This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Miscellaneous, Subject name: Pediatrics
[{'content': 'Encopresis is associated with \nSelect and explain. \nA. Low socioeconomic class, B. Less than 4 year old child, C. Female sex, D. Severe emotional disturbances', 'role': 'user'}, {'content': 'Answer: D \nExplanation: (D) Severe emotional disturbances # Severe emotional disturbances> Encopresis (also known as paradoxical diarrhea) is involuntary fecal soiling in adults and children who have usually already been toilet trained. Persons with encopresis often leak stool into their undergarments.> Strong emotional reactions typically result from failed and repeated attempts to control this highly aversive bodily product.> These reactions then in turn may complicate conventional treatments using stool softeners, sitting demands, and behavioral strategies. The estimated prevalence of encopresis in four-year-olds is between one and three percent.> The disorder is thought to be more common in males than females, by a factor of 6 to 1.', 'role': 'assistant'}]