and inconsistency in statements and actions, insufficient independence, and increased suggestibility. The mood is unstable, affective outbursts easily occur, which also quickly pass.
Disharmonic Infantilism can be designated as psychopathic I., because manifestations of I. are organically included in the structure of a psychopathic personality, often hysterical and unstable. The features of the child’s psyche in these cases are especially sharpened, the disharmony of mental properties, irritability and imbalance, the inability to control one’s behavior, which is subordinated primarily to the desires of the present moment, clearly appears. In addition to the immaturity of thinking, there is a predominance of imagination over logic; traits of mental immaturity are combined with normal or even advanced physical. development and accelerated puberty.
With organically caused I., mental immaturity appears against the background of organic failure caused by encephalopathy or hron, an organic process. In these cases, mental illness manifests itself along with signs of organic psychosyndrome. Irritable weakness, increased exhaustion, weakening of memory and attention are clearly evident.
Features of mental illness in endocrine pathology are determined primarily by the symptoms of the underlying disease; mental disorders in these cases are different. With congenital hypogenitalism, the most characteristic features of children are the inability of children to exert long-term volitional tension, a tendency to reason instead of act, and emotional lability with a general complacent background of mood. Frivolity and increased self-esteem, boasting are combined with a feeling of inferiority. There is extreme lack of independence and suggestibility, absent-mindedness, slowness and clumsiness of movements. Pituitary subnanism is characterized by a combination of a childish appearance with age-inappropriate solidity (“little old people”); There is a change in depressive and euphoric states, secrecy and distrust. Along with this, increased suggestibility, insufficient independence, and instability of behavior characteristic of I. are manifested.
In schizophrenia that develops at an early age, the signs of general I. and schizophrenia are combined. In other cases of schizophrenia, manifestations of I. appear along with symptoms of the defect as an expression of personality regression. Wedge, I.’s originality is manifested in a special pretentiousness and mannerism, eccentricity of appearance and behavior (exaggerated disharmony up to caricature).
I., noted in some cases of epilepsy in children, is found along with symptoms of personality changes and dementia characteristic of epilepsy.
Mental I. in chronic, somatic diseases manifests itself in the form of cerebrasthenic, disproportionate variants and in combination with pronounced underdevelopment of the emotional-volitional sphere.
Infantile behavior, caused by incorrect, pampering upbringing, is characterized by egocentrism and capriciousness. The constant desire for recognition and sympathy stems from narcissism; unjustified claims are combined with helplessness and sometimes with defenselessness, that is, there is a general failure, despite full intelligence.
The danger of infantilism
The main danger for a person suffering from infantility is, of course, social maladjustment. As a result of the fact that it is difficult for such people to adapt to the world and people around them, they often find themselves alone, and they may have a feeling of inferiority and uselessness. This can ultimately lead to various kinds of neuroses and depression, which in some cases end in suicide.
For a child who was indulged in everything in childhood and protected in every possible way from difficulties and troubles, the frustrating circumstance will be that in adulthood he will have to decide everything himself, and no one will fulfill his wishes on demand. And this again will lead to the fact that such a person will be rejected by society. As a result, the risk of developing neuroses and depressive states with all the ensuing consequences increases.
In professional activities, such people also, as a rule, do not achieve significant success. They do not know how to navigate emergency, extreme situations, and often shift the solution to problems that arise onto the shoulders of their colleagues. In this regard, infantile people rarely occupy good positions and are fired quite often. Losing a job for people with this type of disorder is also akin to a disaster. It is very difficult for them to navigate what happened, adequately assess the reason for the dismissal and start looking for a new job. They, as a rule, blame the employer for their dismissal and go into their feelings about the injustice of what happened. Many never start looking for work, plunge into depression, start playing computer games, trying in this way to escape the reality that oppresses them. The financial situation is deteriorating, which leads to the fact that such people try to find a person who can be their dependent.
For those around them, infantile people do not pose a danger as such. As a rule, the main difficulties arise as a result of their immaturity and impaired social adaptation. At their core, they are big children, and in their professional activities such workers are ineffective in many areas. Any difficult situation can unsettle them and deteriorate the quality of work, which is undesirable for the employer. On the other hand, violations of social adaptation will lead to the fact that it will be difficult for such a person to join the work team and build adequate relationships with colleagues. And this will lead to industrial conflicts, which in turn will be very undesirable for the employer.
As for family life, as a rule, infantile people are afraid to take responsibility and get married and have children. But if this does happen, then you cannot rely on such people in family life. They are unlikely to be able to be the head of the family, they are unlikely to be able to fully provide for themselves and their loved ones, or cope with the difficulties that arise. And besides, a child raised in a family where there is an infantile parent is also highly likely to become infantile. Or he will form a misconception about the role of the mother or father in family life. Girls who grew up in a family with an infantile mother are highly likely to copy her infantile behavior when building their family life. If the father was infantile, then there is a high probability that such girls will choose infantile men in the future, since such a pattern of behavior will be the only possible one for them. The same thing happens with boys.
