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PubMed1986

Unemployment-related lifestyle changes and health disturbances in adolescents and children in the western countries.

According to official statistics 11 million under 25's, thereof 5-6 million under 20's in the 12 OECD member states are unemployed at any given time. In depth studies show that this figure is at least 40-50% higher. In many countries a systematic under-reporting exists in the registration of unemployed. Surveys used to show more relevant figures. Unemployment hits mainly adolescents, school leavers, young adults (unskilled male and female) immigrants and then, indirectly, those who are in need of familial and social support, i.e. the frail, sick, disabled children and old people. In many cities in Europe 40-50% of 18-25 year olds are unemployed and figures as high as 90% have been reported (inner cities). Unemployment is endangering the socio-economic status of people, in spite of short-time unemployment benefits and is creating inequalities in health and serious social misfits. Loss of job or the mere prospect of becoming jobless have, in follow-up studies on an individual level, been found to cause elevated blood pressure and serum cholesterol, increased concentration of blood catecholamine and elimination of noradrenaline, an increase in the frequency of stress and psychosomatic diseases. After regaining employment, these values have normalized. Unemployment is therefore considered by many as a real source of stress. Chronic stress is now considered as a major contributor to cardiovascular diseases, ulcers, asthma and some other diseases. According to several well designed and controlled studies on the individual level in the developed countries, the majority of young people do not learn to cope with unemployment. It fosters isolation, loss of self-esteem, frustration and hopelessness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

Disclosure of traumas and psychosomatic processes.

Results from a series of studies are summarized in support of a general theory of inhibition and psychosomatics. According to this view, to inhibit thoughts, feelings, or behaviors is associated with physiological work. In the short term, inhibition results in increased autonomic nervous system activity. Over time, inhibition serves as a cumulative stressor that increases the probability of psychosomatic disease. Actively avoiding thoughts and feelings surrounding a trauma and/or not discussing a trauma is a particularly insidious form of inhibition. The results from recent surveys and experiments indicate: (a) childhood traumatic experiences, particularly those never discussed, are highly correlated with current health problems; (b) recent traumas that are not discussed are linked with increased health problems and ruminations about the traumas; (c) requiring individuals to confront earlier traumas in writing improves health and immune system functioning; (d) actively talking about upsetting experiences is associated with immediate reductions in selected autonomic activity. Implications of these findings for our understanding of disclosure, trauma, and disease are discussed.

Adaptation, Psychological↗

PubMed1983

The differentiation of individual-specific, stimulus-specific, and motivation-specific response patterns in activation processes: an inquiry investigating their stability and possible importance in psychophysiology.

The role of specific response patterns obtained by means of psychophysiological activation and their temporal stability are meeting with an increasing interest in the literature because of a low correlation between psychophysiological variables and of possible implications with regard to pathogenetic mechanisms in psychosomatic disease. Two empirical studies are presented that were conducted under similar stress conditions (mental arithmetic, free speech, cold-pressor test, blood-taking) and have been monitoring similar activation variables (seven physiological and four or five psychological variables) - one of which using a large sample of 125 students, the other one consisting of 47 students, who were tested three times week- by-week. Findings reveal that substantial proportions of variance in the three-factorial ANOVA (subjects, situations, variables) may be considered on the basis of individual-specific (23-29% for physiological variables, 6-11% for psychological variables), stimulus-specific (5-19% for physiological variables, 1-11% for psychological variables), and motivation-specific (21% for physiological variables, 10% for psychological variables) response patterns. Five evaluation procedures on nominal, ordinal, and interval data levels as well as various definitions of similarity found in the reaction patterns are used in a comprehensive approach to the analysis of specificities. Estimation of variance components, global tests, and individual tests are applied. The results prove to be reliable and rather stable, at least over a period of several weeks. In total, about one fourth of the subjects show a stable individual-specific response pattern on physiological variables. The results are discussed with respect to data and sampling problems as well as to various methods of data analysis.

Adult↗

PubMed2001

Social defeat as a stressor in humans.

