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ALTHOUGH encopresis or fecal soiling has long been recognized as a manfl. ifestation of emotional disturbance (3), its association with the development of megacolon has not been noted until recently (4). It is our objective, therefore, to extend our previous study by presenting our observations on ten children with both fecal soiling and megacolon which we believe constitute a specific syndrome.The introduction of an effective surgical treatment for congenital megacolon (Hirschsprung's disease) by Swenson (23) has rendered its differentiation from psychogenic megacolon of considerable clinical significance. This paper is presented, therefore, in an effort to facilitate such differentiation and to provide further understanding of this syndrome.Historically, the term encopresis was first employed by Weissenberg (28) in 1926, although the psychogenic basis for fecal soiling was recognized by Fowler (3) in 1882. Ostheimer (17) in 1905 observed three cases to be associated with severe constipation. Goodhart and Still (5) in 1905 suggested mental instability as a cause and found that frequently placement "away from home" led to a cessation of soiling.Morichau-Beauchant (15), Pearson (18), and von Glanzmann (27) suggested various psychologic mechanisms. These included "paragenital autoerotism," aggressive tendencies, anal sexuality, and anxiety neuroses. Thom (25), in a study of one patient, found the symptom to represent a reaction to jealousy and Pototzky (19), in another, thought that it represented a method of punishment of parents. Shirley (20), in a comprehensive study of encopretic children, reported his findings in 70 cases observed over a seven-year period. Though 26 of these were feebleminded and 10 of borderline intelligence, 33 of the group had IQ's of 80 to 130. The incidence was significantly higher in males.Shirley pointed out that "while a clearcut classification was not possible," many of the children came from unhappy homes, at least 12 of which were highly undesirable environments. Among the characteristics of the parents, he noted instances of overprotection, overanxiety, preoccupation with bowel function and use of manipulative procedures and cathartics. Eighteen of the 25 intellectually adequate children were in difficulty at school; reading disability was present in 5. One patient had typical X-ray and proctoscopic

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