Gratification disorder

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Gratification Disorder
Other names infantile masturbation, [1] benign idiopathic infantile dyskinesia, [1] infantile gratification [2]
Specialty Pediatric psychiatry, pediatric neurology, child sexuality
Symptoms vocalizations with quiet grunting, flushing of the face , sweating, crossing or flexing legs
Durationvariable
CausesNo known causes
Diagnostic method Based on symptoms, presence of consciousness, stopping upon distraction

Gratification disorder is a rare and often misdiagnosed form of masturbatory behavior, or the behavior of stimulating of one's own genitals, seen predominantly in infants and toddlers. [1] Most pediatricians agree that masturbation is both normal and common behavior in children at some point in their childhood. [1] [3] The behavior is labeled a disorder when the child forms a habit, and misdiagnoses of the behavior can lead to unnecessary and invasive testing for other severe health conditions, including multiple neurological or motor disorders. [1] [4] [5]

Contents

Signs and symptoms

The behavior of gratification disorder closely mimics that of a seizure, though the exact appearance varies. [4] It often involves symptoms of flushing, or when the skin of the face becomes red, sweating, grunting, and erratic movements of the body. [6] The child remains conscious during episodes of infantile masturbation and can be distracted from the behavior, which could help rule out the suspicion of a serious condition. [5] Additional symptoms can include: rhythmic or rhythmical rubbing of genitals against objects or hands; [7] a fixated or dazed gaze; [8] straightening of the legs or crossed legs; [8] and a pleasant feeling post-episode. [7]

Duration and frequency of the episodes vary from as little as 5–10 minutes, [8] to episodes reported to last 30–40 minutes. [7] Some episodes occur weekly, while other reports document episodes occurring multiple times throughout a single day. [7] In general, parents of children affected by gratification disorder noted an increase in both duration and frequency as time went on before an intervention, or remedy, such as behavioral therapy was introduced. [7]

Because this behavior can be worrisome, the possibility of sexual abuse to the child should be thoroughly examined by parents and/or health care professionals to help determine that this is not the likely reason for this behavior. [4] This masturbatory behavior tends to diminish with age, and as of 2023, there were no clinical trials that explore medical approaches or defined treatment options for gratification disorder. [3] [5]

Diagnosis

Gratification disorder may be unrecognized by both families and clinicians, [9] possibly due to the absence of genital manipulation or physical touching of the genitals. [9] Because of the inability to correctly recognize and diagnose gratification disorder, children are put at higher risk for more invasive testing because the disorder and its characteristics are largely misunderstood. [4] Failure to correctly diagnose can lead to an increased risk of unnecessary testing or the use of potentially harmful medications, such as medications used for seizures or other neurological disorders. [3] [4]

Differential diagnosis

Little research has been published regarding this early childhood condition, but it is likely misdiagnosed when the child's bodily movements are of concern. [3] The behavior can look different from case to case and does not always involve direct stimulation of the genitals, so the movements exhibited by the child can also resemble conditions such as epilepsy, a neurological condition that causes unprovoked and recurrent seizures; paroxysmal dystonia, a neurological disorder causing episodes of spastic movements that cause muscles to contract involuntarily; dyskinesia, a disorder involving the involuntary contraction of muscles; and gastrointestinal disorders, which would be health issues relating to the stomach or GI tract. [1] [4] [5]

A strategy for differentiating gratification disorder, or infantile masturbation, from other movement disorders or seizure disorders is via direct observation. [10] Usually in cases of gratification disorder, the physical and laboratory examination results are normal. [10] Consciousness is also not altered in gratification disorder, which can be another key element in the differential diagnosis. [11] Children with gratification disorder are likely responsive and should stop an episode upon distraction, which is not something that would be seen in movement or seizure disorders. [5] Several studies stress the importance of direct observation and identifying features of gratification disorder to prevent unnecessary invasive testing and diagnoses. [5]

Epidemiology

Most instances of gratification disorder occur from the ages of 3 months to 3 years but it can sometimes resurface in older adolescence. [1]

Related Research Articles

<span class="mw-page-title-main">Epilepsy</span> Group of neurological disorders causing seizures

Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. An epileptic seizure is the clinical manifestation of an abnormal, excessive, and synchronized electrical discharge in the neurons. The occurrence of two or more unprovoked seizures defines epilepsy. The occurrence of just one seizure may warrant the definition in a more clinical usage where recurrence may be able to be prejudged. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain. These episodes can result in physical injuries, either directly, such as broken bones, or through causing accidents. In epilepsy, seizures tend to recur and may have no detectable underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to the alarming nature of their symptoms.