Studies on social defeat in humans, and their similarities with studies on social defeat in animals are reviewed. Studies on social defeat in humans typically are conducted as a branch of social psychology, most often focusing on bullying in schools and in workplaces. Victims of bullying are known to suffer from depression, anxiety, sociophobia, loss of self-esteem, psychosomatic diseases, and other behavioral symptoms. On the other hand, animal studies on social defeat, usually based on the rodent resident--intruder paradigm, present findings related to physiological rather than to behavioral consequences of defeat. The two branches use different terminology, e.g., "dominant" and "subordinate" (animal studies) and "bully" and "victim" (human studies). It is suggested that the two fields could benefit from a mutual exchange in theory and methodology.

Female↗

PubMed2003

The place of the Triune Brain in psychiatry.

MacLean's pioneering concept of "The Triune Brain" began to emerge in 1949 with his publication Psychosomatic disease and the "visceral brain", followed in 1952 by Some psychiatric implications of physiological studies on frontotemporal portion of limbic system (visceral brain). This shows that his seminal ideas grew out of his astute observation of psychiatric signs and symptoms. Later on, he observed the broad spectrum of human epileptic seizures and its cause in the limbic system. A large variety of uncontrolled feelings and emotions, together with bizarre motor behavior, is elicited by seizures in the hippocampus and other limbic structures.Meanwhile, based on the triune brain model, a new approach to psychopathology has taken shape. It is the evolutionary perspective of mental diseases such as the major psychoses, anorexia nervosa, anxiety disorders, and also brain diseases such as Parkinson's disease or Huntington's disease. Many mental illnesses are marked by severe deficits in social behavior and social communication. The social communication system disintegrates, especially in the major psychoses. The response choices to social or other external signals in a given situation become limited or even distorted, and reasoning is no longer part of decision making. The emphasis of this contribution is on the disintegration of social behavior in psychopathology, based on evolutionary psychiatry. MacLean's concept provides valuable insight for understanding the biological roots of human social behavior and communication. It is time to uncover the ties between the natural and the social sciences.

Animal Communication↗

PubMed1999

Breast cancer, personality and the feminine role.

This article argues that it may be illuminating to look at breast cancer also from a cultural point of view. It is built around a hypothesis which proposes that, on a certain level, breast cancer can be seen as an attempt by women to rid themselves of the breast as a symbol of some of the essential aspects of their femininity, as feminine qualities are seen as of little import in today's industrialized Western world. The argumentation begins by showing that there is a certain type of personality which is prone to cancer: One of the main characteristics of this personality is either the repression or the inability to express or feel anger. Furthermore, studies on sex-roles and defence mechanisms have shown that persons with feminine sex-role orientations use more repressive, self-blaming defence mechanisms. The author finally goes on to discuss the psychic mechanisms thought to lie behind somatization and cancer as a psychosomatic disease.

Anger↗

PubMed1999

The use and development of anxiolytics in Japan.

More than half of the out-patients in Japanese hospitals receive anxiolytics or hypnotics for basic symptomatic management. Benzodiazepines (BZDs) are the most frequently prescribed by psychiatrists and by internists for the treatment of anxiety symptoms (mainly generalised anxiety disorder, psychosomatic diseases and autonomic dystonia). Although numerous BZDs and their analogues were introduced into the Japanese market during the last three decades, thienodiazepine derivatives have the predominant market share, in contrast to the US and the UK. Approved doses are also lower. The lack of buspirone and SSRIs in the market may contribute to the widespread prescription of BZDs in Japan. Several newer anxiolytic candidates, such as BZD receptor partial agonists and 5-HT1A receptor agonists, are currently in various phases of clinical research in Japan. However, the designs of clinical trials, particularly diagnostic precision, need to be revised.

Anti-Anxiety Agents↗

PubMed1985

Behavioral inhibition and electrodermal activity during deception.

We tested the assumption that the act of inhibiting ongoing behavior requires physiological work. In a guilty knowledge test (GKT) paradigm, subjects were induced to attempt to deceive the experimenter on two separate occasions while electrodermal activity was measured. For 20 of the 30 subjects, overt behaviors (changes in eye movement and facial expression) were recorded during the second GKT. Results indicated that the incidence of behaviors decreased during their deceptive responses. This behavioral inhibition coincided with increases in skin conductance level. In addition to suggesting nonverbal correlates of deception, the results indicate that long-term behavioral inhibition may be a factor in psychosomatic disease.

Arousal↗

PubMed2003

Alopecia areata: psychiatric comorbidity and adjustment to illness.

