Conscious and unconscious identification of female anorectic patients in in-patient psychotherapy

Women are up to ten times more likely to develop anorexia nervosa (AN) than men. Psychoanalytic explanations of this disparity generally emphasize female identification problems due to unresolved conflicts with maternal representations. Based on clinical observation, we identify a subtype of AN patients characterized, first, by consistent idealization of the father who needs the patient for the fulfilment of his own narcissistic needs and, second, by the patient's need to be idealized by the father due to suffering in connection with early emotional malnutrition on the part of the mother. To illustrate this hypothesis, we present the case of a well-educated young woman displaying unconsciou…

Psychoanalytically-Oriented Inpatient Psychotherapy of Somatoform Disorders

Somatoform disorders have been neglected in psychoanalytic publications. Unlike the descriptive approach of DSM-IV and ICD-10, sophisticated psychoanalytical models have been proposed for many years explaining the development of physical symptoms without definable medical cause. Based on a review of the psychoanalytic models of somatization and conversion, this article explores difficulties in the medical and psychotherapeutic treatments of somatoform disorders. The unique tradition of psychosomatic inpatient treatment in Germany is illustrated by the psychoanalytic treatment setting at the University of Mainz. A case report of a somatoform patient shows how childhood trauma is activated an…

The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults

Introduction We investigated the impact of attachment distress on affect-centered mentalization in a clinical and a non-clinical sample, comparing mentalization in a baseline condition to mentalization under a condition of attachment distress. Methods The sample consisted of 127 adults who underwent inpatient psychosomatic treatment, and 34 mentally healthy adults. Affect-centered mentalization was assessed by analyzing participants’ narratives on interpersonal situations in a baseline condition with the Levels of Emotional Awareness Scale (LEAS), and an experimental condition inducing attachment distress with the Adult Attachment Projective Picture System (AAP). Unlike the LEAS, the AAP is…

Soziale Phobie – eine im psychosomatischen Ambulanz- und Konsildienst unterdiagnostizierte Angsterkrankung?

Social fears are common, whereas Social Phobia is diagnosed infrequently. Therefore, we compared the clinical diagnoses (ICD-10) in an outpatient and CL service of a psychosomatic university hospital to patients' self ratings in social fears on the Liebowitz Social Anxiety Scale (LSAS). Over the course of one year 688 patients could be characterized regarding their clinical diagnoses, LSAS-scores, symptom severity (SCL-90R) and psychosomatic complaints (GBB-24). Patients were assigned to three groups by their levels of social fears (LSAS). Social Phobia was diagnosed rarely by clinicians (5.5%), but generalized social fears (LSAS>60) were commonly reported by patients (14.6%). Patients with…

Ungesunder Lebensstil bei Patienten einer psychosomatischen Poliklinik und Konsilambulanz

Patienten mit psychischen Storungen haben ein hoheres Risiko fur die Entwicklung korperlicher Erkrankungen. Als wesentlicher Risikofaktor hierfur gilt ein ungesunder Lebensstil. Um praventive Ansatzpunkte zu finden, untersuchten wir, wie haufig ein ungesunder Lebensstil bei psychosomatischen Patienten vorkommt und wie dieser mit psychischen und somatischen Beschwerden zusammenhangt. Hierzu wurde die klinische Basisdokumentation der Jahre 2009–2011 von n=1 919 ambulanten psychosomatischen Patienten ausgewertet. Korperliche Inaktivitat war mit 62,4% das haufigste Lebensstilrisiko, gefolgt vom Rauchen (33,2%) und Adipositas (17,4%). Alle Lebensstilrisiken waren mit einer hoheren Symptombelastu…

Emotion Regulation and Mentalization in Somatoform Disorders

Alexithymia, characterized by deficits in the awareness and differentiation of emotional states, is hypothesized as underlying somatoform disorders. Mentalization as a construct investigated in cognitive psychology is defined as the ability to refer mental states of others in order to predict their behavior. Developmental psychologists claim that the ability to represent emotions mentally is the cornerstone for the emergence of mentalizing capacity. Therefore, linking alexithymia and mentalization, it is argued that patients with somatoform disorders may not only be hampered in their ability to be consciously aware of their emotions, but may also suffer from deficits in mentalizing capacity…

Neural Correlates of Deficits in Pain-Related Affective Meaning Construction in Patients With Chronic Pain Disorder

