ENURESIS, EARLY ATTACHMENT AND INTIMACY

Enuresis is a common childhood problem which, although it causes considerable distress to both children and parents, nearly always responds to at least one of the available treatment modalities. These treatment options include behavioural techniques, cognitive therapy, medication and psychotherapeutic interventions. However, both behavioural treatment and pharmacotherapy have high relapse rates. In spite of the general acknowledgement that enuresis (especially secondary enuresis)indicates underlying psychological problems, few cases are described in the literature where a psychodynamic approach was used successfully. This is especially noticeable given the growing acceptance that enuresis is related to sub‐optimal parenting, poor child‐rearing practices and disruption of maternal care. The clinical vignette described is a case of secondary enuresis in a 10‐year‐old boy which responded favourably to psychodynamic input after behavioural, cognitive and family therapies failed to resolve the problem. The dynamic formulation postulated a desire for intimacy, following failed mother‐infant bonding due to maternal depression, which was obtained through enuretic symptoms and interpersonal conflict. This quest for intimacy through replication of early pleasurable somatic sensations and the utilization of conflict for attention‐seeking may rapidly develop into a repetitive cycle involving delinquency, crime and sexual perversions later in life. In such cases, a psychodynamic understanding is most likely to succeed as the enuresis represents an ego‐syntonic solution to possible ego‐fragmentation, or an attempt at preventing pending psychological breakdown.