Home > International Dictionary of Psychoanalysis > Encopresis

Encopresis is the name for problems with control of the anal sphincter after the age when such control is normally acquired (two or three years). The condition may be primary or secondary after a period of continence, and is characterized by bowel movements, usually during the daytime, under socially unacceptable conditions and excluding true incontinence, as produced by organic disorders of the sphincter or its related nerve structures. The term, used in clinical pediatric psychiatry, was introduced by Siegfried Weissenberg in 1926.

A clearer understanding of this symptom can be achieved by considering it in relation to the erotogenicity of the anal zone (Freud, 1905d), with its various components, including excitation of the mucous membranes and the pleasures derived from expulsion and muscular control. Michel Soulé views the erotization of retention as the central phenomenon. Non-renunciation of these instinctual satisfactions is rooted in the individual's conflictual relations with the people surrounding him during the period of toilet training—that is, the anal-sadistic stage, which is focused on issues of possession, on mastery of one's own body, and of others. The child's stools are cathected as a part of his or her own body and as representing internal objects; the subject refuses to give them up for exchange and instead saves them, often owing to a deficiency in symbolization that impedes the displacement of interest onto other objects. Anxiety plays a role, sometimes manifesting itself as a genuine defecation phobia with archaic contents, such as the destruction of internal objects, or the destruction of links, often in connection with the traumatic effects upon the child of intrusive parental fantasies or existential events involving loss.

Symptoms of encopresis can also arise from an inadequate cathexis of the body on the part of a child subject to some forms of deprivation. The secondary gains are proportionate to the involvement of the child's entourage: maintaining regressive ties to the mother; feelings of omnipotence; masochistic gratification. The failure of repression and the non-establishment of reaction-formations attest to the resistance of pregenital fixations to oedipal resolution—the definitive aim of toilet training, according to Anna Freud. Although encopresis can have a bearing on all types of psychopathology in the child, ranging from psychosis or perversion to quasi-normality, Bertrand Cramer has noted that the majority of cases involve neurosis.

GÉRARD SCHMIT

See also: Anality; Coprophilia; Eroticism, anal; Gift; Infantile neurosis; Libidinal stage; Mastery; Pregenital; Psychosexual development.