Neurotic and psychosomatic disorders interdependence in terms of the search activity concept

There are no correlations between MMPI Hysteria (Hs) and Depression (D) scales in psychosomatic patients in contrast to other patients with somatic disturbances, neurotic disturbances, and in healthy subjects. The roles of depression and hypochondria in the dynamics of psychosomatic disturbances are discussed according to the search activity concept. It is suggested that hypochondriacal complaints are prognostically favorable in comparison with anxiety-depression complaints.     

Exposure in vivo vs social skills training for social phobia: long-term outcome and differential effects

This study examined the long-term effectiveness of specific exposure in vivo (individual IE or group GE) and of office-based social skills training (group SST) in two groups of patients with social inhibition (primary social skills deficits or primary social phobia). Seventy-eight outpatients were divided into these two subgroups according to clinical assessment. Twenty-seven patients received SST which consisted of 25 twice a week 90-min group sessions: 32 patients received GE and 17 IE. Exposure in vivo consisted of 4 weekly (8-hr in the group condition included 2 hr discussion; 3 hr in the individual condition included 1 hr discussion) sessions. Self-rating-assessments were carried out at pre- and post-treatment, at 3 months- and 2.5 yr follow-up. The general results indicate that all three treatment modes led to clinically and statistically-significant improvements in the main problem area (social anxiety, skills deficits), in other neurotic complaints (depression, obsessions, psychosomatic complaints) and in attribution-style. Patients with the diagnosis of primary phobia seemed to get the same profit from either treatment and showed slightly better gains (in all treatment modalities) than patients with skills deficits at long-term follow-up. Within the subgroup with skills deficits there was a tendency for superior outcome of group exposure. These results and recommendations for future research are discussed.     

Does heart rate differentiate neurotic from normal people in a conditional reflex test?

This study is to compare heart reactivity between normals and anxiety neurotic patients. Five male and five female patients with anxiety neurosis and four male and five female normal persons were submitted to classic delayed conditional reflexes with different probabilities of reinforcement (shock), to a defensive instrumental conditional reflex, and to a neutral nonreinforced stimulus. The basal heart frequency was higher in neurotics and in women than in normals and men. The conditional stimulus (CS) associated with a shock generally produced a bradycardia in normal individuals and in neurotic men, but a tachycardia in neurotic women (effects most pronounced in cases with 100% shock probability). The instrumental CS caused a tachycardia in all of the groups, with highest values in neurotic women. The neutral stimulus produced bradycardia in all persons. The aftereffect of the light stimulus depended on whether a shock was administered and on the CS. The differences between neurotics and normals are explained as caused by the heightened excitatory level of the CNS of the neurotic group, produced by the unspecific activating effect of chronic anxiety, and differences of plastic processes in both groups, resulting in different effects of phasic anxiety on the heart. Complex inhibitory-excitatory interactions of the sympathetic and the vagal system underlying the heart rate changes may be assumed. Possible mechanisms leading to sex differences are discussed.     

Defense and resistance in the psychoanalytic process

"Defense" and "resistance" are usually regarded as two separate and distinct concepts, the first belonging to psychic functioning in general and the second to therapy, yet this distinction is far from constant. Clinical observations indicate a frequent overlapping of these two mental functions or positions. A patient's behavior may convey the meaning of either or both concepts, and a position or response that one assumes to bespeak resistance may reveal defense instead. This state of affairs may be seen in the analysis of patients with a relatively well-integrated neurotic identity, but its main import is in the analysis of psychosomatic patients and those with severe personality disorders. Insufficient holding experiences during the infancy of these patients do not enable them to develop functional structuralization. Deficient mothering in the first stages of life also prevents the stable differentiation between defense against threats from within and resistance against influence from outside.     

The cybernetic approach to the treatment of neurotic disorders

This work is an attempt at a cybernetic analysis of the process of treatment of neurotic disorders. This approach is based on the consideration of a patient as an object of control. Assuming that the neurosis is an expression of some imbalance in an organism, the process of treatment is reduced to the exertion of influence on the system thrown out of balance (i.e., the patient) so that its homeostasis with the environment is restored. Thus the treatment of neurotic disorders consists of the use of negative feedback, both internal (those within the patients organism) and external (those within the system created by the interaction of patient and environment).     

Internalization of the therapeutic process: differences between borderline and neurotic patients

Intersession process in psychotherapy refers to the thoughts, memories, and feelings about each other and about their therapy sessions that participants experience during the intervals between sessions. This study compared the intersession process experienced by patients who had been diagnosed with severe borderline personality disorders (BPD) with others who had not. A total of 76 patients with neurotic disturbances and 20 patients with BPD were treated in a therapeutic day clinic and completed the Intersession Experience Questionnaire (IEQ) before sessions of individual psychotherapy and the Session Questionnaire (Stundenbogen) after those sessions. Comparison of the two groups on these measures of intersession process and postsession outcome showed markedly different patterns in patients' evaluations and internalizations of in-session therapeutic experiences: most prominently, that BPD patients internalize therapy sessions with much more negative and contradictory emotions.     

