Einschränkungen der Willensfreiheit bei somatoformen Störungen

Etiopathogenetic models of somatoform disorders and philosophical concepts of free will refer to theories of affect processing: affective dysregulation can promote psychosomatic ailments as well as problems in decision making. This observation brings forth the question if freedom of will is impaired in persons with somatoform disorders. By compiling, analyzing and contextualizing relevant models of current neuroscience, psychosomatic medicine and philosophy the psychodynamic construct of alexithymia as an etiologic factor of somatoform disorders and the conceptual integration of affective factors in a model of free will are developed on the basis of a common concept of affect. The synthesis of the discussed results and considerations, the multidimensional impairment of the ability to decide freely and self-determinedly due to somatoform disorders, is critically reflected; however, a blanket assumption is not admissible.     

Effekte regionaler Psychosomatiktherapiemodule

Psychosomatics from the perspective of medicine assumes that somatic, psychological, and social aspects must always be taken into consideration. By combining psychosomatic and psychiatric care in community psychiatric/psychosomatic networks, existing structures can be used and costs decreased due to synergies (best point of treatment). Using a 1?year pre-/postcatamnesis comparison of 106 patients, it was possible to determine the cost of the 3?week psychosomatic treatment with respect to the medical, sociotherapeutic, and psychotherapeutic treatment effects and how long it helped. Based on the results, inpatient intensive therapy of psychosomatic illnesses in regional psychiatric departments of general hospitals can be recommended as a future treatment option – taking into account that patient-related factors can predict treatment success.     

Psychosomatik in der Dermatologie

Psychosomatic dermatology deals with skin disorders that are substantially influenced by psychosocial causes, sequelae or circumstances or in which these are important in the selection of therapy for the particular patient. In this context, skin diseases have been recognized in a biopsychosocial model for holistic medicine. In a wider sense, psychosomatic dermatology embraces every aspect of intra- and interpersonal problems relating to skin disorders and psychosomatic trigger mechanisms and/or ways of coping with skin disorders. A distinction is made between primarily psychic conflicts, psychosomatic diseases and somatopsychic aspects. Approaches to treatment take account of the doctor (doctor’s–assistant)–patient relationship, compliance factors, the dermatosis patient’s quality of life and the psychosocial health of the dermatologist, and also steps that can be implemented in the context of the practice management and basic psychosomatic treatment including referral for special psychotherapy     

An Application of Brief Therapy to Family Medicine

The Solution-Focused Brief Therapy model has been applied to support families with various problems commonly met at the department of family medicine in a large, urban teaching hospital in Seoul. Korea. Many cases there show a different distribution of problems when compared with a tertiary family therapy center. The majority involve psychosomatic problems, family distress around a chronically-ill member, the loss of a family member, and severe illness, only a few involving drinking problems, family violence, or abuse. The SFBT model meets the seven requirements of Doherty and Baird (1983) for a family therapy model to be useful in a medicine setting.     

Standards der sozialmedizinischen Leistungsbegutachtung in der Psychosomatischen Medizin und Psychotherapie

Sociomedical problems are playing an increasingly important role in both psychosomatic medicine and psychotherapy and in psychiatry. The present article examines the standards relating to content and method in sociomedical assessments, primarily in the discipline of psychosomatic medicine and psychotherapy. The focus is on the assessment of performance, highlighting the fact that performance and performance deficits cannot primarily be derived from the medical diagnosis; instead, psychosocial variables that influence the processes of dealing with disease in particular affect the actual performance status. The article pays particular attention to aspects that aggravate or dissimulate performance competence. Finally, the principles of integrating the various findings and results that are incorporated into the assessment report are outlined.     

The structure of occupational well‐being: A study among Dutch teachers

This study examined the structure of occupational well‐being among 1,252 Dutch teachers. Building on Warr (1994) and Ryff (1989), a multidimensional model for occupational well‐being (including affective, cognitive, professional, social and psychosomatic dimensions) was proposed and tested. Confirmatory factor analysis supported the distinction between these dimensions. A second‐order factor analysis revealed that affect was the most central dimension, supporting earlier conceptualizations of subjective well‐being that mainly focused on affect.     

Helen Flanders Dunbar: Physician,medievalist, enigma

Helen Flanders Dunbar was a psychiatrist, an early leader in the field of psychosomatic medicine, and a prophetic proponent of supervised clinical training for clergy. She was a prolific writer educated in theology and medieval studies as well as medicine. Yet she remains largely an enigma despite her achievements. This article explores Dunbar's life and attempts an explanation of why her person and ideas are not widely recognized today.     

