Pathologisch autodestruktives Verhalten und Verhaltenstherapie

The literature on pathological self-destructive behaviour (apart from psychotic, substance-induced or brain disorders) and behaviour therapy is reviewed. An introduction on definition, classification, current typological approaches, occurrence, pathogenesis, and psychopathology is given. From a behavioural theoretic perspective, functional aspects of self-destructive behaviour are emphasised. Basic treatment problems are outlined. They particularly concern covert self-destructive behaviour (artificial disease, Munchhausen-syndrome) that is typically met in a medical hospital setting. Recommendations from the literature are resumed. Most of the relevant publications are psychoanalytically based. Case reports on self-destructive patients predominate even in behaviour therapy publications. These are briefly reviewed. So far, the most elaborate approach is considered to be M. Linehan's Dialectic-Behavioral-Therapy which has been developed for the treatment of borderline personality disorders. A considerable overlap between overtly self-destructive patients and borderline patients underlines the usefulness of this approach. Nonetheless, a further development of behavioural therapeutic methods with regard to different types of self-destructive behaviour is considered to be indicated.     

Soziale Phobie

Social anxiety is characterised by overwhelming fears in social interactions or performance situations. Its life-time prevalence is high (about 13%) and relapses are quite common. Social anxiety disorder is a chronic disease with a high impairment for the persons afflicted. Cognitive-behavioural, psychodynamic and neurobiological models have promising implications for psychotherapy and pharmacological treatment. Neurobiological approaches have identified risk factors and possible somatic mechanisms. Cognitive-behavioural models explain the development of dysfunctional beliefs and the maintenance of social anxiety. Psychodynamic approaches refer to a disturbed self-concept and underline the importance of prior negative interpersonal relationships. Manualised treatments exist for the cognitive-behavioural approach and a manual for psychodynamic psychotherapy was recently developed. This paper presents the different approaches (neurobiological, cognitive-behavioural, psychodynamic) to social anxiety disorder and possible implications for therapy are discussed.