Der Arztbrief

The right of inspection in the hospital documents, the hospital discharge report for example, is often refused to patients in in-patient psychotherapeutic treatment (psychiatry, psychosomatic and psychotherapeutic medicine) with reference to the protection of the patients themselves, their doctors or relatives. Within a systemic therapy approach patients of an acute psychosomatic care unit in a hospital the patients could inspect the report of their hospital treatment including all ?objective” and ?subjective” data of their hospital stay. The conversation with patients and their relatives about this report and modifications of the details and addresses of the report in case of patients’ objections is considered as a psychotherapeutic tool (narrative of doctor and patient) in order to improve the transparency of the diagnostic and therapeutic process and the insights in the psychosomatic mechanisms of the patient’s disease. We discuss our organisation of cocreating the hospital discharge report and our experiences with this type of patient-doctor-communication.     

Differential diagnostic value of the Diagnostic Test for Cerebral Damage in clinical practice

The paper considers the effective inclusion in differential diagnosis of DCS in decisions involving groups of patients not yet primarily exposed to the process. 55 patients were involved in two samples taken within the group as a whole. One of the samples is characterised as being unambiguously diagnosed neurotic without there being any neurologic-psychiatric or other (internal medical) findings (no organic brain injury, no symptoms of seizure, no cerebro-vascular insufficiency CVI, etc.). The other sample comprehended patients with a clear CVI diagnosis, minor EEG findings, and with or without internal medical findings. By applying a specific "index of instability" resulted in an assured diagnostic distinction.     

The narcissistic difficulties presented to the observer by the psychosomatic problem1

Dealing with psychosomatic realities often generates narcissistic neurotic resistances in the observer that form an obstacle to carrying out scientific work. The tendencies towards schematization and the enforced investigation of arbitrarily defined objects of study, such as they appear in some theoretical standpoints, are aspects of these resistances. The self-destruction evoked by the problem of the ‘death drives’ in its superficial dimension constitutes an obstacle of the same kind.     

Application of the MacAndrew Alcoholism Scale to Alcoholics With Psychiatric Diagnoses

The MacAndrew Alcoholism scale scores of 140 mate patients from a large VA hospital were examined to assess whether the MAC scale can detect alcoholism among patients with psychiatric diagnoses. There were five diagnostic groups, each with 28 patients: alcoholics, alcoholics with neurotic disorders, alcoholics with personality disorders, nonalcoholic patients with neurotic disorders, and nonalcoholic patients with personality disorders. The MAC scale was able to differentiate alcoholics and nonalcoholic psychiatric patients, but was unable to differentiate either of the alcoholic psychiatric groups from its nonalcoholic psychiatric counterpart. Thus, it appears that the MAC scale may be unable to identify alcoholism among patients with combined alcoholic-psychiatric diagnoses.     

Application of the MacAndrew alcoholism scale to alcoholics with psychiatric diagnoses

The MacAndrew Alcoholism scale scores of 140 male patients from a large VA hospital were examined to assess whether the MAC scale can detect alcoholism among patients with psychiatric diagnoses. There were five diagnostic groups, each with 28 patients: alcoholics, alcoholics with neurotic disorders, alcoholics with personality disorders, nonalcoholic patients with neurotic disorders, and nonalcoholic patients with personality disorders. The MAC scale was able to differentiate alcoholics and nonalcoholic psychiatric patients, but was unable to differentiate either of the alcoholic psychiatric groups from its nonalcoholic psychiatric counterpart. Thus, it appears that the MAC scale may be unable to identify alcoholism among patients with combined alcoholic-psychiatric diagnoses.     

Experience using the Catathymic Picture Perception in group therapy of adolescents

The Guidelt Affective Imagery (Katathymes Bilderleben (KB) by abundant trials of identification and identity within an imagination in groups of youth to be taken ill with psychogenic and psychosomatic diseases is used prevalent for the treatment of the disturbance of ego. Psychodynamic individualities during the process of imagination in groups follows from the dialectic proportion between the individual and the collective psychodynamic of the whole group.     

