[Childhood abuse experiences and chronic low back pain. Direct and mediated effects of childhood abuse in different pain dimensions of nonspecific chronic low back pain]. / Frühe Missbrauchserlebnisse bei chronischem Kreuzschmerz. Direkte und mediierte Effekte früher Missbrauchserlebnisse auf verschiedene Schmerzdimensionen chronischer nichtspezifischer Kreuzschmerzen.

BACKGROUND: Physical, sexual and emotional abuse in childhood and adolescence is considered to play a role in the etiology and generalization of chronic pain in adulthood. However, it remains unclear whether abuse is specifically associated with different dimensions of nonspecific chronic low back pain (CLBP) and if these associations are mediated by psychological symptoms. MATERIAL AND METHODS: A total of 103 patients with validated CLBP were assessed by pain drawing, the multidimensional pain questionnaire and the pain experience scale. The childhood trauma questionnaire was used to retrospectively screen for physical, sexual and emotional abuse in childhood and adolescence. Patients were also screened for symptoms of depression, anxiety and dissociation in order to look for possible mediators. RESULTS: Patients with CLBP who reported childhood abuse showed higher pain intensity, higher spatial extent of pain, higher affective and sensory pain sensation and more pain disability compared to CLBP patients who had not experienced abuse. However, multivariate analyses revealed that only the spatial extent of pain was directly associated with childhood abuse. Furthermore, a significant association between childhood abuse and sensory pain sensation was found to be mediated by symptoms of anxiety and dissociation. CONCLUSION: The influence of childhood abuse on CLBP is different for specific pain dimensions; therefore, CLBP should be faced as a complex construct that comprises different dimensions. Childhood abuse is suggested as a risk factor for spreading pain in CLBP persons; therefore, CLBP patients reporting additional pain locations might benefit from diagnostic and therapeutic interventions specific for childhood abuse experiences.

[The Tsunami of 2004: Diagnosis of trauma sequelae in primary care]. / Tsunami 2004: Diagnostik von Traumafolgen in der Allgemeinarztpraxis.

This report amplifies specific needs and concerns related to primary care for patients with trauma-related disorders who seek help at private practices. The review focuses on potential psychological sequelae in victims of mass emergencies, such as the Tsunami-Disaster of December 26, 2004 in the Indian Ocean. General recommendations for treatment of traumatically stressed patients are proposed, particular features of such treatment are outlined. Furthermore, potential comorbid disorders and possible future courses of trauma-related disorders are outlined. Finally, frequently used psychodiagnostic screening-methods in current psychotraumatology are introduced.

From object-relations theory to the theory of alterity: shame as an intermediary between the interpersonal world and the inner world of psychic structure.

Proceeding from a critical discussion of positions adopted in object-relations theory and of recent approaches to the understanding of shame (exemplified with reference to Wurmser's concept of shame), the paper demonstrates that intrapsychic structures should not be regarded as preconditions for shame but as themselves evolving in the first place from contact with experiential forms of the shame affect. The paper takes its theoretical bearings from object-relations theory and the theory of psychic structure, expanding the purview of these approaches by incorporating the reciprocity aspect and thus outlining a comprehensive "alterity theory." "Shame" is presented as an "interface affect," manifesting itself initially in the external interactional dimension and constituting the relational structure of "self-consciousness" via the internalization of the reciprocal relation between subject and object. From the angle of developmental psychology, three characteristic forms of such stages of internalization (identified by mythological figures) are described. (1) Narcissus, characterized by the absence of any reciprocal relation and accordingly termed "unreflected," (2) Tiresias, with a capacity for taking up the position of the vis-à-vis temporarily and looking critically at one's own self from that perspective, yet lacking the faculty of self-objectification without the help of the vis-à-vis. Self-objectification is therefore taking place in the interactional dimension. This stage is thus designated as "externally reflected." (3) Oedipus, who has reached the stage to be termed "self-reflected" or "self-referential." The gaze is directed initially toward the outside in search of external sources of guilt but then falls back upon the subject itself. The gaze "turns inward" (to use an experientially suggestive image) and in the mythology this is represented by Oedipus' self-blinding. The subject is capable of "critical," dissociating functions, in the sense of self-objectification, thus attaining to a capacity for self-recognition, self-criticism and self-judgement. These three stages are seen to be progressive, not mutually exclusive. Self-referentiality in the broadest sense is regarded as being hierarchically stratified.

[Operationalized Psychodynamic Diagnosis in a trial--results of multicenter acceptability and practicability study]. / Operationalisierte psychodynamische Diagnostik (OPD) in der Erprobung--Ergebnisse einer multizentrischen Anwendungs- und Praktikabilitätsstudie.

During a multicentric field trial involving 134 diagnosticans from 16 centres in a first phase and 38 diagnosticans from 5 centres in a second phase a preliminary version of the manual "Operational Psychodynamic Diagnosis (OPD)" was tested. Focussing on feasibility, practicability and interrater-reliability the different axes of the new system were assessed as comparatively easy to use. The goodness of fit for diagnostic categories and the confidence in the diagnostic process showed a sufficient acceptance of the system. The percentage and chance-corrected inter-rater-reliability coefficients were acceptable for the most axes. It could be demonstrated that interrater-reliability depends on the degree of experiences with the OPD approach. Therefore a systematic training is necessary to use the system.

