Funnel chest. Psychological and psychosomatic aspects in children, youngsters, and young adults.

BACKGROUND: When considering the indications for operative correction of funnel chest, the first question is what is medically actually necessary, and what is founded simply on 'doctors opinion'. Furthermore symptoms are often only indirectly correlated with the basic illness. This paper suggests a possible way of objectivating the symptoms in 56 patients with funnel chest.

METHODS: According to the results of our retrospective examinations the differentiation between 'physical' and (merely) 'cosmetic' findings in the definition of indications for operation of funnel chests in children, youngsters and young adults, should be dispensed with. The symptoms of "funnel chest" can be of varied significance, according to the degree of deformity, ranging from cosmetic fault to a severe handicap. Definition of indication thus depends in each case on all-inclusive plus differential plus interlocking-systemic diagnosis. In the course of this, not only somatic data, but also psychosocial characteristics can be objectivated and quantified.

RESULTS: The results of our examinations show that the handicaps of a funnel chest influence all areas of life. Older children (over 11 years) display as a whole more psychological disorders. Along with specific embarassment reactions, social anxiety, feelings of stigma, limited capacity for work, orientation towards failure, reduced tolerance of frustration and temptation, limited capacity for communication and even markedly depressive reactions are observed.

CONCLUSIONS: The underlying deformity and the psychological reactions to it make a long-term psychotherapy necessary. This may be laid out methodically more simply and takes less time, when a permanent correction is brought about at operation.