[Not Available]. / Hysterie und Borderline - Einige empirische Annäherungen an den "Paradiesvogel"/ Hysteria and Borderline - Some empirical approaches to the "bird of paradise".

The intention of the study is the empirical differentiation between "mature" and "immature" (borderline-) hysterics. 366 inpatients of the Department of Psychoso-matic Medicine of the Central Institute of Mental Health in Mannheim (university of Heidelberg) were diagnosed with regard to the existence of hysterical personality traits. 146 patients shared the criteria of the DOPSY-system for hysteria. This group was divided by assistance of the Bordcrlinc-Syndromc-Index (BSI) into a subgroup of n = 79 "mature" and a subgroup of n=67 "immature" Borderline hysterics. The distri-bution was validated by the Freiburger Personality inventure (FPI). Both groups are similar referring to age, gender and schooleducation. On the level of symptomatology we found the same feature of diagnoses in the area F40-45 in the ICD-10. Two third of the patients with hysterical personality traits have got an additional classification of personality disorder, but only 48% in the group of mature hysterics and 37% in the group of immature hysterics were classified by experienced psychoanalysists as his-trionic personality disorder (F60.4, ICD-10). With respect to risk factors in the life history we found that mature hysterics much more often were characterized by a loss of father in the first three years and the position of the eldest (and sometimes only) child. The results pointed to distinct developmental lines, which suggest, that the two hysterical groups can be differentiated by the style of coping and defense.

[Not Available]. / Wenn der Vater fehlt. Epidemiologische Befunde zur Bedeutung früher Abwesenheit des Vaters für die psychische Gesundheit im späteren Leben/ The missingfather. Epidemiological findings on the significance of early absence of the father for mental health in later life.

Facing the increasing number of single-parent-families we investigated the impact of fathers absence within the first six years of childhood on psychic/psychosomatic impairment in later life. We used data from the Mannheim Cohort Study on the Epidemiology of Psychogenic (neurotic spectrum) Disorders for a comparison of extreme groups with a favourable or bad course of clinical impairment. In adition we performed regression analysis of the long term course of clinical impairment for the total follow-up sample (mean follow-up intervall 11 years, N=301) with psychometric, clinical and childhood variables. The absence of the probands father (> six months within the first six years of life) was a significant independend predictor of clinical impairment in later life, accompanied by clinical and psychometric variables. A significant and increasing impairment existed even in 73 of 125 older probands (birth cohort 1935), who missed their father in early childhood. The sociopolitical implications of these findings are discussed.

[Indications for inpatient psychotherapy. When does your patient belong in a clinic?]. / Indikationen für die stationäre Psychotherapie. Wann gehört Ihr Patient in die Klinik?

Institutionalized psychotherapy is indicated for specific disorders, the treatment of which at certain times or phases cannot be implemented in the doctor's office. Further Indications are patient denial and lack of motivation, a need to remove the patient from a pathogenic environment, a need for outpatient treatment initiation, and, in selected patients, a crisis situation, when the symptoms become acute or when internistic reasons are present. When these positive indication criteria apply--apart from emergency and crisis situations--a mental and somatic pre-evaluation--best done by the admitting institution--should be part of the pre-diagnostic work-up.

[Results of genesis and diagnosis of schizoid disorders]. / Ergebnisse zur Genese und Diagnostik schizoider Störungen.

A group of 25 schizoid patients were compared with 76 neurotic patients and 103 healthy persons in terms of perceived parent imago and family dynamics. The following findings should be emphasized: 1. Schizoid persons can be distinguished well from other persons on the basis of their experience of family. 2. A clear delimitation of schizoid persons from neurotic persons is possible only when the factor of sex is considered. 3. Schizoid women differ from neurotic women in terms of their distinctive mother experience: The mothers of schizoid women are marked by a weak ego and are apprehensive and extremely permissive. 4. Schizoid men differ from neurotic men both in terms of a distinctive mother experience and a distinctive father experience. In their case, a negative mother imago is contrasted with an ambivalent father imago. Neurotic men, on the other hand, possess a mother imago nearly as positive as that of healthy men, although they do exhibit a distinctly more negative father imago. 5. Schizoid women differ from schizoid men in terms of a distinctively negative mother imago. Whereas the mothers of schizoid women are experienced above all as exhibiting a weak ego and traits of dependency, the mothers of schizoid men are perceived more as being strong and independent.

