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Encopresis

Question:

We have custody of my husband’s 9 year old daughter. She recently returned for a visit during her summer visitation with her mother. Her mother has been a cocaine user, exhibits bipolar behavior, has low self esteem and numerous personality disorders. Our daughter has told us many disturbing stories, domestic arguments, police coming to the house, etc., Last night we had her and she told us of one of her mother’s disorders which has me totally floored. She apparently enjoys defecating in public places, in parking lots, in the car in pizza boxes and coffee cans, in the garage, in our daughter’s bathroom and shower (refusing to clean it up – our daughter finally had to), in the living room, wherever she happens to be. Jennifer says she appears to be amused by it and makes no effort get adult diapers or even attempt to get to the bathroom in time. I asked Jennifer how often this occurs and she said, all the time – daily. My husband related the same such experiences with her although not as frequent as our child reports. He also recalls during his police training, in a psychological conference of hearing of this type of disorder. We have also seen this behavior exhibited in the Soprano’s HBO series. We are obviously quite concerned and need to find a name to this disorder so we can try to find help for her. Thank you for your help.

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Answer:

The proper DSM-IV category for this type of (disgusting!) behavior is Encopresis – which is defined by: A. Repeated passage of feces into inappropriate places (e.g., clothing, the floor) whether involuntary or intentional, B. At least one such event a month for at least 3 months., C. Four years or older, and D. Not due to another (medical) problem or to laxative abuse. Generally, this is a disorder of childhood (although obviously some adults will act in this way). It sounds like there is a whole lot of other stuff going on for this woman as well.

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p>It is questionable (in my mind anyway) as to whether someone who acts in this disorganized manner should have extended custody over a minor child. Have you considered calling child protective services (the child abuse people)? I would probably do so as a professional if I were confronted with such a situation.

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p>I’m no expert on Encopresis, but my best sense is that if there is help for it – it will come in the form of behavior therapy of some sort (and not in the form of a medicine, or standard ‘dynamic’ psychotherapy).

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