Childhood asthma: a psychosomatic disorder? Some epidemiological considerations.

Epidemiologists with an interest in bronchial asthma, have given little attention to the psychiatric aspects of this condition, particularly as it occurs in childhood. Clinical impressions, rather than the results of systematic studies, are responsible for the fact that some paediatricians and psychiatrists have come to view the personality of the asthmatic child in terms of a stereotype engendered by a particular type of mother-child relationship (Abramson, 1954). Moreover, there is a general belief that asthmatic children are neurotic and that this neurosis is manifest in their general behaviour, but in fact there is conflicting evidence on this point (Harris and Shure, 1956; Leigh and Marley, in press) and no definitive information is available. Children corresponding to this stereotype, over-dependent on their over-protective mothers, anxious, tense, shy, afraid to show their emotions, yet at the same time intelligent, ambitious, and perfectionist, are not uncommon, but the evidence for the stereotype is lacking (Dubo, McLean, Ching, Wright, Kaufman, and Sheldon, 1961). Studies carried out on total populations (Kraepelien, 1954; Eriksson-Lihr, 1955) have stopped short of the examination of psychiatric correlates, while those that have looked at the prevalence of psychological factors in established asthmatics have in general based their studies on patients attending hospitals (Neuhaus, 1958) or, more rarely, general practitioners (Leigh and Marley, in press). Such patients may well be highly selected from the point of view of personality and neurotic illness, and total population studies have something to contribute in these areas. The findings of a study of this type form the material of the present paper.