<span class="mw-page-title-main">Convulsion</span> Medical condition where body muscles contract and relax rapidly and repeatedly

A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking. Because epileptic seizures typically include convulsions, the term convulsion is often used as a synonym for seizure. However, not all epileptic seizures result in convulsions, and not all convulsions are caused by epileptic seizures. Non-epileptic convulsions have no relation with epilepsy, and are caused by non-epileptic seizures.

Absence seizures are one of several kinds of generalized seizures. In the past, absence epilepsy was referred to as "pyknolepsy," a term derived from the Greek word "pyknos," signifying "extremely frequent" or "grouped". These seizures are sometimes referred to as petit mal seizures ; however, usage of this terminology is no longer recommended. Absence seizures are characterized by a brief loss and return of consciousness, generally not followed by a period of lethargy. Absence seizures are most common in children. They affect both sides of the brain.

A headache is often present in patients with epilepsy. If the headache occurs in the vicinity of a seizure, it is defined as peri-ictal headache, which can occur either before (pre-ictal) or after (post-ictal) the seizure, to which the term ictal refers. An ictal headache itself may or may not be an epileptic manifestation. In the first case it is defined as ictal epileptic headache or simply epileptic headache. It is a real painful seizure, that can remain isolated or be followed by other manifestations of the seizure. On the other hand, the ictal non-epileptic headache is a headache that occurs during a seizure but it is not due to an epileptic mechanism. When the headache does not occur in the vicinity of a seizure it is defined as inter-ictal headache. In this case it is a disorder autonomous from epilepsy, that is a comorbidity.

Landau–Kleffner syndrome (LKS)—also called infantile acquired aphasia, acquired epileptic aphasia or aphasia with convulsive disorder—is a rare childhood neurological syndrome.

Psychogenic non-epileptic seizures (PNES), also referred to as pseudoseizures, non-epileptic attack disorder (NEAD), functional seizures, or dissociative seizures, are episodes resembling an epileptic seizure but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disorders (FND) and are typically treated by psychologists or psychiatrists.

Non-epileptic seizures (NES), also known as pseudoseizures, non-epileptic attack disorder (NEAD), functional seizures, or dissociative seizures, are paroxysmal events that appear similar to an epileptic seizure, but do not involve abnormal, rhythmic discharges of neurons in the brain. Symptoms may include shaking, loss of consciousness, and loss of bladder control.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.

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<span class="mw-page-title-main">GLUT1 deficiency</span> Medical condition


GLUT1 deficiency syndrome, also known as GLUT1-DS, De Vivo disease or Glucose transporter type 1 deficiency syndrome, is an autosomal dominant genetic metabolic disorder associated with a deficiency of GLUT1, the protein that transports glucose across the blood brain barrier. Glucose Transporter Type 1 Deficiency Syndrome has an estimated birth incidence of 1 in 90,000 to 1 in 24,300. This birth incidence translates to an estimated prevalence of 3,000 to 7,000 in the U.S.

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<span class="mw-page-title-main">Paroxysmal kinesigenic dyskinesia</span> Medical condition

Paroxysmal kinesigenic dyskinesia (PKD), also called paroxysmal kinesigenic choreoathetosis (PKC), is a rare hyperkinetic movement disorder of the paroxysmal dyskinesias characterized by attacks of involuntary movements, which are triggered by sudden voluntary movements. The number of attacks can increase during puberty and decrease in a person's 20s to 30s. Involuntary movements can take many forms such as ballism, chorea or dystonia and usually only affect one side of the body or one limb in particular.