Multivariate modelling and personality organization: A comparative study of the Defense Mechanism Test and linguistic expressions

The main aim of the study is to establish an empirical connection between perceptual defences as measured by the Defense Mechanism Test (DMT)–a projective percept-genetic method–and manifest linguistic expressions based on word pattern analyses. The subjects were 25 psychiatric patients with the diagnoses neurotic personality organization (NPO), borderline personality organization (BPO) and psychotic personality organization (PPO) in accordance with Kernberg's theory. A set of 130 DMT variables and 40 linguistic variables were analyzed by means of partial least squares (PLS) discriminant analysis separately and then pooled together. The overall hypothesis was that it would be possible to define the personality organization of the patients in terms of an amalgam of perceptual defences and word patterns, and that these two kinds of data would confirm each other. The result of the combined PLS analysis revealed a very good separation between the diagnostic groups as measured by the pooled variable sets. Among other things, it was shown that NPO patients are principally characterized by linguistic variables, whereas BPO and PPO patients are better defined by perceptual defences as measured by the DMT method.     

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.     

A comparative study in multiple-factor analysis of neurotic tendency

The original aim of this investigation was to discover what relations exist between race attitudes and certain personality traits. For that purpose, a standard neurotic inventory and an attitude scale were applied to three dissimilar groups of subjects, and the results, obtained by multiple-factor analysis carried out independently for each of the three groups, compared with one another. The components of neurotic tendency, as displayed by each of the three groups, show a high measure of agreement and appear to be reconcilable with other interpretations of neurotic personality. So far as the original aim of the study is concerned, there appears to be a slight but significant tendency for the neurotic factor of hypersensitiveness to affect the race attitudes of Europeans towards the native in South Africa in a negative or unfavorable direction.     

Questions concerning fear of success and its conceptual relatives

Several measures of fear of success have been constructed, yet little attempt has been made to study the relations between them. Moreover, it is not clear that most of the measures can be differentiated from measures of fear of failure. Few fear of success researchers have worried about the relationship between their work and the large body of literature dealing with achievement motivation and fear of failure. Arguments about behavioral correlates of achievement-related anxieties should acknowledge the possibility that some people are both successful and anxious, and that they suffer on dimensions other than performance (e.g., psychosomatic illness). Two general forms of success anxiety — cultural and neurotic — have been discussed; both seem to require more intensive study than has been devoted to either one so far.     

Existential and psychopathological evaluation of group psychotherapy of neurotic and psychotic patients

General problems in researching group psychotherapy are reviewed, especially for those with similar theoretical and methodological approaches. The sample consisted of 100 subjects, 26 of whom were neurotic and 24 of whom were psychotic. They were treated in small groups, headed by the author (the experimental group). An equal number and the same categories of patient attended control psychiatric sessions (the control group). All subjects were tested twice. With three instruments: the semantic differential (with twelve existential categories, five general therapy, and three ego psychology categories), the Kotchen test, and MMPI (midiform). A discriminative analysis of tests and the repeated test data, statistically significant, revealed experiential changes in existential categories, such as "Freedom," "Sex," and "Love" amongst psychotics; and in the case of both psychotic and neurotic patients, treated in groups and compared with the controls, such categories as "Understanding among people." With the help of MMPI, a statistically significant reduction of hysteria in neurotic subjects was established, as well as the preventive effects of group psychotherapy regarding the emergence of psychopathy in psychotic patients. Correlation calculations indicated a greater discrimination in the perception of changes using existential categories in the experiencing of psychotic and depressive patients. Finally, the results obtained are discussed from the viewpoints of clinical experience, results obtained in similar research studies, and unanswered questions resulting from such research.     

The contribution of feedback to outcome in long-term group psychotherapy

Two long-term analytic inpatient psychotherapy groups, comprised of severely disturbed neurotic and personality disordered patients, were intensively investigated using process ratings and therapist and patient reports to examine the contribution of interpersonal feedback to treatment outcome. We found that feedback was important throughout the course of therapy, and that patients who derived the most benefit from the groups were those who experienced a greater level of group cohesiveness and were most active in terms of self-disclosure, receipt of feedback, and making significant behavioral modifications within treatment. These successful patients received both positive and negative feedback, primarily from other group members, and worked effectively toward the goals that brought them to treatment.     

The evolution of mental disturbances in the concentration camp syndrome (KZ-syndrom)

As a result of long-term clinical research on former prisoners of the Nazi concentration camps, I analyzed the evolution of the clinical and psychopathological pattern of the KZ-syndrome. One can differentiate the following characteristic phases: psychosomatic inanition, latency of disease, personality and adaptation disturbances, a pseudo-neurotic and depressive phase, premature aging, and an organic phase. The stigma of KZ-syndrome is present in a second generation in different forms: personality disturbances, emotional and/or social immaturity, social disadaptation, higher frequency of neurotic states, divorce, alcoholism, and suicide. The camp stress has left in human nature traces so painful that they cannot disappear when the generation of former prisoners is gone.