Psychological and psychiatric aspects of nocturnal enuresis

Psychological factors play an important role in nocturnal enuresis. The comorbidity of enuresis and clinical mental disorders, as well as subclinical psychological symptoms is reviewed. In epidemiological, as well as clinical studies, 20-30% of all children with nocturnal enuresis have a manifest clinical disorder - two to three times higher than non-wetting children. Children with a secondary nocturnal enuresis carry the highest risk for a disorder, those with primary monosymptomatic nocturnal enuresis the lowest. Internalizing disorders are less common than externalizing ones. There is a specific association with ADHD. These disorders require specific treatment. In addition, subclinical emotional and behavioral symptoms are common. These will often recede upon attaining dryness and self-esteem can increase. A general screening for psychological symptoms and disturbances is recommended.