Eine streitlustige psychoanalytische Psychosomatik und die gegenseitige Analyse von Ferenczi und Groddeck

This article is the third part of an originally unplanned trilogy caused by the internal logic of the research process on psychosomatic theories. On the background of Freud’s difficulties with the illness and disease theory the fragmentation of the field of psychosomatic medicine has been described and presented in the two previous parts as an attempt to explain its tortuous developmental course. In the first part of this current paper the author tries to understand both the ideas and sociopolitical forces that were involved in the historical development of psychosomatic medicine. The scope of the field as well as the models used oscillated greatly. Psychoanalysis has played an important role in this development even if the mainstream psychoanalysts showed relatively little interest. Psychosomatics also required therapeutic approaches that were foreign to the accustomed psychoanalytical setting. Occasionally the influence of various physiological models was strongly displayed (e.g. Selye’s stress model and the influence of the immune system). The deepening of the psychological understanding is nevertheless due to original marginal psychoanalytic thinkers, such as Ferenczi and Groddeck. Under the influence of Ferenczi the unconventional search was completed by Balint to some extent either through development of the psychotherapeutic technique or by the influence of listening to the doctors in their interaction with patients.     

Status der psychosomatischen Forschung im deutschsprachigen Bereich

Psychosomatic medicine aims at exploring the relationships between biological, psychological and social factors in onset, maintenance and treatment of psychosomatic disorders. The present article describes current topics and methodological approaches in the field of psychosomatic research. A bibliometric analysis of two German journals in 2009 and 2010 was conducted, yielding 43 articles dealing with different aspects of psychosomatic medicine: chronic illness, somatoform disorders and pain, trauma-related disorders, borderline personality disorder and attention deficit hyperactivity disorder. The results show that psychosomatic research covers a variety of topics with different research designs. However, there is still a paucity of controlled studies in the field.     

Associations between Stress,Psychosomatic Complaints,and Parental Criticism among Affluent Adolescent Girls

A growing body of research has shown that adolescent girls in the context of affluence face a series of unique pressures that may increase social-emotional problems. Little research, however, has examined associations between perceived stress and psychosomatic complaints among privileged youth. In the present study, we investigated the relationships between stress, psychosomatic complaints, and parental criticism in a sample of preadolescent and adolescent girls (n?=?218) from selective, private schools. Using OLS regression analyses, cross-sectional and longitudinal associations were evident between perceived stress and psychosomatic complaints, with increases in stress associated with increases in psychosomatic problems. Parental criticism was also examined as a predictor of girls’ psychosomatic complaints and stress levels. Results indicated that parental criticism was significantly and positively associated with psychosomatic problems in cross-sectional models and that perceived stress levels mediated this association. Additional analyses demonstrated that the relationship between psychosomatic complaints and stress may be bidirectional. Taken together, results from this exploratory study suggest that girls in the context of affluence may also experience psychosomatic complaints, in addition to social-emotional problems.     

Adolescents' psychological health and experiences with unwanted sexual behavior at school

This paper examines the relationship between experiences with unwanted sexual behavior at school and adolescents' health. Adolescent boys and girls (N = 2,808) participated in a 1998/1999 survey of secondary school students in two regions of The Netherlands. The psychological issues investigated included psychosomatic problems and self-esteem. It was hypothesized that adolescents who have experienced unwanted sexual behavior at school would report more psychosomatic problems and lower self-esteem. Furthermore, it was hypothesized that girls would report lower self-esteem and more psychosomatic problems than would boys. Regression analysis indicated that experiences with unwanted sexual behavior were related to adolescents' psychological health, independently of other variables.     

Psychosomatic diseases and the Rorschach test

Despite numerous efforts to identify a Rorschach profile uniquely associated with and helpful in diagnosing psychosomatic conditions, none has been demonstrated to exist. Although certain Rorschach characteristics have been consistently observed in studies of patients with psychosomatic diseases and can shed light on personality features of these individuals, similar characteristics are encountered in a variety of other conditions as well. This state of affairs is attributable not to short-comings in the Rorschach test, but rather to inadequate conceptualization and categorization of psychosomatic disease.     

Secret médical en santé au travail

The occupational physicians are obliged, like any doctor, to respect the ethical obligations imposed on their profession, including in the exercise of the missions specific to occupational medicine and contained in the Labor Code. The occupational physician is not isolated and works in a multidisciplinary team of a health service at work. He must communicate with other health professionals, but also with employers, representative bodies of staff. Medical confidentiality holds a special place in the triangular relationship between the occupational physician, the employee and the employer. The medical practice in the field of occupational health requires that many provisions of the Labor Code be followed, including the respect of the secret of manufacture and the position of advising employers and employees. The occupational physician must communicate with the employer in order to best achieve his mission, but in practice, it may be difficult for the occupational doctor to make his recommendations heard to improve the working conditions of employees without power, when he cannot argue his opinions on medical information.     