[Ulcerative colitis. A contribution to the discussion of causes]. / Colitis ulcerosa. Ein Beitrag zur Verursachungsdiskussion.

A group of patients with a sure diagnosis of colitis ulcerosa (n = 17) was compared with a same-sized group with eating disorders (anorexia nervosa/adipositas) and a group of neurotic patients who also had great physical complaints (n = 169) in regard to their strain experienced during childhood and youth. The groups are homogenous concerning age and sex. The results show that the colitis patients have a corresponding strain score to that of healthy persons and therefore lie far above the average strain score of neurotic people. We interpret this result as an indication that we have to view colitis ulcerosa as a somatic psychosomatosa and that the variance share of psychogenic influences should be judged as being rather low.

[Early risk factors in schizoid, neurotic and healthy probands]. / Frühkindliche Risikobelastung bei Schizoiden, Neurotikern und Gesunden.

The following results were obtained on comparing the genesis of schizoid, neurotic and healthy subjects: 1. The schizoid patients examined by us had experienced a greater total risk-associated stress during childhood and adolescence than the comparative groups. 2. Special risk-associated stress is due to: a) a stress-burdened family atmosphere (laden with conflicts within the family and burdened with diseases), b) stress originating from the mother (risks of old age and diseases), c) stress originating from siblings (large number of siblings, smaller age intervals, etc.), d) stress originating from the parents' low standard of education. 3. Schizoids can be separated from healthy subjects on the basis of the childhood risks assessed above. 4. Schizoids cannot be separated from the group of neurotics by the characteristics listed here. These are not schizoid specific risks but factors of general stress. 5. Marked sex-specific peculiarities were seen. a) These point to a higher degree of diagnostic separation between schizoid and neurotic men than between schizoid and neurotic women. b) Schizoid women cannot be distinguished from neurotic women on the basis of the criteria of genesis covered by our study. c) Schizoid men are easily separated from the two other groups of men. This is mainly due to a genesis of an instability of reference. This, therefore, appears as a genuine schizoid risk.

[What protects against neurosis? Results of a comparative study of neurotic patients with high risk factors and healthy probands]. / Was schützt vor der Neurose? Ergebnisse einer Vergleichsuntersuchung an hochrisikobelasteten Neurotikern und Gesunden.

In a study of 103 adult neurotic persons and a parallel control group of well persons comparable in terms of age, gender and occupation, a total of 48 patients was found to have had a background of extreme family conflict, while 32 of the persons in the control group came from like backgrounds. The persons in these two high-risk groups were examined for differences in their respective histories and in their present life circumstances. The healthy persons could be distinguished from the neurotic persons in the following various respects: 1. through a lack of single-risk factors during childhood and youth (e.g. very young mothers), 2. through an overall lower level of stress during childhood and youth, 3. through a more positive mother-imago, 4. through the presence of compensatory parental relationships, as well as 5. through avoidance-behavior in adulthood in which premature commitments which might otherwise be difficult to dissolve, are circumvented. The findings were further discussed with respect to the disparate family-dynamics to be found in the backgrounds of the patient group and the control group.

["Psychological only children"--neuroses and illness behavior in adulthood]. / "Psychologische Einzelkinder"--Neurose und Krankheitsverhalten im Erwachsenenalter.

