Folie à deux in the parents of psychosocial dwarfs: two cases.

Introduction and Purpose Though the term folie Ii deux (Lasegue and Falret, 1877; Gralnick, 1942) is not common in current psychiatric usage, the phenomenon is recognized from time to time. In its strictest sense it means that two people manifest identically the same symptom, often an idee fixe, or a shared delusion. There is no literature on folie Ii deux in connection with the syndrome of reversible hyposomatotropinism or psychosocial dwarfism (recently reviewed by Patton and Gardner, 1975). The purpose of the present report is to present evidence of pathological collusion which constitutes folie Ii deux in the parents of two separate families. Each family contains one psychosocial dwarf, a victim of child abuse. One parent initiates child abuse while the other condones it. The Nature of the Syndrome of Reversible Hyposomatotropic Dwarfism The presenting complaints of the syndrome are: failure of statural growth, which may be so extreme that at age 4~ a child has the size of a 12-month-old baby; failure of mental growth with apparent mental retardation; and various bizarre forms of behavior associated with self-preservation, such as eating garbage and drinking from a toilet bowl. In affected children, growth hormone secretion is deficient, but the deficiency is subject to reversal upon change of domicile as, for example, when the child is admitted to the hospital. This reversibility is the primary pathognomonic feature of the syndrome. It is accompanied by catch-up statural and mental growth, and by improvement in behavioral pathology. The behavioral pathology of the syndrome, in addition to disorders of eating and drinking, includes disorders of sleeping; disorders of elimination; pain agnosia; elective mutism; accomodation to somatic trauma; short-lived though infrequent temper tantrums; roaming; impaired IQ; impaired motor development; social distancing; delayed puberty; and, during the recovery phase, compensatory hyperkinesis. Temper tantrums, if present, coexist with affection-seeking and social compliance, as does the social-distancing behavior. The compensatory hyperkinesis appears as limit testing and coexists, during the recovery phase, with an increase in both intellectual and statural growth. The diagnosis of reversible hyposomatotropic dwarfism is definitively established not by laboratory or clinical findings alone, but by growth acceleration secondary to increased growth hormone secretion, following change of domicile. The syndrome evidences the clearest known example of a correlation between factors in the social and behavioral environment, on the one hand, and impairment of endocrine regulation of somatic growth as well as behavioral maturation, on the other. …