Pa/enser bien le corps: Cognitive and Curative Language in Montaigne’s <Emphasis Type="Italic">Essais</Emphasis>

Montaigne’s writings on medicine and the body have always been seen as part of a larger project about knowing ourselves. Responding to medical developments that seemed to privilege the anatomical body over the mind or the emotions, Montaigne defended the humoral link between mind and body. His essays make use of word play, puns, and anecdotes based on his own experience and reports from antiquity to counter what he perceived to be an increasingly one-sided approach to medicine. The result is a witty but nuanced argument for a more balanced outlook to what is now known as psychosomatic medicine.     

Family therapy and psychosomatic illness

The author suggests that clinical experience has developed to the point where the question can be asked, “Is a specific psychosomatic illness responsive to a specific type of family therapy?” Examples such as structural family therapy in childhood diabetes, asthma, pain, and anorexia nervosa; cognitive family therapy in adult chronic pain; and marital group behaviour modification in adult obesity, chronic pain, and myocardial infarction, are critically reviewed. The evidence suggests, but does not yet prove, that specific types of marital and family therapy may be effective in a few specific psychosomatic problems, a useful adjunctive therapy in some psychosomatic problems, and that family assessment is helpful in the management of all psychosomatic problems.     

Musiktherapie in der deutschen Psychosomatik

The authors report about the clinical implementation of music therapy in psychosomatic hospitals in FRG based on a survey among practising music therapists: attending especially to the qualification of music therapists, their integration and the problem of indication. The coverage of music therapy in the standard textbooks on psychosomatic medicine is discussed.Finally the state of research on music therapy in psychosomatic hospitals is reviewed.     

Personality and Health in the 1980s: Psychosomatic Medicine Revisited?

This special issue is a sign of a resurgence of interest in the role of personality in health not seen since the 1940s and early 1950s when the promises of the psychosomatic approach to health and illness appeared to be the greatest. This new look at personality and health represented by contributions to this special issue attempts to address the limitations of earlier work in psychosomatic medicine by making more explicit efforts to define personality variables precisely, to distinguish these variables from conceptually related psychological constructs, and to embed them in a body of theory and empirical research. This new work also attempts to remedy methodological limitations of earlier work by placing greater emphasis on prospective research and highlighting distinctions between symptom reports, illness behavior, and actual illness. However, the new work and earlier work in psychosomatic medicine share certain working assumptions, for example, a primary emphasis on the relatively direct impact of personality on disease onset, an assumption that personality variables operate in interaction with stressful events, and a frequent emphasis on general susceptibility to disease. Moreover, this new work frequently risks the same methodological pitfalls that limited scientific progress in psychosomatic medicine. We argue that the rapid rise and decline of psychosomatic medicine is most likely to be repeated in research on personality and health in the 1980s if reasonable criteria for considering personality variables a risk factor for disease are not precisely defined, disease endpoints (the dependent variable) are not assessed precisely, personality variables of interest (the independent variable) are not empirically distinguished from other related psychological variables, and complex relationships among risk factors are not taken into account. It is emphasized that models drawn from personality research cannot be transferred unchanged to the health arena without risking false inferences about the role of personality in health.     

中医临床心理学理论的文化特质与跨文化比较

从文化比较的角度,阐述了中医形与神俱论与西方心身医学、五脏藏神说与情绪生理心理学、精神内守法与西方精神分析及生物反馈技术的区别与联系,指出了中医心身相关理论与技术的文化特质及其蕴涵的现代科学意义。     

Occupational Therapy in a Community-Based Prevention Program

Occupational Therapists have shifted their practice base from a primarily medical model to one involving many different services within the community. Members of this discipline as well as those of the entire health-care field have discovered that preventionj based programs better anticipate and meet consumer needs. The community program described here serves 3, 4, and 5-year -old socio-culturally disadvantaged preschoolers. The program occurs weekly in a local library and includes the librarian's story hour and special activities designed and implemented by the occupational therapists. By observing each child's behavior, occupational therapists can compare normal growth and development with a particular population. The design and delivery of such programs is influenced by many factors including, but not limited to, financing, community values and institutions, and the occupational therapist's understanding of prevention. Increased understanding, as well as the potential application, of occupational therapy's contribution to the prevention of health related problems are further enhanced by the utilization of this program as a field training site for occupational therapy students.