Attention Seeking Behaviour with Molluscum Cantagiosum and Juvenile Diabetes Mellitus

10 yrs old miss D.A. is a known case of juvenile diabetes mellitus (DM) and already under treatment with insulin pump in her body. Since one year ago she’s been   developing round papular eruptions on her face which were diagnosed as molluscum cantagiosum. There were total 12-13 molluscum situated on both sides of the face and one was on her left middle finger which was the oldest one.  Her parents have taken her for many treatments and 2-3 were cauterised, but reappeared. One of my patients who had benefitted from my treatment of the same complaint, referred them here. Miss D.A. stays in an  extended family of 10 members with mother, father, younger brother (4 yrs) grandparents, uncle, aunt and their children. Currently she is in fifth grade.There is a strong history of DM in the paternal family.

She has tendency to recurrent apthous ulcers every 15 days and hair fall issues. Her diabetes is well controlled with insulin. She was born of a planned pregnancy. It was a full term normal delivery, 3 kg at birth and she cried immediately after birth. All her developmental milestones were normal. She was detected for DM at the age of 18 months, when her appetite increased, her urine frequency was very high and she started losing weight.

Her mother says that the girl has been very cranky for 3-4 years, aggressive and will not listen. Gradually the anger is increasing and she becomes very violent and rude to her mother. Once she had written in her diary “I don’t like my parents.” She is argumentative and always feels that what she says is right. She will not accept others’ view point.

She is stubborn, starts crying if not listened to and her mood changes very fast. One moment she is very excited and the next she feels bad and will not talk. She expects a lot of things from us. If she does small things, like drawing, or study, she will show it to all the family members. She will ask again and again how it is and if appreciation or attention is not given, feels very bad, goes and sits alone becomes angry and talks rudely to the person.  She wants to be attended to first, before other children in the family. She is rude and moody and will say   things without thinking that it will hurt you. For example, one question (about craving) was asked of her twice.  She told the physician rudely, you have already asked me this question!

She says “All girls in my school call me Madhury Dixit, as I am very beautiful and they are all behind me.” She feels like a princess and dreams of a big palace and roaming around. She is always very well dressed. She is an extrovert, bold and talkative. She has no stage fear and loves to dance and get appreciation. She has to receive prizes or will weep. She is very active, wants to do dance, gymnastics etc.

F/H/O-Father – childhood asthma, hyperlipidemia, and premature baldness

PGF-DM/HT                                              PGM-ARTHRITIS

 

Analysis of the case and totality

If we analyse her behaviour –everything points towards having a very high self image, dominance, need for getting attention and appreciation. She gives lots of importance to herself and wants the same regard from others.

Delusion great /tall

Longing for good opinion of others

Needs praise and appreciation, flattering

Egotism/proud/selfishness/domineering

Irritable-rude insolent

If we go to materia medica of palladium we read:

Lippe was the first to turn the proving to account, and the mental symptoms provided his best guides. The chief characteristic of Palladium in the mental sphere is:

“Love of approbation,” which lays its victim an easy prey to slights real or imaginary, and easily gives place to a state of “wounded pride and fancied neglect”; irritability which often finds vent in violent expressions.

Love of approbation; seeks the good opinion of others and attaches great importance to them.

Keeps up brightly in company. Fond of the good opinion of others; also too much weight is laid on their judgement; therefore very excited in society, and her complaints are > in company, wants to be flattered.

Dreams: every night; of buildings; wide stairs; many rooms.

On 30/11/11—she was given——-palladium 30 1 dose repeated weekly in water.

Gradually all molluscum started disappearing

We did her psychology assessment and the report is as follows:

Psychology report

Chief complaints

• Behavioural problems

 

Background information

Diya was born of a full term normal delivery, she cried immediately after birth and her developmental milestones were achieved on time. She has Juvenile Diabetes. There is no consanguinity between parents. She lives in joint family with his parents, younger brother, cousins with uncle and aunt. Currently she is stubborn and has difficulty adjusting in most situations. She is attention seeking and has narcissistic personality traits. Socially, she tends to dominate peers. She performs well academically and is independent performing activities of daily living.

 

Behaviour during testing

Diya was co-operative during testing. She responded well to the test taker. She expressed her views towards family, environment, and peers well.

 

Tests administered and Results

 

CHILDREN’S APERCEPTION TEST (CAT)

The Children’s Apperception Test is a projective technique wherein the child is shown a few cards with figures on it to make stories and hence enabling him to project her feelings, emotions and inner needs on the card.

Diya was co-operative and enthusiastic while making stories. The stories had structure and were organized. She identified with herself on most stories as the hero and the theme involved stories about daily family living. Her perception of the environment is that of nurturance. She expressed feelings of ambition. Some needs expressed were that of dominance, achievement and understanding. Also, there were feelings of disappointment. She tends to use sublimation (transformation of negative to positive) and thought suppression as defences to deal with situations. Her relationship with her family members appears good. However, the stories suggest that she expects her mother to behave according to her desires and wishes.

 

Conclusion

As per the test conducted, Diya expressed feelings of dominance and independence on the test. Her relationship with her mother needs to be worked up along with expression of emotion towards family and peers. She has attention seeking and narcissistic personality traits. Individual and parental counselling would be feasible.

 

Recommendations

1. Individual counselling
2. Parental counselling
3. Compliance with medication

 

FU on 21/2/12 – No Molluscum, the hand molluscum was last to disappear. Apthous ulcer occasional and hair fall much better. Mother said that at mind level also she is becoming calm.

FU on 01/4/12  – One new molluscum, hence palladium 200 single dose was given.

FU on 27/6/12 – She received 3 doses of palladium 200 by this time. Palladium was also continued, keeping in mind her mental state. By this time everything was all right. According to her mother, she has more understanding, is more compliant and accepts things easily. I suggested they continue the treatment from a diabetes point of view, but they stopped treatment after that.

After one year her brother also happened to have molluscum and he was also brought for the treatment. At that time I had a chance to talk to her and to my surprise she answered all my questions very maturely and I could not see the old DA longing for appreciation. Mother said now there are no problems. Still she is moody sometimes and has her point of view, but is not childish.