DROMOMANIA (PORIOMANIA, FUGUES) The habit of running away or playing truant is in many eases merely the result of idleness or huproper training, without any morbid element.
In other cases, however, punishment both in school and at home is without avail and the habit has a pathologic cause. Epilepsy, which is a frequent cause of similar abnormalities in adults, is rare in children. As a rule a psychasthenia or psychopathic disability is at the bottom of the trouble. Hysteria is said at times to be responsible for similar vagaries (Pick), but we hesitate to adopt his view of these eases.
These attacks nf running away, when they rest on a psychasthenic basis, begin in a characteristic manner. The first time, and possibly the two or three succeeding times, the boy (the anomaly is much rarer in girls) is seized by an insurmountable feeling of unrest and is prevented from running away only by fear of punishment, ill treatment or the prospect of hard work. He roams about aimlessly, possessed only with the desire to go as far away as possible, begs his way, if necessary, and after a few days is either picked up in a state of squalor and extreme hunger and sent home again, or returns of his own accord after the psychic storm has abated. Consciousness is perfectly clear during the entire time, memory is intact, and the boy's behavior while he is on his wanderings quite rational. Not infrequently the children resort to lies while on these expeditions or after their return, in order to elicit pity or escape punishment.
In other eases the children run away not from fear, but because they are seized with an intense longing, amounting to "dysphoria," to roam about at their own free will or play with their friends. They often steal money- in order to carry out their purpose.
Later on the attacks of dromomania are brought on by the most trivial causes. The dysphoria or ill humor may even come on without any external cause that can be interpreted as a psychologic motive and its advent may betray itself to the attentive observer several days in advance by inattention, irritability and other psychic disturbances.
When the dysphoria ha.s reached a certain degree, a nervous discharge takes place and the child runs away. These cases often resemble the epileptic form of dromomania, although careful observation of the child's subsequent life fails to reveal anything that could be interpreted as epilepsy.
During the intervals between the "attacks" many children appear to be quite normal while others exhibit certain defects of character, such as a tendency to lie, cruelty, dishonesty and the like; or they show signs of slender intellectual endowment and are easily led away by bad companions.
In the diagnosis of psychasthenie dromomania we must exclude epilepsy on the one hand and mere lack of training on the other. Epi lepsy is excluded by the absence of other circumstances pointing' to the disease, such as isolated, typical convulsive seizures or, rarely, nocturnal enuresis. The question whether the bad habit is due to lack of training is determined by a study of the boy's environment and particularly his education. As we have already hinted, we do not consider that the hysterical form of dromomania in children has ever been proven.
The prognosis depends on the possibility of instituting suitable treatment, which in epileptiform conditions consists in giving bromides, and in the psychasthenic form in educational measures and in guarding the boy from the causes of dy.sphoria. In order to accomplish anything the boy in practically every case has to be sent to an institution or at least placed under altogether different surroundings.