Search

Die Mentalisierungstheorie gewinnt in den letzten Jahren in der psychologischen Forschung immer mehr Bedeutung. Sie wurde durch Fonagy (1998) und andere ForscherInnen etabliert und stellt eine Weiterentwicklung der Bindungstheorie und der Theory of Mind dar. Als Mentalisierung wird dabei die Fähigkeit verstanden, die es ermöglicht, sich innere Zustände in Form von Gefühlen und Motiven im anderen und bei sich selbst vorstellen zu können (Fonagy, 2011). Sie bildet ein zentrales Element für soziale Interaktionen und tragfähige Bindungen. Die Forschung beschäftigte sich häufig mit der Mentalisierungsfähigkeit bei Personen mit Borderline-Persönlichkeitsstörung. Diese Studie möchte hingegen den Bezug zur schizoiden Persönlichkeitsstörung herstellen, da diese gekennzeichnet ist durch eine reduzierte emotionale Ausdrucksweise und einen unzureichenden menschlichen Kontakt, bei gleichzeitig hohem Wunsch nach Beziehung (Suslow & Arolt, 2009). So geht die vorliegende Arbeit der Frage nach, inwieweit sich die Mentalisierungsfähigkeit im therapeutischen Prozess bei PatientInnen mit schizoider Persönlichkeitsstörung verändert. Daran anschließend wird die Frage untersucht, ob sich die Allgemeinsymptomatik der PatientInnen verändert. Zu diesem Zweck wurde die Mentalisierungsfähigkeit von drei Patientinnen im Verlauf der Therapie mittels der Reflective Functioning Scale auf Grundlage von Transkripten eingeschätzt und miteinander verglichen. Die allgemeine Symptomatik der PatientInnen wird mithilfe der Symptom Checkliste 90-R ermittelt. Als Ergebnis konnte festgestellt werden, dass zwei der drei PatientInnen keine Veränderung der Mentalisierungsfähigkeit über den Therapieverlauf aufwiesen. Eine dieser PatientInnen zeigt starke Verbesserungen ihrer allgemeinen Symptomatik über alle drei Messzeitpunkte hinweg, wohingegen bei der anderen eine leichte Verschlechterung zu verzeichnen war. Die dritte PatientIn zeigt einen leichten Anstieg der Mentalisierungsfähigkeit, zu der eine langfristige Symptomverbesserung auch bis zur 1-Jahres-Katamnese kommt. Eine Antwort auf die Frage nach den Gründen für eine solche Stagnation der Mentalisierungsfähigkeit deutet sich, zumindest tendenziell, bereits an. Am wahrscheinlichsten scheint die Ursache im Zusammenhang mit strukturellen Benachteiligungen von Personen mit schizoider Persönlichkeitsstörung zu liegen, für die der soziale Kontext einer Therapie eine Stresssituation darstellt., Alexander Heinrich Dämmer, Masterarbeit Universität Klagenfurt 2021

From a perspective of conceptual evolution schizoidia was initially considered to describe features both of the premorbid personality of schizophrenic patients and of the personalities of non-psychotic family members (Bleuler, Kahlbaum, Kraepelin). On a psychopatholocial level a close link to the complex basic symptom of autism was stressed. From the very beginnings of modern psychiatry schizoidia was discussed within a conceptual frame of schizophrenia spectrum disorders (Kretschmer, Hoch, Polatin). Approaches to operationalize these conceptual works laid the basis for the cluster A personalities in DSM-III. Due to the prominent concept of schizotypy (Kety, Rado, Meehl) three split up diagnostic categories of schizotypal, schizoid and paranoid personality disorders resulted. Cluster A personality disorders are frequent in community-based epidemiological studies. Health-care seeking behaviour due to primary personality-related problems, however, seems to be less paramount compared to cluster B and C personality disorders. Many family- and twin-based genetic studies convincingly stress a close link between schizotypal personality disorder and schizophrenia. This link is less pronounced for paranoid personality disorder, and even vanishingly low for schizoid personality disorder. From a perspective of schizophrenia spectrum disorders a vast amount of data from molecular genetic, neurobiological, neuropsychological and psychosocial research has impressingly confirmed this link for schizotypal personality disorder. Major research deficits, however, have to be noticed for paranoid and schizoid personality disorder.