BACKGROUND: Decades ago, alopecia areata (AA) was regarded as a well-known example of psychosomatic disease. The poor development of measurement methods and criteria for the classification of psychiatric disorders at that time was probably partly to blame for the lack of methodologic validity of some studies. METHODS: We studied a random sample of 32 patients with AA (patchy form). Sociodemographic, dermatologic, and psychiatric variables were collected. Psychiatric examination was carried out by standardized interviews: Schedules for Clinical Assessment in Neuropsychiatry (SCAN), International Personality Disorders Examination (IPDE), and Psychological Adjustment to Illness Scale (PAIS), using the Research Diagnostic Criteria of the International Classification of Diseases, 10th edition, to assess the diagnosis. A descriptive and association study was performed, correlating the patient's adjustment and adaptation to the illness to various factors (linear regression techniques and analysis of variance). RESULTS: Sixty-six per cent of patients presented with psychiatric comorbidity, mainly adjustment disorders (F.43.2), generalized anxiety disorders (F.41.1), and depressive episodes (F.32). Overall adaptation to the illness, however, was satisfactory, showing few repercussions in family or social life, work, or sexual adjustment. Poor adjustment was associated with a dependent personality (Pearson's r = 0.66), antisocial personality (r = 0.39), generalized anxiety (P = 0.003), and depression (P = 0.02). CONCLUSIONS: There is a high psychiatric comorbidity in AA (anxiety and mood disorders), requiring systematic psychiatric evaluations of these patients. A satisfactory overall adaptation to mild/moderate forms of the disease is the norm, but adaptation and comorbidity in severe forms (totalis, universalis) are unknown. A dermatology/liaison psychiatry setting could improve the management of AA.

Adaptation, Psychological↗

PubMed2002

[Changes of body image and body awareness in eating-disorder and non eating-disorder patients after inpatient-therapy].

Altered body image and body awareness have significant clinical implications not only for patients with eating disorders. We evaluated therapy-outcome including distortions in body image in 61 inpatients using two instruments assessing body image (FKB-20 Clement and Löwe, and FBeK Strauss and Richter-Appelt ). Eating disorder subjects, as expected, showed the most severely disturbed body image with negative attitudes towards their own body and restricted body dynamics. While body image improved over all diagnostic groups after treatment, anorectic patients improved less than others. This finding confirms the clinical observation of the limited therapeutic influence on body image distortions in anorectic patients. Our results show, that the body image questionnaire FKB-20 discriminates well between healthy and psychosomatically diseased patients and is a suitable instrument for process- and outcome-evaluation.

Adolescent↗

PubMed2002

[Therapeutic factors of outpatient group psychotherapy - the predictive validity of the Group Experience Questionnaire (GEQ)].

It was the aim of the study to investigate different factors of group experience in relation to therapy effects and to prove the predictive validity of the Group Experience Questionnaire (GEQ); for this purpose for each scale of the GEQ the values of later "Responders" and "Non Responders" were compared. The sample consisted of 50 patients with psychosomatic diseases who where treated with outpatient integrated psychodynamic group therapy. We found that the GEQ is able to differentiate between successful and less successful patients. Especially the therapeutic factors "autonomy and optimism" as well as "well-being" are of high predictive value. Contrary to former investigations the therapeutic factor "cohesion" was less important, which could hint at the fact that a medium amount of cohesion might be sufficient for an effective process of treatment.

Humans↗

PubMed2004

[Patterns of neuronal activity related to emotional stimulation in alexithymia].

In alexithymia a frontal dysfunction is supposed to be a neurobiological correlate. This study focuses on distorted patterns of neuronal activity evoked by emotional stimuli in alexithymics and controls. Out of hospitalised patients with psychosomatic diseases 8 patients with a high score (HA) and 8 with a low one (NA) on the TAS-20 were investigated with fMRI during emotional stimulation which included pictures evoking anxiety and disgust as well as neutral illustrations. As response to negative affect arousing visual stimulation HA in comparison to NA showed a lower activation in the right medial prefrontal cortex and in the right amygdala. The results were significant for the emotion disgust. The results support the existence of a complex central feedback circuit consisting of regions of the prefrontal cortex and limbic structures to process negative affects. Hypothetically a fundamental factor for the emergence of alexithymic traits is an inhibiting process between affect processing (e. g. medial prefrontal cortex, anterior cingulum) and affect generating structures (e. g. amygdala). Furthermore our findings confirm the hypothesis that alexithymia is a disorder of higher cerebral function.