[Structure and structural disorder]. / Struktur und strukturelle Störung.

One of the central tasks of psychodynamic diagnosis, next to determining intrapsychic conflicts, central relational patterns, and subjective forms of experiencing is assessing the psychic structure or the structural disorder. This article develops the structure term from object relationship theoretical, ego-psychological, and self-psychological concepts of psychoanalysis. This "Structure of the self in the relationship to others" thus obtained is described with six structural criteria (self-perception, self-control, defence, object perception, communication, attachment). In order to be able to distinguish the extent and the quality of structural disorders four structure levels of integration based on psychoanalytic experience in the out-patient and the in-patient setting are differentiated. A basis for an operationalization is then made; it is made in the system OPD (Operationalized Psychodynamic Diagnostics). First studies regarding practicalibility and reliability are promising.

[Collection of relevant data in psychoanalytically oriented inpatient psychotherapy--The Tiefenbrunn Documentation System]. / Die Erfassung relevanter Daten in der psychoanalytisch orientierten stationären Psychotherapie--das Tiefenbrunner Dokumentationssystem.

We inform about development of the Tiefenbrunn documentation system for inpatient psychotherapy. Aims and scaffolding of the system and some difficulties to make the system run are outlined. The newly developed instruments are sketched. Patients received a questionnaire concerning their social situation and their family of origin. At the same time therapists indicate symptoms, diagnosis, work ability, prognosis, pretreatments and chronification (diagnosis sheet I) and results of treatment (diagnosis sheet II) when patients leave. During treatment complementary therapy (as e.g. massage etc.) is documented. From 1988 on we have 230 variables on every patient in our computers. Actual and further use of the system is described.

[Rumpelstilzchen on the couch--an ensemble of shame, identity and father themes]. / Rumpelstilzchen auf der Couch--ein Ensemble von Scham-, Identitäts- und Vaterthematik.

The fairy-tale "Rumpelstiltsken" is investigated as to its hidden meaning. A method, already described in the literature, is applied which allows conclusions about the hidden meaning to be drawn on the basis of the fairy-tale's place and handling with the history of literature. The hidden meaning found for "Rumpelstiltsken" lies in the question as to how individuation is possible in a symbiotic mother-child relationship. The answer is given in the fairy-tale in that a third person is introduced, who is, however, not involved in the symbiosis. A metapsychological concept of shame is then formulated on the basis of this understanding of "Rumpelstiltsken".

[Psychosocial adjustment of paraplegics]. / Beobachtungen zur psychosozialen Verarbeitung einer Querschnittslähmung.

The present article is concerned with the description and discussion of the results from an investigation on 34 paraspastic of paraplegic male patients. Data on the quality and intensity of functional impairment of the bladder and the intestine and on disorders with regard to the sexual sphere as well as on their psychosocial compensation were obtained in a semi-structured interview of up to four hours duration. Subsequently the data were evaluated with the aid of descriptive statistics. Predominant were two modes of coping with the handicap: Young paraplegics and paraspastics suffering from a traumatic lesion overcame their functional deficits by means of instrumental compensation and almost all of them--after passing through a course of institutionally prescribed developmental steps--achieved a readjustment both with regard to their relationship with the opposite sex and to their professional career. Older handicapped whose lesions were caused by disease persisted in resignation or hypochondriac concentration upon their state of health and were socially isolated.

[Psychiatric and psychological aspects of Fahr syndrome]. / Psychiatrisch-psychologische Aspekte des Fahr-Syndroms.

The following article reports findings concerning a man who first developed symptoms in his late twenties that were later diagnosed as bilateral basal ganglia calcification. The man, now 53 years of age, shows symptoms of an alteration of his personality with despondency and nearly a total loss of drive. Earlier clinical reports assumed that the man's condition was due to a deterioration of his intelligence. The findings presented here, however, show that he had a normal IQ, and that the supposed deterioration of intelligence was only due to his loss of drive.

[Psychosocial processing of disease exemplified by multiple sclerosis. Results of an empirical study of 27 males]. / Die psychosoziale Verarbeitung einer Erkrankung an Multipler Sklerose. Ergebnisse einer empirischen Untersuchung an 27 Männern.

First, some details about the symptoms of Multiple Sclerosis and about theories concerning pathophysiology and etiology are described. After that, results of an enquiry into psycho-social coping mechanisms of 27 male patients living with Multiple Sclerosis are shown. In detail: To 85% of these patients micturation problems were a well-know experience. "Urging need to micturate" made it impossible for these patients to participate in public life and brought social isolation for them. A feeling of helplessness and impotence was caused by the symptom of unnoticed incontinence. No patient were divorced because of Multiple Sclerosis, but it seemed that some patients did not marry because of first symptoms of the disease. Changes in sexual functioning of these male patients depended upon the way of coping with sexuality generally by them, and was not merely a constant physiological defect. An investigation was also carried out about the length of time between first symptoms and the correct diagnosis, between the time of correct diagnosis and the time the patient was informed, as well as an investigation about the mourning process itself. For a better understanding of a patient having to cope with a chronic disease it is recommend to take into consideration also his premorbid life history.