Original Article Familial psychological factors are associated with encopresis Devrim Akdemir, 1 S Ebru Çengel Kültür, 1 I ˙ nci Nur Saltık Temizel, 2 Ays ¸e Zeki 4 and Gülser S ¸ enses Dinç 3 Departments of 1 Child and Adolescent Psychiatry and 2 Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, 3 Department of Child and Adolescent Psychiatry, Ankara Children’s Hematology Oncology Training and Research Hospital, Ankara, Turkey and 4 Barıs ¸ Psychiatry Hospital, Nicosia, Cyprus Abstract Background: The aim of this study was to assess maternal psychiatric symptoms, family functioning and parenting styles in children with encopresis. Methods: Forty-one children with encopresis were compared to 29 children without any psychiatric disorder. Results: Higher maternal psychiatric symptoms were found in children with encopresis. The general family functioning and strictness/supervision in parenting were significant predictors of encopresis. Conclusions: Family functioning may be screened in children with encopresis, especially when standard interventions have had limited success. Identification and treatment of familial factors may enhance the treatment efficacy in encopresis. Key words encopresis, family functioning, maternal psychiatric symptoms, parenting, treatment. Encopresis is defined as both the voluntary and involuntary passage of feces in inappropriate places in a child aged ≥4 years, after medical causes have been ruled out, according to ICD-10 1 and DSM-IV-TR. 2 It is a common childhood disorder and has been reported as approximately 3% in general outpatient clinics, 3 and greater (4%) in developing countries. 4 Numerous studies reported emotional, behavioral and social problems 5–9 and comorbid psychiatric disorders 10,11 in children with encopresis. Despite the fact that encopresis is a common disorder associated with psychosocial problems, there are few publications that address the psychiatric and familial factors that might affect the development, maintenance or treatment of encopresis in children. Factors such as separation from the family, 4,12 difficult child temperament 13,14 and inappropriate or incorrect toilet training 15,16 have been reported to contribute to the development of toileting problems. Reports on parenting style in children with encopresis, however, especially surveys of children on the parenting styles of their parents, are scarce; this may be because encopresis is generally a disorder of earlier childhood. It may be useful to obtain reports of children about the parenting styles of their parents. Familial factors such as maternal depression and/or anxiety symptoms are associated with elimination disorders at school age. 4 Given that depression and/or anxiety reduces capacity to cope with stress, 17 elimination disorders may be accelerated or exacerbated. Ineffectual, disorganized and chaotic families might also have difficulty in handling encopresis symptoms. 6,18 Little work on family environment or functioning, however, has been reported. The aim of this study was to extend the previous litera- ture on the role of familial factors as components of encopresis. Thus, the present study assessed maternal psychiatric symptoms, mothers’ perception of family functioning, and perception of children regarding the parenting behaviors of their parents, in children with encopresis compared to children without any psy- chiatric disorder. We hypothesized that children with encopresis, when compared to children without any psychiatric disorder, would have (i) mothers with more maternal psychiatric symp- toms; (ii) an impairment in family functioning; and (iii) less strictness/supervision in parental parenting behaviors. Methods Participants The study group consisted of 41 children with encopresis and their mothers. The inclusion criteria were admission to the child and adolescent psychiatry outpatient clinic with a complaint of fecal incontinence and diagnosis of encopresis; lack of medical causes of encopresis; and volunteering for participation. The presence of a pervasive developmental disorder, a neurological disorder or mental retardation, and refusal to participate in the study were the exclusion criteria. Constipation was not an exclu- sion criterion because it is often associated with encopresis. Chil- dren with encopresis were evaluated by the Gastroenterology Unit of the Department of Pediatrics at Hacettepe University. There were no identified medical causes of encopresis in any children after physical examination and appropriate laboratory tests. Patients with encopresis were included in the study in order of application, so they were consecutive patients. The study group consisted of 46 children fulfilling the criteria and aged between 6 Correspondence: Devrim Akdemir, MD, Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey. Email: devrimak@hacettepe.edu.tr Received 20 March 2014; revised 26 May 2014; accepted 4 June 2014. Pediatrics International (2015) 57, 143–148 doi: 10.1111/ped.12427 © 2014 Japan Pediatric Society