OBJECTIVE Psychological and neural mechanisms of the affective dimension of pain are known to be disturbed in patients with chronic pain disorder. The aim of this functional magnetic resonance imaging study was to assess the neurofunctional and behavioral measures underlying the ability to construct pain-related affective meaning in a painful situation by comparing 21 clinically and psychometrically well-characterized patients with persistent non-nociceptive somatoform pain with 19 healthy controls. METHODS The functional magnetic resonance imaging task involved viewing pictures depicting human hands and feet in different painful and nonpainful situations. Participants were asked to estimat…

The Social Phobia Psychotherapy Research Network

This paper presents the Social Phobia Psychotherapy Research Network. The research program encompasses a coordinated group of studies adopting a standard protocol and an agreed-on set of standardized measures for the assessment and treatment of social phobia (SP). In the central project (study A), a multicenter randomized controlled trial, refined models of manualized cognitive-behavioral therapy and manualized short-term psychodynamic psychotherapy are compared in the treatment of SP. A sample of 512 outpatients will be randomized to either cognitive-behavioral therapy, short-term psychodynamic psychotherapy or waiting list. Assessments will be made at baseline, at the end of treatment and…

Minimization of childhood maltreatment is common and consequential: results from a large, multinational sample using the childhood trauma questionnaire

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale-originally designed to assess a positive response bias-are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ's MD scale: 1) its prevalence; 2) its latent struc…

Dizziness: Anxiety, health care utilization and health behavior—

Background: Due to the lack of epidemiological data on the relation of dizziness and anxiety, we investigated the prevalence of dizziness and anxiety in a representative sample of the German population. We explored the consequences of comorbid anxiety for emotional distress, functional impairment, health care utilization, and health behavior in dizziness. Methods: By the end of 2006, we surveyed a total of 1287 persons between 14 and 90 years of age in their homes by trained interviewers with standardized self-rating questionnaires on anxiety (Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Mini-Social Phobia Inventory) and dizziness (Vertigo Symptom Scale). The sample was…

Treating anxiety disorders by emotion-focused psychodynamic psychotherapy (EFPP)-An integrative, transdiagnostic approach.

Anxiety disorders are characterized by high levels of anxiety and avoidance of anxiety-inducing situations and of negative emotions such as anger. Emotion-focused therapy (EFT) and psychodynamic psychotherapy (PP) have underscored the therapeutic significance of processing and transforming repressed or disowned conflicted or painful emotions. Although PP provides sophisticated means of processing intrapsychic and interpersonal conflict, EFT has empirically tested a set of techniques to access, deepen, symbolize, and transform emotions consistent with current conceptualizations of emotions and memory. Based on our clinical experience, we propose that an integrative emotion-focused and psycho…

Stationäre integrative Psychotherapie

Anfange der psychosomatisch-psychotherapeutischen Behandlung gehen in Deutschland bis in die 20er und 30er Jahre des vergangenen Jahrhunderts zuruck (Hartkamp u. Hildenbrand 2009, Tress 2005): Ansatze zur integrierten psychosomatischen Medizin wurden von Internisten und Neurologen u. a. in Heidelberg (Ludolf von Krehl, Richard Siebeck, Viktor von Weizsacker) und Berlin (Ernst von Bergmann, Kurt Goldstein) eingefuhrt, gepragt durch die Psychoanalyse; stationare psychotherapeutische Einrichtungen wurden von Ernst Simmel in Berlin-Tegel, Georg Groddeck in Baden-Baden und Frieda Fromm-Reichmann in Heidelberg begrundet. Nach deren Zerstorung im Nationalsozialismus wurden neue Ansatze nach dem Zw…

Affective Change in Psychodynamic Psychotherapy: Theoretical Models and Clinical Approaches to Changing Emotions.

Affective change has been considered the hallmark of therapeutic change in psychoanalysis. Psychoanalytic writers have begun to incorporate theoretically the advanced understanding of emotional processing and transformation of the affective neurosciences. We ask if this theoretical advancement is reflected in treatment techniques addressing the processing of emotion.We review psychoanalytic models and treatment recommendations of maladaptive affect processing in the light of a neuroscientifically informed model of achieving psychotherapeutic change by activation and reconsolidation of emotional memory.Emotions tend to be treated as other mental contents, resulting in a lack of specific psyc…

Does unresolved attachment predict functional cognitive impairments after the activation of attachment related anxiety?