Family diseases represent a risk factor in the multifactorial etiology model regarding the genesis of eating disorders. In German-speaking countries only a few studies give attention to this topic. The aim of this study is to investigate the occurrence frequency of psychiatric disorders and personality styles among parents of juvenile patients with eating disorders. Furthermore a comparison between parents of patients with restrictive anorexia nervosa (AN-R) and parents of patients with bulimia nervosa (BN) is carried out. Psychiatric disorders listed on Axis I and Axis II of DSM-IV (American Psychiatric Association (APA), 1994) and personality styles were assessed in 73 mothers and fathers of 27 patients with AN-R and 13 patients with BN. The results show a high psychiatric strain among parents of patients with AN-R and BN. However the overall psychiatric strain does not differ among the parents of patients with AN-R and BN. Depressive disorders were more frequently observed among mothers of patients with AN-R. Parents of patients with BN showed higher occurrences of paranoid and schizotypal personality styles. A vulnerability of psychiatric disorders is indicated among parents of patients with eating disorders in general but nonspecific for AN-R or BN.

The study investigates how a psychoanalytic institution reaches its aims by identifying different factors like diagnosis, sociodemographic characteristics of the patient, motivation of the psychoanalyst, and their impact on the indication-process.38 patients diagnosed as having severe personality disorders and treated in a psychoanalytic outpatient clinic were compared with 49 patients who were referred for psychoanalytic treatment to a private practice.Although the groups were similar regarding the severity of their problems, more comorbidity and a more stable professional life were found in the group referred to private practice. Patients who tend to distort their social life in order to maintain a fragile psychic balance are more likely to get institutional treatment. The psychoanalytic team-conference and discussion of unconscious object-relationship pattern had great impact on the process of giving correct indications.The indication for psychoanalytic treatment does not correlate with personality disorder diagnosis or with the motivation of the therapist. Nevertheless, more differentiated, in clinical routine practicable instruments measuring reflective functioning, or the quality of object relationship have to be developed in order to give an adequate indication for psychoanalytic treatment.

We report the case of a 31 year old healthy man without coronary risk factors, who made a suicide attempt with insulin caused by a chronic schizoid psychosis. The man was admitted to the hospital 14 hours later with non-specific chest pain and dizziness as clinical signs of a lateral wall myocardial infarction. The coronary angiography demonstrated intact coronary circulation and a broad area of myocardial damage of the left ventricular lateral wall. It is hypothesized that coronary artery vasospasm induced by hypoglycemia/hyperinsulinemia caused the myocardial infarction.

Following the introduction to the history of the concepts of abnormal personality, with regard to the schizoid and schizotypal forms, we present their systematic assessment in the modern classification systems.Both, the schizoid and schizotypal forms, are usually considered as schizophrenia-spectrum disorders. Biological and clinical data indicate relations to other axis-I disorders as well. However there are few systematic and strictly controlled studies on the psychotherapeutic and pharmacological treatment of schizotypal and schizoid personality disorders. Basic theoretic assumptions concerning both treatment concepts - for personality disorders in general, and especially in schizoid and schizotypal personality disorder - are given. Finally the role of neuroleptics and antidepressants for schizophrenia-spectrum disorders is discussed. New possibilities may emerge from the use of the recently developed atypical drugs, but further research in randomised studies is needed. Current prospective studies on early detected schizophrenia-spectrum disorders will broaden our knowledge about prevention and therapy.

Twelve experienced psychoanalysts diagnosed during a depth-psychological examination of 604 patients, coming from two different outpatient institutions, distinct clinical schizoid personality traits of 65 patients (10.7%). A further analysis researched the contribution to patient and therapist bindings and influences on the diagnosis. With the aid of a step by step regressions analysis including "solid" patient and therapist data as well as countertransference reactions of the investigator, we were able to establish an accurate diagnostical model, which enables a correct assignment with the probability of 90%. The most important diagnostic criterion proved to be the countertransference of the investigators. This demonstrates that affective processes from the therapist side-should be assessed as a potent criterion that distinctively increases the validity of the diagnosis.

The following results were obtained on comparing the genesis of schizoid, neurotic and healthy subjects: 1. The schizoid patients examined by us had experienced a greater total risk-associated stress during childhood and adolescence than the comparative groups. 2. Special risk-associated stress is due to: a) a stress-burdened family atmosphere (laden with conflicts within the family and burdened with diseases), b) stress originating from the mother (risks of old age and diseases), c) stress originating from siblings (large number of siblings, smaller age intervals, etc.), d) stress originating from the parents' low standard of education. 3. Schizoids can be separated from healthy subjects on the basis of the childhood risks assessed above. 4. Schizoids cannot be separated from the group of neurotics by the characteristics listed here. These are not schizoid specific risks but factors of general stress. 5. Marked sex-specific peculiarities were seen. a) These point to a higher degree of diagnostic separation between schizoid and neurotic men than between schizoid and neurotic women. b) Schizoid women cannot be distinguished from neurotic women on the basis of the criteria of genesis covered by our study. c) Schizoid men are easily separated from the two other groups of men. This is mainly due to a genesis of an instability of reference. This, therefore, appears as a genuine schizoid risk.