In addition, if it so happens that both parents are immature individuals, then the personal development of their child will also suffer. In almost one hundred percent of cases, the child will be infantile at best. In the worst case, mental retardation may also be added to this, or deviant behavior will begin to appear.
Diagnostics
Clinically, the diagnosis of Infantilism is made on the basis of the absence of secondary sexual characteristics at the age when they should develop during normal growth of the body. X-rays can reveal a delay in bone age. Sexual I. is established based on signs of underdevelopment of the genital organs. With bicontrast gynecography (see), women find a decrease in the uterine cavity, an elongation of the cervical canal, long, narrow, tortuous fallopian tubes, and reduced ovaries.
To diagnose the causes of I. in men, a determination of the morphotype, testicular biopsy, etc. are carried out. With severe sexual I., a decrease in the content of sex hormones is detected in the blood and urine. The determination of sex chromatin is of great importance (see); its absence indicates a male genetic type.
Laboratory studies often reveal anemia and lymphocytosis. For differential diagnosis of primary and secondary hypogonadism, the content of gonadotropins in the blood serum is determined to develop treatment tactics.
Manifestations of infantilism in life
Much has already been said about the behavior of infantile children and adults; now these topics need to be summarized.
The infantilism of children begins to manifest itself more clearly and noticeably at school age. Children learn worse and have problems concentrating. They may get up and leave in the middle of class or interrupt the teacher. Their play activities prevail over their learning activities. In communication with peers, infantilism manifests itself in the inability to control one’s behavior, in a direct reaction to what is happening around. Such children are gullible and naive. Often their social circle consists of younger children, since they are closer to them in terms of development.
Naivety and spontaneity also persist in adults. Their emotional reactions are not always adequate to the situation. In addition, in adults, infantilism manifests itself in an unwillingness to take responsibility for one’s actions. Such people rarely get married or start a family on their own initiative. In relationships, such people, on an unconscious level, will look for someone who can play the role of a parent, that is, care and patronize. In professional activities, immature individuals will avoid responsibility in every possible way. This category of people does not like to solve problems. When faced with difficulties, they either run away from them, or try to forget, or shift them onto the shoulders of other people. They are dependent on the opinions of others, so they are afraid of criticism and react very sharply to it.
Many psychologically immature people subsequently become dependents. Women find wealthy men who fully provide for them. Male infantilism often manifests itself in reluctance and inability to run a household. Such men will look for women on whom they can shift all the worries about the household.
Of course, for the most part, manifestations of infantilism do not pose a threat to the life and health of the person himself or his relatives and friends. But still, this phenomenon cannot be ignored.
Treatment
Treatment should be aimed at the underlying disease that caused the developmental delay. It is necessary to carry out therapeutic and health measures (improving living conditions, nutritious nutrition with an increase in the amount of animal protein and vitamins, therapeutic exercises, sanatorium treatment, limiting mental stress). Delicate correction of hormonal disorders and disturbances in protein metabolism is necessary (somatotropin, insulin, anabolic steroids, B vitamins, aloe, blood transfusions, etc. are prescribed). At the same time, treatment of genital I. is carried out in order to cause maturation of the genital organs, the formation of secondary sexual characteristics and normalize the functions of the gonads.
Therapy for sexual infantilism in women is determined by the degree and nature of ovarian dysfunction. For mildly expressed symptoms of I. and ovarian hypofunction with the presence of ovulation, cyclic hormonal therapy is indicated; Therapy with synthetic progestins has become widespread; Prescribe a combination of drugs such as Infecundin or Bisecurin (from the 5th day from the start of menstruation for 21 days, two or three courses in a row, then at intervals of 2-3 months).
With pronounced I. and uterine hypoplasia, Haller (J. Haller, 1971) recommends treatment with large doses of synthetic progestins for 4-6 weeks. This treatment is aimed at inhibiting the function of the hypothalamic-pituitary-ovarian system during hormone intake and is designed for subsequent activation of the function of this system according to the “withdrawal phenomenon” type. However, with pronounced inhibition of ovarian function, drugs that directly stimulate the function of the gonads are more often prescribed.
In 1961, R. B. Greenblatt proposed using Clomid (syn. clostilbegit - see Clomiphene citrate) to stimulate ovarian function; During treatment, the patient must be carefully monitored (examination and palpation of the abdomen, gynecology, research to determine the size of the ovaries, examination of functional diagnostic tests). If there is an effect, repeat courses of treatment are prescribed with increasing doses of the drug; In total, no more than 3-6 courses of treatment are carried out. In the absence of effect from treatment with clomiphene citrate, treatment with gonadotropins is indicated in patients with severe symptoms of I. and amenorrhea. Most clinicians recommend using this treatment under monitoring of estrogen concentrations in the blood or urine.
