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Medical condition
| Gratification Disorder | |
|---|---|
| Other names | infantile masturbation, benign idiopathic infantile dyskinesia, infantile gratification |
| Specialty | Pediatric psychiatry, pediatric neurology, child sexuality |
| Symptoms | vocalizations with quiet grunting, flushing of the face , sweating, crossing or flexing legs |
| Duration | variable |
| Causes | No known causes |
| Diagnostic method | Based on symptoms, presence of consciousness, stopping upon distraction |
Gratification disorder is a rare and often misdiagnosed form of masturbatory behavior, or the behavior of stimulating of one's own genitals, seen predominantly in infants and toddlers. Most pediatricians agree that masturbation is both normal and common behavior in children at some point in their childhood. The behavior is labeled a disorder when the child forms a habit, and misdiagnoses of the behavior can lead to unnecessary and invasive testing for other severe health conditions, including multiple neurological or motor disorders.
Signs and symptoms
The behavior of gratification disorder closely mimics that of a seizure, though the exact appearance varies. It often involves symptoms of flushing, or when the skin of the face becomes red, sweating, grunting, and erratic movements of the body. The child remains conscious during episodes of infantile masturbation and can be distracted from the behavior, which could help rule out the suspicion of a serious condition. Additional symptoms can include: rhythmic or rhythmical rubbing of genitals against objects or hands; a fixated or dazed gaze; straightening of the legs or crossed legs; and a pleasant feeling post-episode.
Duration and frequency of the episodes vary from as little as 5–10 minutes, to episodes reported to last 30–40 minutes. Some episodes occur weekly, while other reports document episodes occurring multiple times throughout a single day. In general, parents of children affected by gratification disorder noted an increase in both duration and frequency as time went on before an intervention, or remedy, such as behavioral therapy was introduced.
Because this behavior can be worrisome, the possibility of sexual abuse to the child should be thoroughly examined by parents and/or health care professionals to help determine that this is not the likely reason for this behavior. This masturbatory behavior tends to diminish with age, and as of 2023, there were no clinical trials that explore medical approaches or defined treatment options for gratification disorder.
Diagnosis
Gratification disorder may be unrecognized by both families and clinicians, possibly due to the absence of genital manipulation or physical touching of the genitals. Because of the inability to correctly recognize and diagnose gratification disorder, children are put at higher risk for more invasive testing because the disorder and its characteristics are largely misunderstood. Failure to correctly diagnose can lead to an increased risk of unnecessary testing or the use of potentially harmful medications, such as medications used for seizures or other neurological disorders.
Differential diagnosis
Little research has been published regarding this early childhood condition, but it is likely misdiagnosed when the child's bodily movements are of concern. The behavior can look different from case to case and does not always involve direct stimulation of the genitals, so the movements exhibited by the child can also resemble conditions such as epilepsy, a neurological condition that causes unprovoked and recurrent seizures; paroxysmal dystonia, a neurological disorder causing episodes of spastic movements that cause muscles to contract involuntarily; dyskinesia, a disorder involving the involuntary contraction of muscles; and gastrointestinal disorders, which would be health issues relating to the stomach or GI tract.
A strategy for differentiating gratification disorder, or infantile masturbation, from other movement disorders or seizure disorders is via direct observation. Usually in cases of gratification disorder, the physical and laboratory examination results are normal. Consciousness is also not altered in gratification disorder, which can be another key element in the differential diagnosis. Children with gratification disorder are likely responsive and should stop an episode upon distraction, which is not something that would be seen in movement or seizure disorders. Several studies stress the importance of direct observation and identifying features of gratification disorder to prevent unnecessary invasive testing and diagnoses.
Epidemiology
Most instances of gratification disorder occur from the ages of 3 months to 3 years but it can sometimes resurface in older adolescence.
References
- ^ Ibrahim A, Raymond B (October 2013). "Gratification Disorder Mimicking Childhood Epilepsy in an 18-month-old Nigerian Girl: A Case Report and Review of the Literature". Indian Journal of Psychological Medicine (Case report). 35 (4): 417–419. doi:10.4103/0253-7176.122247. PMC 3868101. PMID 24379510.
- Nemati H, Ahmadabadi F, Shahisavandi M, Farjoud Kouhanjani M, Rostamihosseinkhani M (March 14, 2022). "Treatment of Child Gratification Disorder". Iranian Journal of Child Neurology (Review). 16 (2): 9–16. doi:10.22037/ijcn.v16i2.35480. PMC 9047836. PMID 35497101. S2CID 248494534.
- ^ Nemati H, Ahmadabadi F, Shahisavandi M, Farjoud Kouhanjani M, Rostamihosseinkhani M (March 14, 2022). "Treatment of Child Gratification Disorder". Iranian Journal of Child Neurology (Review). 16 (2): 9–16. doi:10.22037/ijcn.v16i2.35480. PMC 9047836. PMID 35497101.
- ^ Nechay A, Ross LM, Stephenson JB, O'Regan M (March 2004). "Gratification disorder ("infantile masturbation"): a review". Archives of Disease in Childhood (Review). 89 (3): 225–226. doi:10.1136/adc.2003.032102. PMC 1719833. PMID 14977696.
- ^ Yang ML, Fullwood E, Goldstein J, Mink JW (December 2005). "Masturbation in infancy and early childhood presenting as a movement disorder: 12 cases and a review of the literature". Pediatrics (Review). 116 (6): 1427–1432. doi:10.1542/peds.2005-0532. PMID 16322167. S2CID 34015324.
- Mink JW, Neil JJ (July 1995). "Masturbation mimicking paroxysmal dystonia or dyskinesia in a young girl". Movement Disorders (Case report). 10 (4): 518–520. doi:10.1002/mds.870100421. PMID 7565838. S2CID 27538663.
- ^ Moktan S, Karki U, Bista I, Devkota N (June 2021). "Gratification Disorder Associated With Perineal Irritation in Young Children: Management and Short-Term Outcome". Journal of Psychosexual Health. 3 (3): 265–269. doi:10.1177/26318318211023321. ISSN 2631-8318. S2CID 237218172.
- ^ Satapathy AK, Das L, Biswal B (March 5, 2020). "Gratification behaviour: A seizure mimicker in children". Sri Lanka Journal of Child Health. 49 (1): 75. doi:10.4038/sljch.v49i1.8903. S2CID 216410435.
- ^ Leung AK, Robson WL (April 1993). "Childhood masturbation". Clinical Pediatrics (Review). 32 (4): 238–241. doi:10.1177/000992289303200410. PMID 8462237. S2CID 5573727.
- ^ Wolf DS, Singer HS (August 2008). "Pediatric movement disorders: an update". Current Opinion in Neurology (Review). 21 (4): 491–496. doi:10.1097/WCO.0b013e328307bf1c. PMID 18607212. S2CID 23533555.
- Nagy E, Hollody K (October 1, 2019). "Paroxysmal non-epileptic events in infancy: five cases with typical features". Epileptic Disorders: International Epilepsy Journal with Videotape (Review). 21 (5): 458–462. doi:10.1684/epd.2019.1098. ISSN 1950-6945. PMID 31649006.