<span class="mw-page-title-main">Paroxysmal exercise-induced dystonia</span> Medical condition

Paroxysmal exercise-induced dystonia (PED) is a rare neurological disorder that belongs to the paroxysmal dyskinesias, a group of rare movement disorders that involve attacks of hyperkinesia with intact consciousness. It is characterized by sudden, transient, involuntary movements, often including repetitive twisting motions and painful posturing triggered by exercise or other physical exertion. The term paroxysmal indicates that the episodes are sudden and short lived and usually unpredicted, and return to normal is rapid. The number of reported cases of people with PED is very small leading to difficulty in studying and classifying this disease and most studies are limited to a very small number of test subjects.

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<span class="mw-page-title-main">Epilepsy in children</span>

Epilepsy is a neurological condition of recurrent episodes of unprovoked epileptic seizures. A seizure is an abnormal neuronal brain activity that can cause intellectual, emotional, and social consequences. Epilepsy affects children and adults of all ages and races, and is one of the most common neurological disorders of the nervous system. Epilepsy is more common among children than adults, affecting about 6 out of 1000 US children that are between the age of 0 to 5 years old. The epileptic seizures can be of different types depending on the part of the brain that was affected, seizures are classified in 2 main types partial seizure or generalized seizure.

<span class="mw-page-title-main">Infantile convulsions and choreoathetosis</span> Medical condition

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References

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  2. Nemati H, Ahmadabadi F, Shahisavandi M, Farjoud Kouhanjani M, Rostamihosseinkhani M (March 14, 2022). "Treatment of Child Gratification Disorder". Iranian Journal of Child Neurology (Review). 16 (2): 9–16. doi:10.22037/ijcn.v16i2.35480. PMC   9047836 . PMID   35497101. S2CID   248494534.
  3. 1 2 3 4 Nemati H, Ahmadabadi F, Shahisavandi M, Farjoud Kouhanjani M, Rostamihosseinkhani M (March 14, 2022). "Treatment of Child Gratification Disorder". Iranian Journal of Child Neurology (Review). 16 (2): 9–16. doi:10.22037/ijcn.v16i2.35480. PMC   9047836 . PMID   35497101.
  4. 1 2 3 4 5 6 Nechay A, Ross LM, Stephenson JB, O'Regan M (March 2004). "Gratification disorder ("infantile masturbation"): a review". Archives of Disease in Childhood (Review). 89 (3): 225–226. doi:10.1136/adc.2003.032102. PMC   1719833 . PMID   14977696.
  5. 1 2 3 4 5 6 Yang ML, Fullwood E, Goldstein J, Mink JW (December 2005). "Masturbation in infancy and early childhood presenting as a movement disorder: 12 cases and a review of the literature". Pediatrics (Review). 116 (6): 1427–1432. doi:10.1542/peds.2005-0532. PMID   16322167. S2CID   34015324.
  6. [ non-primary source needed ]Mink JW, Neil JJ (July 1995). "Masturbation mimicking paroxysmal dystonia or dyskinesia in a young girl". Movement Disorders (Case report). 10 (4): 518–520. doi:10.1002/mds.870100421. PMID   7565838. S2CID   27538663.
  7. 1 2 3 4 5 [ medical citation needed ]Moktan S, Karki U, Bista I, Devkota N (June 2021). "Gratification Disorder Associated With Perineal Irritation in Young Children: Management and Short-Term Outcome". Journal of Psychosexual Health. 3 (3): 265–269. doi: 10.1177/26318318211023321 . ISSN   2631-8318. S2CID   237218172.
  8. 1 2 3 [ medical citation needed ]Satapathy AK, Das L, Biswal B (March 5, 2020). "Gratification behaviour: A seizure mimicker in children". Sri Lanka Journal of Child Health. 49 (1): 75. doi: 10.4038/sljch.v49i1.8903 . S2CID   216410435.
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  11. Nagy E, Hollody K (October 1, 2019). "Paroxysmal non-epileptic events in infancy: five cases with typical features". Epileptic Disorders: International Epilepsy Journal with Videotape (Review). 21 (5): 458–462. doi:10.1684/epd.2019.1098. ISSN   1950-6945. PMID   31649006.