Our first basic hypothesis concerning the increased " overindulgence " of the "only child" according to the psychological definition of the term (hereafter referred to as "only child") and his associated characteristic qualities, e. g. neurotic passiveness , attitudes of indolence and pretension , inclination toward substitute gratification, lack of control, and timid evasion, has not proved valid where our patients are concerned. The "only child" among our patients did not exhibit these qualities any more often than our other neurotic patients. In the male "only child" we observed a conspicuous psychopathologic accentuation with regard to his behaviour in personal attachments. Also, provided that age groupings are the same, he is more often unmarried than other male neurotic patients, and he exhibits patterns of contact and attachment which are characterized by suspicion and remoteness . There is no indication that the "only child" among our patients seeks medical advice earlier or with fewer mental reservations because of his being accustomed to take advantage of outside help. In contrast to expectation, the behaviour of the male "only child" with regard to accepting the assistance of others is characterized by extraordinary reserve. He is not reported ill as often as the other male neurotic patients nor does hospitalization for longer periods of time occur as frequently as with them. This is interpreted as an indication that the male "only child" is "healthier" than other neurotic patients and less frequently tends to inflict injuries upon himself. With regard to his qualifications in school and in his profession the "only child" is particularly advanced. The question is raised as to whether the literary stereotype of the " overindulged " only child is in need of a certain differentiation, at least with respect to the social background of the patient. Our "only-child" patients originate predominantly from lower social strata and do not exhibit the classical attitudes of overindulgence any more often than other neurotic patients. Possibly " overindulged " patients mainly descend from the upper social classes.

[Slight sibling age difference--a risk factor in the genesis of schizoid disorders?]. / Geringer geschwisterlicher Altersabstand--ein Risikofaktor in der Genese schizoider Störungen?

615 neurotic patients from two outpatient Clinics were divided into three groups: only children, siblings with minimal age difference group, siblings not of minimal age difference group. The following hypothesis were to be examined: The younger of two siblings with minimal age difference are at greater risk to develop schizoid disorders. The hypothesis was proved correct. Amongst our patients the younger of two siblings of minimal age difference were at a particularly high risk in becoming schizoid. In addition we found the following risiko configuration in the early developmental period. Frequently these patients originated from families with many children, the age difference to the next sibling is also minimal, the mother is frequently lost before the age of three and the father is often self employed. These results confirm the so called "hypothesis of neglect" as it is observed in the development of schizoid disorders. A reexamination of the result of this research is to be desired.

Anorexia nervosa and Turner's syndrome.

Publications about Turner's syndrome and anorexia nervosa are extremely rare. All of them, including a new case, are listed up and discussed under psychodynamic aspects. The conclusions drawn from these 21 cases might be essential for genetic counseling, hormonal treatment and psychotherapy in Turner's syndrome. (1) There is a connection between the beginning of the hormonal treatment and the onset of anorexia nervosa in Turner's syndrome. The anxiety during hormonal treatment is due to sexual feelings and the confrontation with the gender role. As the manifestation of anorexia nervosa ought to be taken into account the beginning of a hormonal treatment should be decided in individual context. (2) The early childhood of girls with Turner's syndrome is striking with respect to psychosocial constellations. Short stature and other deficits mean narcissistic wounds. Therefore understanding and affectionate parents are most important to them as they particularly suffer from conflicts with the family.

[Countertransference in schizoid disorders]. / Gegenübertragung bei schizoiden Störungen.

Twelve experienced psychoanalysts diagnosed during a depth-psychological examination of 604 patients, coming from two different outpatient institutions, distinct clinical schizoid personality traits of 65 patients (10.7%). A further analysis researched the contribution to patient and therapist bindings and influences on the diagnosis. With the aid of a step by step regressions analysis including "solid" patient and therapist data as well as countertransference reactions of the investigator, we were able to establish an accurate diagnostical model, which enables a correct assignment with the probability of 90%. The most important diagnostic criterion proved to be the countertransference of the investigators. This demonstrates that affective processes from the therapist side-should be assessed as a potent criterion that distinctively increases the validity of the diagnosis.

[Childhood stress and neurosis--results of a control group study]. / Kindheitsbelastung und Neurose--Ergebnisse einer Kontrollgruppenuntersuchung.

Biographical stress-risk was compared between a group of 68 neurotic-psychosomatic patients and a parallel control group matched in terms of age and sex. This risk rate was established using a so-called risk-index in which 8 known and variably weighted risk factors were taken into consideration. The following hypotheses were confirmed in the study: Neurotically ill persons show a higher stress-risk (risk-index) in their childhood and pre-adolescence than is found in healthy persons. A person's stress-index is related to the degree of neurosis (r = .42).

Schizoid and narcissistic features in personality structure diagnosis.

