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Paper text:
a hiccup is an involuntary , paroxysmal , inspiratory movement of the chest wall , associated with contraction of the diaphragm and accessory respiratory muscles , with synchronous glottis closure the cause of such hiccups may not always be organic .
here we present a series of four cases in the pediatric age group , who presented with hiccups of psychogenic origin to our center and were treated accordingly .
table 1 depicts cases of the four children and adolescents presenting with psychogenic hiccups seen at the psychiatry outpatient clinic of a tertiary care hospital in north india , between july 2011 and december 2012 .
the cases were aged between 11 and 13 years ; three of them were male and one was a female .
three of the patients belonged to a rural background and all of them were from hindu nuclear families .
the duration of hiccups for which treatment was sought ranged from three to fourteen months .
the most common secondary gain that was identified in these cases involved parental acquiescence of school avoidance , lesser scolding from the parents , and getting eatables of choice .
the intelligence quotient ( iq ) was done for three of the cases and ranged from 74 to 84 .
the patients were managed by counseling and parental psychoeducation about the problem and cutting down the secondary gain .
two of the patients had improved on the same day when detailed assessments were done , and all of the patients had improved on follow up .
the cases highlight that in children and the adolescent age group , hiccups may present as a manifestation of psychological distress .
the psychogenic hiccups are classified under somatic autonomic dysfunction ( f45.3 ) according to icd 10 and undifferentiated somatoform disorder according to the dsm iv tr . whether the symptoms were intentionally produced can not be commented with complete accuracy , as the boundaries between unconscious and conscious productions of symptoms blur . yet , on assessment of the patient by trained psychiatrists , a diagnosis of psychogenic vomiting was considered the most appropriate in the above - mentioned cases .
in - fact psychogenic hiccups are considered a subtype of intractable hiccups ; the other causes of intractable hiccups being organic or idiopathic . in a series of 220 adult patients , about 22% of the cases seemed to have a psychogenic cause for intractable hiccups .
this is perhaps the first case series of psychogenic hiccups in children and adolescents from india .
these include a wide variety , ranging from hypnosis to yogic therapies to attempts at changing family situations and the family dynamics , among others . in the present cases ,
educating the family members to cut down the secondary gains helped substantially to reduce the symptoms .
the use of double bind and suggestion were also effectively used to treat the cases .
the cases described herein suggest that psychological factors may cause and exacerbate hiccups , and such patients can be effectively treated .
eliciting contributory psychosocial and emotional factors before subjecting a patient to extensive and potentially hazardous medical diagnostics would help in prudent clinical care .
such symptoms when present in children and adolescents require consideration to the developmental aspects and sympathetic understanding of the associated problems and stressors .
hiccups can be due to organic diseases or psychogenic causes . 
 psychogenic hiccup in children is an understudied area . 
 we report a series of four cases presenting with psychogenic hiccups to the psychiatry outpatient clinic of a tertiary care hospital in north india . 
 the cases were aged 11 to 13 years ; three of them were males and one female . 
 three of the patients belonged to a rural background and all of them were from hindu nuclear families . 
 the duration of hiccups for which treatment was sought ranged from three to fourteen months . the most common gains seen in two of the patients were , lesser scolding from the parents and getting eatables of their choice . 
 the patients were managed by counseling and psychoeducation about the problem and cutting down the secondary gain . 
 techniques of suggestion and double bind were tried . 
 two of the patients had improved on the day detailed assessments were done , and all of the patients had improved on follow up . 
 psychogenic hiccups in children and in the adolescent age group can be effectively managed by using non - pharmacological methods and appropriate education of the parents .