Sunday, September 19, 2010


When counselling children and parents sometimes one has to deal with the basics of life. That includes what goes in one end and what comes out the other and all the psychological problems that can be associated with either. What goes in one end can result in the eating disorders and what comes out the other end can result in the elimination disorders like enuresis (bed wetting) and encropesis (soiling).

Kahless, in the previous post comments about people taking control of their body through eating.

When the little child enters the world it has no control. Instead its life is controlled by mother and father. Well it hopes they control it because if they don’t then the child suffers and can even die. For instance it needs mother to control its eating by the provision of nutritious food or it dies. It needs mother to provide love or it psychologically suffers.

Big hair

However as it grows and develops it begins to need less control by mother. Until one day it realises that it does actually have some control. It begins to realise that it has something that mother wants. Mother wants it to take food into its mouth and then swallow that food. It now can exercise control over mother by choosing when to do that and when not. Hence food refusal can be a child exercising its control. This can form part of the eating disorder of anorexia.

As the child grows more so its little brain develops even further and when it reaches about 2 years of age it begins to make a major shift from maternal control to self control. This is a major and very important psychological task for the child to make. If it does not successfully achieve it then all sorts of psychological problems can develop.

Around the same age the child becomes ready for toilet training. When it learns to take control of its bladder and bowel. Up to that point it didn’t need to as it had a nappy and mother took care of those sorts of things.

hands connect

So the important psychological shift from maternal control to self control and control of the bladder and bowel can all get mixed up with each other. This makes it a potential psychological nightmare where numerous life long psychological problems can evolve from. And the child cannot do it just by itself, it is the mother child relationship that has to successfully traverse this rickety bridge over the river full of crocodiles.

If not successful the child can develop conditions like enuresis (bed wetting) and encropesis. Encropesis is the unintentional or intentional act of defecating or soiling self in places that are not appropriate.

(Note: There are a whole array of reasons when a child may become encropetic and I will only discuss a couple here).

I have always found the definition cited above a bit odd as in my view unintentional encropesis and intentional encropesis are two quite different psychological conditions that involve alternative psychological structures in the personality. However diagnostic systems like the DSM include them under the one title which probably leads to people using the wrong treatment at times. Maybe I should express my views to the DSM 5 people?

Hippo chase man

Two types of encropesis can either be anxiety based or anger based. The counsellor needs to make an assessment of the emotional basis of the child’s personality structure. Anxiety based encropesis with tend to result in unintentional soiling whereas anger based encropesis will tend to result in intentional soiling.

The human body is designed such that if people are placed under extreme stress then they can loose control of their bladder and bowel. Hence we hear people make statements like, “I was so scared I almost shat myself” or, “If you go on that roller coaster ride make sure you wear your brown pants”.

Some children who are anxious can develop encropesis and enuresis as an expression of this natural reaction of the body

Other children may be encropetic because they are angry. For a child (or adult) to intentionally defecate in its pants or on the floor can be a very oppositional and defiant act. Indeed it is hard to think of an act that is more oppositional to authority.

However there is one and that involves faecal smearing. This is where the child (or adult) smears its faeces over a wall of clothing or bedding and so forth. If a child displays a pattern of faecal smearing this indicates significant psychological maladjustment and professional assistance is required. It is such an anti social act and hence tends to be anger based rather than anxiety based.

shit creek

Encropesis can also be caused by a child not defecating for a many days. The child continues to eat so its bowel fills up such that it can no longer keep the faeces in. This is where the line between anger based encropesis and anxiety based encropesis can get blurry. Some children are very anxious so they develop a pattern of holding their lower abdomen and pelvic region very tight such that bowel movement is interfered with. Hence one gets the unintentional encropesis from anxiety based problems.

Some children refuse to defecate for the same reason other children do food refusal. It is a defiant act where it rebels against what mummy wants and thus takes control of its body in this way. This can result in unintentional encropesis as the bowel simply gets too full and this could be seen to have an anger basis to it. So there can be one type of unintentional encropesis that is anger based if these are the circumstances. However on most occasions unintentional encropesis is anxiety based and intentional encropesis is anger based.



  1. For a moment, I was anxious about what pictures you 'd find to illustrate the topic :)

    not only do I learn something new & interesting each time I land here. As late as approaching 40, I found out that the verb sh*t has an irregular past tense :)

    more seriously - my son is nearly 2 yo, I will have an eye on him with regard to this stuff :)

  2. Hi Tony,

    I didn't know there were suicide pact sites, like pro-ana sites.

    I thought you would be interested in this article.

    online suicide pact


  3. Yes Zbig. Finding photographs was difficult.

    Good to hear that you have a young son


  4. Ohh - there's a lot involved with the ins and outs of it all. Very interesting post thanks Tony

  5. More outs it seems Roses, lol!
    Hey, are you still studying ?