Adult↗

PubMed2005

[Psychogenic Disorders in German soldiers during World War I and II].

In the First and Second World War German soldiers frequently suffered from psychogenic disorders. By comparison a change in the prevalences can be noted: in the First World War dissociative disorders dominated the clinical impression ("shell shock"), in the Second World War they could rarely be seen but were replaced by somatoform and psychosomatic diseases. The discussion about numerous reasons for this development has not been completed yet and is still not free from political attitudes. To achieve a more scientific point of view, the perspective of psychotraumatology might be helpful. According to psychotraumatic research, dissociative and somatoform disorders can emerge in a close relation to a Posttraumatic Stress Disorder. The choice of symptoms depends on personality traits of the victim, but also on specific factors that characterise the situation in which the trauma appears. The mixture of pathogenetic and protective influences includes e. g. the possibility of flight- or fight reactions, feelings of trauma-associated guilt and group cohesion in the military unit. These factors can be useful to help explain the change of symptoms between both wars. In addition the analysis of situational conditions in former wars can give hints to actual planning and prophylaxis strategies in modern military psychiatry, that has to adjust to very different military operation fields.

Culture↗

PubMed2005

[Significance of the chronic fatigue syndrome in rehabilitation medicine--status and perspectives].

It appears that from a clinical point of view chronic exhaustion or fatigue is an important factor in rehabilitation. This is, however, first of all a phenomenon that can be described as a function in accordance with the International Classification of Functioning, Disability and Health (JCF), caused by chronic illnesses or chronic excessive stress. The clinical and sociomedical ranking of chronic fatigue or exhaustion in respect of rehabilitation was discussed in the framework of a Workshop at the 12th Rehabilitation Science Colloquium, 2003 from the viewpoints of psychiatric rehabilitation, methodology, sociology and practical rehabilitation, and conclusions for future research were drawn. The definition of chronic fatigue is first of all mainly based on the feeling of chronic tiredness but also on phenomena of disturbed concentration, physical discomfort, headache and disorders of "drive" and mood. A psychiatric diagnosis linked with symptoms of chronic fatigue is neurasthenia, which is arrived at according to precisely defined criteria. Depressive disorder is one of the most important differential diagnoses in this sphere. Examinations by general practitioners revealed that about 90 % of the patients who had been diagnosed as suffering from psychovegetative disorders completely agreed with the diagnosis of neurasthenia. Neurasthenia resulted more often in work disability periods than disorders of somatisation and other psychosomatic diagnoses. Basing on the "IRES" scale "vital exhaustion", singular of even serious changes become evident in about 50 % to 90 % of the patients undergoing rehabilitation, depending on their individual range of indications. As was to be expected, the majority of pathologic findings concerns patients undergoing psychosomatic rehabilitation, since in such cases there is an overlapping with symptoms of psychosomatic diseases. It is, however, remarkable that also in somatically oriented orthopaedic rehabilitation symptoms of fatigue are seen in up to 50 % of the patients. Preliminary studies have shown that these symptoms can be definitely ameliorated within the rehabilitation framework, although pathological signs are still abundantly apparent in follow-up examinations. Markedly severe degrees of "vital exhaustion" and "vocational exhaustion" are also seen in rheumatology patients undergoing somatic rehabilitation. This agrees with case history details related by many female and male patients. Hence, it appears necessary to adapt rehabilitative intervention to both the psychovegetative and the medical behavioural aspects of this symptom. Scientific classification of the entire sphere of chronic fatigue in respect of rehabilitation requires classification of the relevant functions within the ICF framework. To this end it would be necessary to conduct patient inquiries within cross-sectional studies on the one hand and, on the other, a systematic consensus process among experts would have to be used for allocation to the relevant functions. This is the basis for development of suitable assessment tools for use in prospective studies in order to systematically evaluate the impact on functions and especially their effects on activities and participation.

Disability Evaluation↗

PubMed2005

[Findings on the effectiveness of rehabilitation].