OBJECTIVE: This study examines the relationship between schizoid and narcissistic personality features. While the schizoid personality disorder seems widely accepted as a diagnostic category, the utility of the narcissistic personality disorder construct is under discussion. We regard schizoidism as a primary, structural disturbance of interaction with the world, whereas narcissism appears as a secondary phenomenon of self-organization and self-regulation. This study focuses on the question, whether these features are correlated or interact with each other in personality structure. METHOD: A standardized narcissism inventory is being applied to a group of schizoid and nonschizoid patients. RESULTS: Only 1 of 18 narcissism scales differentiates significantly between these patient groups. By cluster analysis, the group of schizoid patients is divided into two subgroups characterized by their higher or lower narcissism scores. These are contiguous to existing descriptions of an active/fighting and a passive/evading schizoid subtype. CONCLUSION: 'Schizoid' and 'narcissistic' personality features can be regarded as distinct, but complementary personality conditions.

[Stumbling-blocks: initiating a psychosomatic pain clinic]. / Schwellenprobleme Erfahrungen beim Aufbau einer psychosomatischen Schmerzsprechstunde.

OBJECTIVE: Despite psychosocial factors playing an important role in the course of chronic pain disorder, there is a noticeable imbalance between demand and availability of psychosomatic care for these patients. This led us to establish a psychosomatic pain clinic within the framework of our outpatient clinic at the Department of Psychosomatic Medicine and Psychotherapy at the Central Institute of Mental Health, Mannheim, Germany. A recent study aimed at the evaluation of sociodemographic variables, state of chronification, symptom load and psychiatric comorbidity. Additionally we wanted to determine whether existing conditions at our hospital can be considered suitable for those patients. METHODS: During the clinic's first year we assessed 40 consecutive patients based on a psychosomatic interview as well as a set of psychometric questionnaires (BDI, STAI, SCL-90-R). To detect differences between pain patients and psychotherapy inpatients, we compared the two groups in terms of sociodemographic variables and symptom load. RESULTS: Most pain patients were in advanced states of chronification, showing extensive psychiatric comorbidity, particularly anxiety and depressive syndromes. Drug addiction was found more infrequently. Use of the before mentioned questionnaires prevented us from underestimating existing anxiety syndromes. Pain patients differed substantially from psychotherapy inpatients in terms of age, education, family status and symptom load. CONCLUSIONS: Our examination routine effectively demonstrated the special needs of chronic pain patients. As there is significant demand for psychosomatic intervention in those patients, earlier referral appears highly desirable. As pain patients differ also greatly from the remaining hospital population, specialized therapeutic concepts must be developed.

[Emotional disorders. Stable mental health and chronic illnesses over a 10-year course in the general population]. / Seelische Störungen. Stabile Gesundheit und chronische Erkrankungen in der Allgemeinbevölkerung im 10-Jahres-Verlauf.

In a comparison of extreme groups 124 german inhabitants of the city of Mannheim were investigated. They descended from a representative sample with 600 persons out of 3 years of birth (1935, 1945, 1955) in the general population (psychotic disorders were excluded). They were within a period of 10 years either in stable mental health or in chronic illness. The comparison between this two groups concerned demographic variables, development during childhood, personality, stressful life events, social network and clinical data. The ascertained prevalence is 12.7% (from n = 600) for stable mental health and 3.5% for chronic illness. The group with the highest risk of chronic diseases is those of women and men with bad achievement and small social competence.

A decade of spontaneous long-term course of psychogenic impairment in a community population sample.

