|Year : 2014 | Volume
| Issue : 2 | Page : 161-163
Psychogenic hiccup in children and adolescents: A case series
Aseem Mehra, BN Subodh, Siddharth Sarkar
Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
|Date of Web Publication||29-Jul-2014|
Department of Psychiatry, Level 3, Cobalt Block, Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
Hiccups can be due to organic diseases or psychogenic causes. Psychogenic hiccup in children is an understudied area. We report a series of four cases presenting with psychogenic hiccups to the Psychiatry Outpatient Clinic of a tertiary care hospital in North India. The cases were aged 11 to 13 years; three of them were males and one female. Three of the patients belonged to a rural background and all of them were from Hindu nuclear families. The duration of hiccups for which treatment was sought ranged from three to fourteen months. The most common gains seen in two of the patients were, lesser scolding from the parents and getting eatables of their choice. The patients were managed by counseling and psychoeducation about the problem and cutting down the secondary gain. Techniques of suggestion and double bind were tried. Two of the patients had improved on the day detailed assessments were done, and all of the patients had improved on follow up. Psychogenic hiccups in children and in the adolescent age group can be effectively managed by using non-pharmacological methods and appropriate education of the parents.
Keywords: Adolescent, children, management, psychogenic hiccup
|How to cite this article:|
Mehra A, Subodh B N, Sarkar S. Psychogenic hiccup in children and adolescents: A case series. J Family Med Prim Care 2014;3:161-3
|How to cite this URL:|
Mehra A, Subodh B N, Sarkar S. Psychogenic hiccup in children and adolescents: A case series. J Family Med Prim Care [serial online] 2014 [cited 2020 Apr 9];3:161-3. Available from: http://www.jfmpc.com/text.asp?2014/3/2/161/137666
| Introduction|| |
A hiccup is an involuntary, paroxysmal, inspiratory movement of the chest wall, associated with contraction of the diaphragm and accessory respiratory muscles, with synchronous glottis closure  The cause of such hiccups may not always be organic.  Psychogenic causes of hiccups have been described in literature, but mainly in adults. Reports of hiccups of psychogenic origin in children and adolescents have been rare. Here we present a series of four cases in the pediatric age group, who presented with hiccups of psychogenic origin to our center and were treated accordingly.
| Case Report|| |
[Table 1] depicts cases of the four children and adolescents presenting with psychogenic hiccups seen at the Psychiatry Outpatient Clinic of a tertiary care hospital in North India, between July 2011 and December 2012. The cases were aged between 11 and 13 years; three of them were male and one was a female. Three of the patients belonged to a rural background and all of them were from Hindu nuclear families. The duration of hiccups for which treatment was sought ranged from three to fourteen months. The problem was episodic in three of the cases and continuous in one. The most common secondary gain that was identified in these cases involved parental acquiescence of school avoidance, lesser scolding from the parents, and getting eatables of choice. The gastrointestinal investigations, wherever conducted, were normal. The intelligence quotient (IQ) was done for three of the cases and ranged from 74 to 84. The patients were managed by counseling and parental psychoeducation about the problem and cutting down the secondary gain. Techniques of suggestion and double bind were tried. Two of the patients had improved on the same day when detailed assessments were done, and all of the patients had improved on follow up.
| Discussion|| |
The cases highlight that in children and the adolescent age group, hiccups may present as a manifestation of psychological distress. The psychogenic hiccups are classified under somatic autonomic dysfunction (F45.3) according to ICD 10  and undifferentiated somatoform disorder according to the DSM IV TR.  Whether the symptoms were intentionally produced cannot be commented with complete accuracy, as the boundaries between unconscious and conscious productions of symptoms blur.  Yet, on assessment of the patient by trained psychiatrists, a diagnosis of psychogenic vomiting was considered the most appropriate in the above-mentioned cases.
Intractable hiccups are similar, but not synonymous with psychogenic hiccups. In-fact psychogenic hiccups are considered a subtype of intractable hiccups; the other causes of intractable hiccups being organic or idiopathic.  In a series of 220 adult patients, about 22% of the cases seemed to have a psychogenic cause for intractable hiccups. 
The reported cases of psychogenic hiccups from India are few.  The reports of psychogenic hiccups in children and adolescents are also scarce worldwide. This is perhaps the first case series of psychogenic hiccups in children and adolescents from India.
Various treatments have been suggested for the treatment of psychogenic hiccups. These include a wide variety, ranging from hypnosis to yogic therapies to attempts at changing family situations and the family dynamics, among others.  In the present cases, educating the family members to cut down the secondary gains helped substantially to reduce the symptoms. The use of double bind and suggestion were also effectively used to treat the cases.
The cases described herein suggest that psychological factors may cause and exacerbate hiccups, and such patients can be effectively treated. Eliciting contributory psychosocial and emotional factors before subjecting a patient to extensive and potentially hazardous medical diagnostics would help in prudent clinical care. Such symptoms when present in children and adolescents require consideration to the developmental aspects and sympathetic understanding of the associated problems and stressors.
| References|| |
|1.||Kolodzik PW, Eilers MA. Hiccups (singultus): Review and approach to management. Ann Emerg Med 1991;20:565-73. |
|2.||Lembo AJ, Aronson MD, Eamranond P. Overview of hiccups. UpToDate. Waltham MA: UpToDate Inc; 2012. |
|3.||The ICD-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992. |
|4.||American Psychiatric Association. Diagnostic and Statistical Manual of mental disorders DSM-IV-TR (Text Revision). Washington, DC: American Psychiatric Association; 2000. |
|5.||Feldman MD, Cunnien AJ. Factitious disorder in medical and psychiatric practices. In: Rogers R, editor. New York: Clinical Assessment of Malingering and Deception; 2008. p. 128-44. |
|6.||Rousseau P. Hiccups. South Med J 1995;88:175-81. |
|7.||Souadjian JV, Cain JC. Intractable hiccup. Etiologic factors in 220 cases. Postgrad Med 1968;43:72-7. |
|8.||Bhatia MS, Agrawal P, Khastbir U, Rai S, Bhatia A, Bohra N, et al. A study of emergency psychiatric referrals in a government hospital. Indian J Psychiatry 1988;30:363-8. |
|9.||Bobele M. Interactional treatment of intractable hiccups. Fam Process 1989;28:191-206. |