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PubMed1983

The structure of psychosomatic symptoms.

1. According to our findings, a psychosomatic structure is not an alternative to neurosis. The syndrome of alexithymia appears to be, in our cases, a transitional phase, the dynamics of which can be understood and treated by psychotherapy. In the course of psychotherapeutic treatment, alexithymia always disappears. 2. However, a special psychotherapeutic technique is advisable, one different from that applied in classical neurosis. 3. For this reason the term psychosomatic structure can be used as a way of expressing a variation of neurosis. 4. Modern concepts of psychosomatic disease describe pathological personalities that are different from the classic pseudoneurotic type because of their narcissistic and pregenital structures. These structures can be concealed underneath a facade of genital and psychoneurotic defense. 5. The old relationship between psychosomatosis and psychosis can be better understood on the basis of our findings, which reveal a borderline structure and splitting mechanisms in many psychosomatic patients. 6. Psychosomatic pathology can be better understood today by relating it to the structure of the psychosomatic family. 7. It appears that if, on the one hand, psychosomatic diseases of a more hysterical picture are frequent among preindustrial cultures and in low-income classes, on the other hand psychosomatic syndromes of a narcissistic and borderline type are characteristic for our civilization.

Humans↗
PubMedDate not supplied

Gestosis and the psychosomatic phenomenon--an empirical investigation.

Patients suffering from psychosomatic diseases in the strict sense of the term (asthma, ulcers, colitis etc.) have characteristic object relations which we call the 'relation blanche'. The present investigation aims at finding out whether similar features can be observed in patients suffering from early and late gestosis. The results indicate that there is a definite connection between gestosis and the group of strictly psychosomatic diseases, thus confirming our hypothesis that gestosis does not primarily represent a neurotic conflict situation nor a psychotic breakdown.

Female↗
PubMed1983

Do alexithymic traits predict illness?

The common theoretical speculation that alexithymic personality characteristics (impoverished fantasy life and difficulty expressing feelings verbally) lead to psychosomatic disease was tested in a sample of 181 men. Unlike previous investigations, this study used a measure of alexithymic characteristics taken at least 1 year before any of the men became ill. Comparisons were made of the premorbid MMPI alexithymia scale scores of groups of men who remained well for 10 years or within 10 years developed either physical illness (cancer or benign tumors), "classical" psychosomatic disease (hypertension or gastrointestinal ulcers), or psychiatric disorder (schizophrenia). Results did not support the notion that alexithymia leads to illness onset. There were no significant differences among the groups in their premorbid alexithymia scores. Furthermore, the groups did not differ in the percentage of individuals labeled alexithymic with the use of previously established cut-off points. Although the findings cast doubt on alexithymia as a cause of illness, they do not conflict with the idea that alexithymia can result from the stress of disease or that this type of personality configuration may lead to a decreased response to treatment and a prolonged course of illness.

Adult↗
PubMed2003

Cognitive and emotional characteristics of alexithymia: a review of neurobiological studies.

OBJECTIVE: To review neurobiological studies of alexithymia in order to achieve a better understanding of the relationship between alexithymia and psychosomatic diseases and psychiatric illnesses. METHODS: Neurobiological studies of alexithymia were reviewed with a special focus on how emotional and cognitive elements of alexithymia are reflected in earlier research. RESULTS: Studies that have correlated alexithymia to corpus callosum dysfunctioning have mainly found impairments in cognitive characteristics of alexithymia, whereas from studies of right hemisphere and frontal lobe deficits, it may be concluded that both cognitive and emotional characteristics of alexithymia are impaired. CONCLUSION: The fact that there is no general agreement on how to define alexithymia seems to have hampered theoretical and empirical progress on the neurobiology of alexithymia and related psychosomatic diseases and psychiatric illnesses. Alexithymia should no longer be approached as one distinct categorical phenomenon and follow-up studies should monitor subjects according to both the cognitive and emotional characteristics of alexithymia.

Affective Symptoms↗
PubMedDate not supplied

[Therapeutic approach in psychosomatic gastroenterology (author's transl)].

The therapeutic approach in psychosomatic medicine requires the somatician to keep psychological factors in mind and the psychiatrist to recall the somatic complaint. The therapeutic attitude will be different according to the psychofunctional problem or an authentic psychosomatic disease. However, in every case, the total patient must be considered and a good doctor-patient relationship must be established. Thanks to this relationship, the doctor can better understand the emotional and intellectual aspects of his patient and therefore plan his therapeutic purposes. Thus it takes into consideration the following: 1. reducing the anxiety by explaining to the patient the possible correlations between his complaints and emotional factors; 2. adopting a supportive attitude; 3. offering to the patient the possibility to explain verbally certain repressed ideas (ventilation psychotherapy); 4. manipulating, if necessary, the milieu in which the patient lives (treatment centered on the environment); 5. starting a deep rooted psychotherapy in certain cases. The problem of psychosomatic diseases in gastro-enterology, like duodenal ulcer and hemorragic ulcerative colitis, is discussed in more details. Concerning duodenal ulcer, one can distinguish between two levels of psychotherapy: 1. psychological approach for the gastro-enterologist with a proper background in the psychological approach of patients; 2. psychotherapy. Anyway, the treatment of this disease is always multidimensional, utilizing both psychological and drug treatment. Concerning hemorragic ulcerative colitis, supportive psychotherapy is crucial during the acute phase. It takes effect by an entire affective relationship with the patient and the all therapeutic team. During a remission, the therapist must provide the patient with the type of relationship he desires, and be available to the patient. In some cases, a deep psychotherapy should be used, even in conjunction with somatic care.

Anxiety↗
PubMed2003

Efficacy of diazepam as an anti-anxiety agent: meta-analysis of double-blind, randomized controlled trials carried out in Japan.

Diazepam is one of the most widely used, broad-spectrum anti-anxiety agents. The aim of this study was to evaluate the efficacy of diazepam, and to establish whether it is more effective than a placebo in improving the various neurotic anxiety states seen in patients with neurosis or psychosomatic disease. Of the recently established comprehensive register of psychotropic drug trials carried out in Japan, a total of 17 double-blind, randomized controlled trials were identified on the treatment of neurosis using anti-anxiety compounds, in which both diazepam and placebos were used. Meta-analysis of these 17 studies demonstrated that diazepam is significantly more effective than a placebo (relative risk 1.35, 95% confidence interval 1.21-1.51, number needed to treat 9). The maximal effective dose of diazepam seems to be 12 or 18 mg/day with a treatment duration of 2 or more weeks. There was no significant difference between the effects of placebo and a diazepam dose of 6 mg/day. Caution should be exercised in assessing these results, however, since this is the first meta-analysis showing the significant effectiveness of diazepam in the treatment of neurosis or psychosomatic disease.

Anti-Anxiety Agents↗