The German Federal Ministry of Education and Research (BMBF) and the German Pension Insurance scheme established a funding programme for research in rehabilitation. This review presents the findings of 38 available evaluation studies analyzing the effects of medical rehabilitation in Germany in different indications. With a total of 10 studies, the effectiveness of rehabilitation in chronic low back pain was evaluated most frequently. The other research projects analyzed the effects of rehabilitation in psychosomatic diseases (9 studies), cardiac diseases (9), cancer (4), neurological diseases (3), bowel diseases (1) and rehabilitation of children and juveniles (2). According to the results at hand, medical rehabilitation significantly improves the patients' state of health at the end of the rehab measure. Effectiveness is maintained in numerous patients also in the medium or fairly long-term. Hence, rehabilitation accomplishes a prerequisite for further gainful employment. Most of the patients treated have been suffering from chronic illness for many years and have developed psychological complaints besides their serious somatic symptoms and impairments. Here, rehabilitation takes on a fundamental assignment in the care of chronically ill patients. The projects carried out under the promotional focus highlight concrete perspectives for evidence based enhancement of medical rehabilitation. This, amongst others, also holds true for the positive experience with treatment modules within specific vocational training and with patient education. Some of the insights gained are already being realized. As a current task of development, the findings point to further improving the sustainability of rehabilitation's positive impact particularly in chronic low back pain. Pertinent conceptual approaches can be derived from the projects presented.

Back Pain↗

PubMed1980

[Psychosomatic aspects of asymptomatic hirsutismus (author's transl)].

In a statistical study the somatic and psychic variables of 42 unselected women were evaluated who were seen with the presenting symptom of hirsutismus at a medical out-patient department. An organic source for the hirsutismus was excluded. The mean 17-ketosteroid values and the plasma testosterone values were normal. The following results were obtained: Patients with hirsutismus do not have specific personality traits. Hirsutismus is not a psychosomatic disease. There is not endocrine psycho-syndrome in hirsutismus. The suffering from hirsutismus is independent of the objective degree of hirsutismus. Women with the presenting symptom of hirsutismus regard their male type of body hair as a scapegoat and as the cause for their problems which in reality are neurotic problems. Unless contraception is desirable, we do not suggest treatment of hirsutismus with Cyproteronacetate.

17-Ketosteroids↗

PubMed1984

Psychological factors in ulcerative colitis.

Almost 50 years ago ulcerative colitis was included among the seven classical psychosomatic diseases. The psychodynamics and personality structures specific to ulcerative colitis sufferers were sought and the main-stay of treatment was psychotherapy. However, for the past decade the psychogenic approach to this disorder has been replaced by physiological and immunological explanations and treatments. The history of medical and psychogenic explanations and treatments of ulcerative colitis has been traced to the present. Ulcerative colitis remains a "riddle," as it was described almost 50 years ago, a complex disorder whose pattern is to flare up and subside, its cause and cure still unknown despite almost 100 years of study.

Colitis, Ulcerative↗

PubMed2001

Association of symptoms of TMD and orofacial pain with alexithymia: an epidemiological study of the Northern Finland 1966 Birth Cohort.

Alexithymia is a term denoting a deficit in the ability to differentiate emotional from physical states and to identify and describe one's feelings, as well as a preference for external oriented thinking. Alexithymia has been linked with various somatic and psychosomatic diseases, especially with chronic pain. The aim of this study was to evaluate the association between alexithymia and symptoms of temporomandibular disorders (TMD) as well as oro-lingual and dental pain, in a large representative population sample of young adults. The study was a part of the 31-year follow-up study of the Northern Finland Birth Cohort originally consisting of 12058 live births in the year 1966. In 1997, 4893 subjects living in northern Finland or in the capital area, who participated in a field study of the project and later returned a postal questionnaire, made up the sample of this study. Information concerning symptoms of TMD and oro-lingual and dental pain was collected from the subjects. To assess alexithymia, the Toronto Alexithymia Scale-20 (TAS-20) was used. In addition, information about depression, marital status and self-rated health was collected. The proportion of alexithymics (TAS score over 60) was higher in subjects with the most orofacial symptoms than in asymptomatic subjects. In men, alexithymia associated significantly with facial pain, difficulties in mouth opening, oro-lingual pain and dental pain, and in women with pain on jaw movement and dental pain. After adjusting for depression, marital status, and self-rated health, a significant association remained between alexithymia and the symptoms mentioned, except for facial pain in men. It can be concluded that alexithymia is connected with orofacial symptoms. Clinicians treating these symptoms should be familiar with the concept of alexithymia.

Adult↗