Prevalence and determinants of online-sex use in the German population.

Introduction The unlimited access to sexual features in the World Wide Web has raised concerns about excessive and problematic online-sex use. However, little is known about antecedents of internet-sex use of different intensity. Based on a representative German sample of 2,522 participants between the ages of 14 and 97 years, the aims of the present study were (1) to determine the prevalence rates of online-sex users with the short version (ISSTGSV) of the Internet Sex Screening Test and (2) to associate online-sex use with anxious vs. avoidant partner attachment patterns and “Big Five” personality traits as potential antecedents. Results The ISST is a brief, one-dimensional and reliable m…

SOPHO-NET – Forschungsverbund zur Psychotherapie der Sozialen Phobie

This paper presents the Social Phobia Psychotherapy Research Network (SOPHO-NET). SOPHO-NET is among the five research networks on psychotherapy funded by "Bundesministerium fur Bildung und Forschung". The research program encompasses a coordinated group of studies of social phobia. In the central project (Study A), a multi-center randomized controlled trial, refined models of manualized cognitive-behavioral therapy (CBT) and manualized short-term psychodynamic psychotherapy (STPP) are compared in the treatment of social phobia. A sample of n=512 outpatients will be randomized to either CBT, STPP or wait list. For quality assurance and treatment integrity, a specific project has been establ…

Prevalence, correlates, and predictors of depersonalization experiences in the German general population.

The survey aimed to investigate the prevalence of depersonalization (DP) experiences, its sociodemographic characteristics and its associations with medical conditions, illness behavior, and potential etiologic factors. A representative face-to-face household survey was conducted. The sample consists of n = 1,287 participants aged 14 to 90 years. Sociodemographic variables, medical conditions, current mental disorders, health care utilization, and childhood adversities were assessed. A total of 1.9% participants scored in the range of clinically significant DP (DP-C) and 9.7% reported at least some impairment through DP (DP-I). DP-C/DP-I were strongly associated with depression and anxiety.…

Konsiliar-Liaisondienst und Ambulanz einer Psychosomatischen Universitätsklinik: Patientenzuweisung, Anlass der Vorstellung, Empfehlungen

Zusammenfassung {! Fragestellung:} Obgleich psychosomatische Kliniken an Krankenhausern in der Regel sowohl einen Konsiliar-Liaisondienst (CL-Dienst) als auch eine Ambulanz vorhalten, fehlen bislang direkte Vergleiche der beiden Versorgungsansatze. {! Methode:} Im Vergleich zwischen 750 Patienten eines Jahrgangs aus dem CL-Dienst und 617 Patienten aus der Ambulanz einer psychosomatischen Universitatsklinik werden Unterschiede zwischen den beiden Patientenkollektiven, Hintergrunde der Patientenvorstellung und Empfehlungen zur psychotherapeutischen Behandlung erhoben. {! Ergebnisse:} CL-Patienten waren mit ca. 50 Jahren alter als Patienten der Ambulanz (43 Jahre). Es zeigte sich im CL-Dienst …

Theory of Mind and Emotional Awareness Deficits in Patients With Somatoform Disorders

To explore whether deficits are present in the mental representation of emotion signals and whether these are related to more general deficits in Theory of Mind (ToM) functioning test. To test this hypothesis in patients suffering from somatoform disorders, we used the Frith-Happé-Animations Task (AT)-an established ToM measure. We previously demonstrated that somatization in psychiatric patients is associated with decreased emotional awareness as measured by the Levels of Emotional Awareness Scale (LEAS). These findings suggest that individuals with decreased emotional awareness often fail to experience affective arousal as feelings and instead experience emotional distress somatically.We …

Repressive Coping Style and Its Relation to Psychosocial Distress in Males With Erectile Dysfunction

ABSTRACT Introduction There is evidence that repressive coping adversely affects medical conditions such as coronary heart disease, hypertension, and bronchial asthma. Erectile dysfunction (ED) is known to have a severe and lasting negative impact on health, quality of life, and partnership. Although ED may be eminently threatening for the self-image of affected men, a repressive coping style and its consequences for their mental health and partnership has not yet been investigated. Aim Based on the presumption that the male self-image is threatened by ED, we expected men with repressive coping strategies—although reporting the same degree of impairments regarding their sexual function—to d…