To stimulate sexual development in men, choriogonin is used in courses of 15-20 injections. In order to enhance growth, the use of anabolic steroids or small doses of androgens is recommended.
For mental disorders, neuroleptics, antidepressants, tranquilizers are also prescribed, as well as dehydration and other symptomatic therapy if indicated. Treatment and pedagogical measures are of great importance, especially for children and adolescents.
Egocentrism
The first sign of an infantile personality is egocentrism. Moreover, it is worth noting that the concept of egocentrism is not identical with egoism. A selfish person simply does not care about the feelings and needs of other people, while a person with pronounced egocentrism is not even able to understand the state and needs of another. For such people there is only one center of the universe - they themselves. And there is only one correct point of view - the point of view of the egocentric himself. The people around him seem to be present in this person’s picture of the world, but the egocentric is not able to understand these others. Their thoughts, feelings, hopes - all this is of no interest to the egocentric. The people around him are assessed according to the criterion of “usefulness - uselessness.” If a particular person satisfies the needs of an egocentric person and creates an atmosphere of comfort for him, then such a person is assessed as “good”, and if not, then he is assessed as “bad”.
For a small child, this position is natural - he has not yet learned to put himself in the place of another, has not learned to understand other people and accept their point of view. However, over time, the child learns to understand the world around him, he learns to appreciate the experiences of other people. This is probably why the behavior of an egocentric adult looks so unnatural: outwardly an adult, but acts like a child. And egocentrism does not have a positive effect on relationships, because establishing a relationship with a person who does not know how and does not want to understand you is not at all easy.
Forecast
The prognosis depends on the nature and possibility of eliminating the cause and severity of I. Restoration of normal development under the influence of treatment is usually observed in I., concomitant with endocrine diseases that respond well to hormone therapy (hypothyroidism, diabetes mellitus), and mild infantilism caused by malnutrition during the growth period . Normalization of the body's development process is questionable in chronic or rapidly progressive diseases, which are often difficult to treat. I. associated with impaired intrauterine development of the fetus or birth trauma is especially unfavorable prognostically.
general information
Mental infantilism is a pathology characterized by delayed emotional and personal development. The word "infantilism" comes from Latin. Means “infant, childish.” Essentially, this is a discrepancy between actions, emotions and feelings and age requirements. In ordinary life, an infantile person is naive, dependent on others, and often cannot cope even with common everyday problems.
Interestingly, mental infantilism syndrome is considered a separate disease in the International Classification of Diseases (ICD-10). Its name is infantile personality disorder.
In some cases, mental infantilism is a sign of neuroses and psychopathy. Sometimes this is a reaction to stressful situations. Of all patients, 1.6% are children. Moreover, there are equal numbers of boys and girls.
Prevention
Prevention involves preventing chronic infections, creating the right gig. and dietary conditions during the child’s development, exclusion of chronic intoxications in parents; proper upbringing prevents the occurrence of psychogenically caused mental infantilism.
Bibliography:
Breitman M. Ya. Clinical semiotics and differential diagnosis of endocrine diseases, p. 164, L., 1949; Bukhman A. X-ray diagnostics in endocrinology, M., 1974, bibliogr.; Vartapetov B.A. Primary (testicular) hypogonadism, Kharkov, 1973, bibliogr.; Zhukovsky M. A. Children's endocrinology, M., 1971; Clinical Psychiatry, ed. G. Grule et al., trans. with German, p. 706, M., 1967; Sokolov D. D. Endocrine diseases in children and adolescents, M., 1957, bibliogr.; Starkova H. T. Fundamentals of clinical andrology, M., 1973; Sukhareva G. E. Clinical lectures on childhood psychiatry, vol. 2, p. 208, 328, M., 1959; Teter E. Hormonal disorders in men and women, trans. from Polish, Warsaw, 1968; Wilkins L. Diagnosis and treatment of endocrine disorders in childhood and adolescence, trans. from English, M., 1963; Bleuler M. Endokrinologische Psychiatrie, in: Psychiatrie der Gegenwart, hrsg. v. HW Gruhle ua, Bd 1/1 B, S. 161, B. ua, 1964.
N. A. Zarubina; B. A. Vartapetov, A. N. Demchenko (yp.), M. I. Vrono (psychiat.), T. Ya. Pshenktaikova (gin.).
What it is?
Infantility, infantilism is immature behavior of a woman that does not correspond to her actual age.
There are two types of infantilism:
- physiological . With it, infantilism manifests itself, among other things, in appearance, when a person looks younger than he actually is;
- psychological _ In this case, the woman behaves in adulthood like a teenager.
At the same time, infantilism becomes a problem not only for the woman herself, but also for her environment.
