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PubMed1980

Münchausen syndrome: a review and two case reports.

In the light of the pertinent literature, 2 illustrative cases of the Münchausen syndrome are presented. In both patients there had been dynamically significant losses in the oedipal age leading to an intense feeling of being rejected. Both patients also exhibited problems of dependence, perfectionistic attitudes toward the self, and fear of social failure. In addition, characteristics typical of alexithymia could be noted. As a dynamical interpretation it is proposed that in these patients basic helplessness and inadequacy of expressing feelings have been channelled into multiform psychosomatic symptoms. The latter in turn have caused continuous seeking for acceptable somatic etiology and treatment of the symptoms. Thus, gradually, the clinical picture of the Münchausen syndrome has developed.

Adolescent↗
PubMed1982

Explicit incestuous motifs in psychosomatic patients.

In this study, which is the first ever to deal with the issue of incestuous motifs in psychosomatic patients, the author reviewed the charts of all his psychosomatic patients, seen in at least 40 interviews between 1975 and 1980, and the charts of all his non-psychosomatic patients, seen in at least 40 interviews between 1970 and 1975, in order to determine the frequency of explicit incestuous motifs in each group. It was found that the motifs had been reported by more psychosomatic patients than non-psychosomatic patients. Also, it was found that the explicit incestuous motifs which had been reported by the psychosomatic patients were more intense and pervasive than those which had been reported by the non-psychosomatic patients. These findings are discussed with reference to the issue of failure of the ego's defense mechanisms in psychosomatic patients.

Adult↗
PubMed1982

Psychopathology and verbal expression in psychosomatic and psychoneurotic patients.

Psychopathology and verbal expression were investigated in 20 psychoneurotic patients and 20 psychosomatic patients (10 patients with ulcerative colitis and 10 patients with Crohn's disease). The Crohn's disease patients showed as much psychopathology as the psychoneurotic patients, but the ulcerative colitis patients showed significantly less psychopathology. However, the Crohn's disease and ulcerative colitis patients showed a similar reduction in verbal-emotional expression (alexithymia), when they were compared separately with the psychoneurotic patients. It was concluded that alexithymic characteristics are independent from other forms of psychopathology and may be more important in the pathogenesis of psychosomatic disorder.

Adult↗
PubMed1982

Social class and psychosomatic illness.

In six diseases considered psychosomatic (asthma, angina pectoris, migraine, duodenal ulcer, ulcerative colitis and anorexia nervosa), two factors have been studied: social background and social mobility. For none of the first five has any influence of social status on the disease been demonstrated. This means that social learning (norms and values) does not influence the disease. The psychological conflict is rooted earlier in life, before formative learning takes place. For anorexia nervosa, on the other hand, there is a marked difference. Social status plays a significant role, especially middle-class values, those of sexuality being the most important.

Adolescent↗
PubMed1984

Indication in psychotherapy on the basis of a follow-up study.

The problem of indication is a central one of psychotherapy research. Unfortunately up to now only few scientific results contribute to a therapist's decision in selecting patients for a specific therapeutic setting. Thus, indication and outcome research should be combined. A critical view on traditional research strategies demonstrates that psychotherapy research should replace the ideal of normative and general rules by the rational investigation of one's own therapeutic practice. From this point of view some results of the Heidelberg Follow-Up Project of 110 psychotherapies which were started on an inpatient and continued on an outpatient basis are presented. Based on the therapeutic changes of these 110 patients the question is investigated whether the decisions of the indications correspond with the therapeutic goals of the treatment models. Moreover, the question is discussed what kind of success a specific treatment model offers for 'problem patients'.

Adaptation, Psychological↗
PubMed1984

Identification of psychosomatic and psychic disorders in non-psychiatric in-patients.

In 322 in-patients from 5 different departments of the hospital of the Hannover Medical School the occurrence and characteristics of psychic disorders were studied. Patients were surveyed on 11 separate wards (medicine: 3; surgery: 2; neurology: 2; ear, nose and throat: 2; orthopaedics: 2). These patients represented about 78% of the actual population of the wards during a 3-week period. There was a selection bias because severely ill and patients older than 65 years were not surveyed. The screening was done by means of 6 self-report scales which were answered on 2 consecutive days. On the basis of conservative cut-off scores the amount of depressive disorders was estimated, within 5% confidential limits, between 16.1 and 24.9% of the patients of the total sample. Regarding the factor of social anxiety we found 20.7-30.3% of patients with this kind of disturbance. 9.3% of the patients scored high on both kinds of symptoms. So we had a total of 31.4-42.0% of patients with depressive or/and social anxiety disorders which should be treated by psychological means. In addition, all these measures varied for the patients in the 5 departments with the maximum of 49.2% in medicine and the minimum of about 32% in surgery and ear, nose and throat. These results offer a meaningful empirical basis for establishing different concepts of cooperation in the field of consultation-liaison activities. They are discussed with regard to the consequences for psychotherapeutic patient care in non-psychiatric hospital wards.

Adolescent↗
PubMed1985

Verbal measures of alexithymia: what do they measure.

Previous studies have shown that measurement of verbal affective expression is influenced by the method used for obtaining speech samples, thereby supporting a situation-dependent, or state concept of alexithymia. In this study monadic speech samples obtained from 20 psychoneurotic and 20 psychosomatic patients, using selected thematic apperception test (TAT) cards, were examined using different methods of content analysis. Although no differences were found with the Gottschalk-Gleser anxiety, hostility outward and hope scales, the psychosomatic patients had a more limited emotional vocabulary than the psychoneurotic patients as measured by an 'affect vocabulary score' (AVS). In contrast to the Gottschalk-Gleser scores (GGS), the AVS correlated with measures of fantasizing ability and would appear to be a more valid method of measuring alexithymia. The findings also supported a trait concept rather than a state concept of alexithymia.

Affective Symptoms↗
PubMed1986

Therapy motivation in anorexia nervosa: theory and first empirical results.

Anorexia nervosa patients are considered to be unmotivated for psychotherapy of eating disorders, because they present a lack of understanding and feeling for their disease. In order to objectify this lack of therapy motivation we formulated two questionnaires for patients and therapists. The items were obtained from 15 theoretically determined fields of both intra- and interpersonal subsets of motivation, and a 'motivation profile' was gained. In a first clinical application these profiles are obtained from an anorexia sample at the beginning and at the end of an inpatient treatment and combined with the corresponding therapist ratings. The results are compared with two control groups (preattended psychosomatics and somatic patients). Results collected hereby are used for the improvement of our questionnaires and for suggestions concerning further studies.

Adult↗