In treating children with psychosomatic disorders, we noted that intractable patients share common characteristics, such as low self-evaluation and complaints of feeling disrespected or unwanted at school or home. We concluded that an evaluation axis, different from that used for diagnosis, is needed to understand the level of pathology and estimate the prognosis in such cases, and that evaluating self-esteem would be useful for this purpose. We attempted to quantify self-esteem in children with psychosomatic symptoms using Pope's 5-Scale Test of Self-Esteem for Children [5
], and examined the characteristics and prognosis of patients with low self-esteem [28
]. We review a part of this study below.
Although this study showed that low self-esteem across several different areas affects patient prognosis, results also indicated that low self-esteem in one area alone does not necessarily have a negative impact. Resnick [29
] noted that family and school contexts as well as individual characteristics are associated with psychological problems in adolescents. Our examinations led us to conclude that psychological problems are more likely to occur in children if there are problems in at least two of these three elements. Similarly, if self-esteem has been damaged in several different areas, then maladjustment to a degree that requires medical consultation is likely to develop and treatment is likely to be difficult. These results imply, however, that even children with many different issues can show improvement without necessarily improving self-esteem in all areas of life, that is, if their self-evaluations are augmented by acceptance by someone at home, school, or elsewhere.
Furthermore we are examining self-esteem in children with non-attendance at school using Pope's 5-Scale Test of Self-Esteem for Children. In this study self-esteem is compared between the children with non-attendance at school and those who attend school. Therapists and parents tend to think that self-esteem in children with non-attendance at school is low in Social Scale. However, in actually their self-esteem is significantly low in Academic Scale and Family Scale. We can support both areas with comparative ease using methods such as individual study guidance and change of relationships between family members. Evaluating self-esteem facilitate the establishment of tangible treatment plans.
Our institution uses Pope's 5-Scale Test of Self-Esteem for Children as part of the examinations and uses the same in our treatment. A case study is provided below.
Case study: 14-year-old male
Diagnosis: Irritable Bowel Syndrome, Generalized Anxiety Disorder
Process: The subject suffered from abdominal aches in June of the first year of middle school. His abdominal issues worsened over time and symptoms of anticipatory anxiety developed. Thus, the patient was prohibited from leaving the house. He visited our hospital in March of the following year with complaints of abdominal pains leading to school absence. He was diagnosed with irritable bowel syndrome and began medicinal treatment. Physical symptoms improved but the patient was afraid to go outside, and thus was unable to return to school. He began inpatient treatment in May of the third year of middle school. The patient completed Pope's 5-Scale Test of Self-Esteem for Children upon admission (Table ). After admission, he began interacting with others within the in-hospital classes and gained confidence in relationships with others. Upon reflection of his relationship with his parents, we were able to reaffirm that he was accepted within his family. He completed Pope's 5-Scale Test of Self-Esteem for Children again upon discharge, and showed improvement in areas other than Academic Scale and Body Scale. Conversely, because scores in Academic Scale continued to be low, the school was asked to focus on providing remedial study after he returned to school. Individual study guidance was given, and the patient graduated to high school. Medical problems stabilized and treatment was ended.