BACKGROUND: Our epidemiological study demonstrates the spontaneous long-term course of predominantly psychosocially influenced ("psychogenic") disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative community sample of the normal adult population of Mannheim, an industrial and university town in Germany. The natural spontaneous course of these disorders in a population sample over a long period remains largely unknown. METHOD: Beginning in 1979 (nt1 = 600) a random population sample was investigated three times over a mean period of approximately 11 years. The last follow-up study ended in 1994 (nt3 = 301). The follow-up sample was representative of the t1 sample. Psychodynamically trained and clinically experienced interviewers used a semi-structured interview and standardized clinical and psychometric instruments. Psychogenic impairment was assessed using a standardized expert rating (Impairment Score, IS). RESULTS: The mean sum-score of psychogenic impairment after 11 years exceeded the value at t1. The case rate (point prevalence, ICD diagnosis + clinical cut-off/IS) increased from 21.6% at t1 to 26.2% at t3 in the investigated follow-up sample. Intra-individual correlation of psychogenic impairment between t1 and t3 was high (r = 0.55). We found strong evidence for an unfavorable long-term course of psychogenic impairment and only a weak tendency (23.1%) for spontaneous remission of clinically relevant psychogenic impairment. Within a regression model clinical variables, childhood development conditions and personality traits at t1 predicted psychogenic impairment at t3. CONCLUSION: All clinical variables conclusively indicate an unfavorable spontaneous long-term course of psychogenic impairment. Together with the well-known high prevalence of psychogenic disorders in the normal population, this underlines the need for early therapeutic and preventive intervention.

[Motivation for in-patient psychotherapy among patients of a psychosomatic pain clinic]. / Motivation zur stationären Psychotherapie bei Patienten einer Psychosomatischen Schmerzsprechstunde.

OBJECTIVE: For a number of pain patients inpatient psychotherapy is an adequate treatment. Many of these patients are lacking in motivation, though. The present study aimed at identifying factors associated with acceptance or rejection of inpatient psychotherapy. METHODS: 63 patients of a psychosomatic pain clinic underwent a multimodal assessment based on a psychosomatic interview as well as a set of psychodiagnostic questionnaires regarding sociodemographic factors, symptomatology (pain intensity, BSS, SCL-90-R, BDI), state of chronification, psychological defense mechanisms (DSQ) and biographic traumatisation (risk index). RESULTS: 71% of the patients were recommended in-patient psychotherapy. Among those, 63% accepted the recommendation, 27% rejected it. Among the patients who accepted in-patient psychotherapy, the extent of total psychological impairment as well as severity of depression and anxiety were more severe and the state of chronification tended to be less marked than in the rejecting group. Referring to sociodemographic variables, pain intensity,physical impairment and severity of biographic traumatisation,no significant difference between the groups could be shown. CONCLUSIONS: In our highly selected population the extent of psychiatric comorbidity and the state of chronification determined motivation for in-patient psychotherapy. Further studies should focus on unselected pain patients and on differences in motivation between various forms of psychotherapy.

[The Berlin Documentation System for Psychotherapy]. / Das Berliner Dokumentationssystem für Psychotherapie.

A Berlin Team for Documentation in Psychotherapy has developed an extensive documentation system. It provides data of a social, psychological and life-history nature, refering to computerized dataanalysis, which are pertinent in the psychological assessment of patients with neurotic and psychosomatic symptoms. The instrument which serves in collecting the data--a special type of psychoanalytic interview--has been used routinely in the Berlin-Group since 1951 to diagnose neurotic disturbances and to prognostically assess the chances for treatment. Interest in assessment-procedures which especially take into account the social situation of the patient, and the work on documentation procedures which treat psychological and social factors with equal weight, grew out of the tradition of the Psychoanalytic Ambulance of Berlin in the years between 1920 and 1940. The following report, in treating its historical development, describes the psychoanalytic interview as well as the psychoanalytic institutions whose large amount of experience in the treatment of patients made it possible to construct the documentation system (Institut für Psychogene Erkrankungen der AOK Berlin und Abteilung für Psychotherapie und Psychosomatische Medizin im Klinikum Charlottenburg). The authors present the specific elements of the datasystem: the patient's attitude towards his illness, his actual social environment, his early socialization process, personality structure and prognosis. They discuss the relationship between the documentation on the one hand and the process of psychoanalytic interview on the other, which necessitates both the understanding of the patient's life-history and his pattern of social interaction. The possibilities and limitations of the data evaluation especially in regard to ratings are discussed in its methodological aspects. The most important questions to be answered by this project are: Testing of psychoanalytic hypotheses with help of extensive data from numerous patients, the descriptive differentiation of neurotic personality patterns, the testing of social influences on psychosomatic disorders, and the construction of a short version of documentation with which comparative research on psychotherapy should be possible.