Sibling rivalry disorder: causes, symptoms, diagnosis, treatment

Most young children exhibit some degree of emotional distress following the birth of a younger sibling. Typically, this distress is mild and, in the absence of disruptions to parent-child relationships, resolves within a few months. Jealousy towards the next sibling can be persistent, emotionally distressing, and lead to maladjustment not only within the family but also beyond it.

ICD-10 code

F93.3 Sibling rivalry disorder.

Epidemiology

There are no exact data on prevalence, since not all children are monitored by psychiatrists.

Causes and pathogenesis

The presence of pathological character traits in the child, most often demonstrative and epileptoid types, excessive attachment to the mother, a long-term position of the only, beloved child in the family, imaginary rejection by the mother due to her excessive employment or poor health. Other factors associated with the birth of a child, affecting the child's position in the family and society (placement in a kindergarten, transfer to relatives for upbringing).

Symptoms

Emotional disorders can take many forms, but they are always based on jealousy and rivalry for attention and love from parents. This rivalry is accompanied by strong negative feelings towards the sibling. In mild cases, this may manifest itself in the absence of friendly relations with the younger child and attention to him. In more severe cases, rivalry is expressed in open anger and hatred, cruelty towards the younger sibling, up to causing him physical injury. This type of emotional and behavioral disorders is more typical for children with epileptoid character traits.

A fairly common form of the disorder is a tendency toward infantile behavior (children ask to be given a pacifier, swaddled, given the breast), up to a certain regression of behavior with the loss of previously formed skills (control of bowel and bladder function, the appearance of distorted speech). Children often copy the actions of a younger child, attract the attention of their parents (they stop eating, dressing themselves, or do it ineptly, as if needing help from their mother).

Confrontation and opposition in behavior with parents may arise. Often children deliberately behave badly, with disobedience and evil mischief, in order to attract the attention of parents. In affectively excitable children, outbursts of anger and dysphoric (melancholy-angry) mood are noted against the background of behavioral disorder. Aggressive actions towards the parents themselves, damage to things belonging to them are possible.

Emotionally labile children of preschool and primary school age often experience a fairly pronounced degree of anxiety and low mood with the formation of various psychosomatic disorders against this background. Their peculiarity is the appearance in the most traumatic environment (in the home where the youngest child is). In other relatives where there are no small children, psychosomatic disorders are usually not observed in school and preschool groups. In the absence of timely psychological and medical assistance, it is possible to develop a protracted depressive syndrome of the somatized depression type with a drop in activity, affecting school performance, and disruption of contacts with peers.

Diagnostics

The following criteria have been defined for sibling rivalry disorder:

• evidence of sibling rivalry or jealousy;
• beginning within 6 months following the birth of the youngest (usually the next) child;
• emotional disturbances that are abnormal in degree and/or persistence and are associated with psychosocial problems;
• duration of at least 4 weeks.

Indications for consultation with other specialists

In the presence of symptoms of sibling rivalry disorder, a combination of individual rational and family psychotherapy is effective. The family therapist should offer the child's parents a consultation with a psychotherapist. In cases of the development of persistent behavioral disorders or depressive syndrome, a consultation with a psychiatrist is necessary.

Forecast

The prognosis in mild cases is favorable. In the absence of complicating psychosocial situations, jealousy towards the younger sibling is softened and gradually reduced. In severe cases, in the absence of psychological and medical assistance to the family and the child, sibling rivalry disorder can continue for years.