Music therapy yet to be discovered as a target of psychotherapy research. A first step consists in creating adequate samples of significant musical dialogues. Video-recording is an essential requirement for establishing such data. To test the clinical view that the emotional content of the musical dialogue in music therapy reflects the basic relationship issues of a patient was the objective of this study. By using ratings of significant musical dialogue sequences with the instrument of semantic differential comparing groups with varying clinical expertise (music therapists, psychoanalyts, lay persons) the results demonstrate that there is considerable stability of the judgments; however, systematic differences exists among the three groups of raters.

A group of 25 schizoid patients were compared with 76 neurotic patients and 103 healthy persons in terms of perceived parent imago and family dynamics. The following findings should be emphasized: 1. Schizoid persons can be distinguished well from other persons on the basis of their experience of family. 2. A clear delimitation of schizoid persons from neurotic persons is possible only when the factor of sex is considered. 3. Schizoid women differ from neurotic women in terms of their distinctive mother experience: The mothers of schizoid women are marked by a weak ego and are apprehensive and extremely permissive. 4. Schizoid men differ from neurotic men both in terms of a distinctive mother experience and a distinctive father experience. In their case, a negative mother imago is contrasted with an ambivalent father imago. Neurotic men, on the other hand, possess a mother imago nearly as positive as that of healthy men, although they do exhibit a distinctly more negative father imago. 5. Schizoid women differ from schizoid men in terms of a distinctively negative mother imago. Whereas the mothers of schizoid women are experienced above all as exhibiting a weak ego and traits of dependency, the mothers of schizoid men are perceived more as being strong and independent.

A total of 128 physicians and psychologists, working in six psychiatric hospitals, were asked to allocate 10 psychiatric diagnoses on the basis of typical clinical criteria (symptoms, course of illness, etiological and anamnestic data), with which they were supplied. The correct diagnosis was made in 45.3%, while in 82% the broad diagnostic group was correctly ascribed. The respondents were divided into two groups, according to the amount of diagnostic data they had been given (though in fact the information necessary for differential diagnosis was given equally to both groups). The group which made diagnosis on the grounds of more comprehensive data (ten characteristic diagnostic items) did significantly worse them the group which had few data (six characteristic items). The stereotypes for mania, endogenous depression, obsessional-compulsive neurosis, and antisocial personality disorder were correctly defined by 75% of more of the respondents. The profiles of the remaining six diagnostic groups were associated with the corresponding diagnoses by 50% or fewer of the respondents.

A survey of the literature on the primary personality of schizophrenics shows that the essential concepts derive from Kraepelin (1893), E. Bleuler (who also introduced the technical term "schizoid", 1911) and C.G. Jung introversion; 1913). E Kretschmer (1921) adopted these preliminary findings and integrated them into his system of "Constitution" which greatly stimulated research in this field. Most of the following investigations confirmed his hypotheses on the basis of clinical impressions. A few only criticised his teaching, particularly as a theoretical concept. The musculo-somatotonic type apart, Sheldon's (1940) research agrees with Kretschmer to a large degree. Later investigators, however, could not sufficiently support Sheldon's constitutional biology on empirical grounds. No further pre-morbid types were developed in the following years, if one discards the somewhat rare "stormy" character (Arieti, 1955). All attempts to discover differences between the pre-morbid development of personality and the subheadings of schizophrenia failed. Pre-morbid sexual development is not typical, but the disturbances of contact are in the foreground. Whether schizophrenics differ later in their intelligence is still undecided. But it appears certain that, even before the start of their illness, they achieve a lower social status than their siblings. There exists a large experimental psychologic literature on relationships between the original personality, symptoms and psychophysiologic correlates in which it is confirmed again and again that bad pre-morbid adaptation corresponds closely with the severity of symptoms and loss of achievement. There are no consonant result of investigations into the frequency of schizoid structures in schizophrenics, in psychiatric control groups and in the normal population. Psychometric techniques have been used only rarely, but existing publications confirm in principle that schizophrenics are markedly more schizoid than control groups. As with schizophrenia, there are contrasting ideas as to the cause and pathogenesis of the pre-morbid personality. Psycho- and socio-genetic, behavioral, genetic and neurochemical hypotheses have their adherents. According to recent studies of adoption the genetic factor appears to predominate. The clinician relies on pre-morbid development of the personality in his search for a "kink in the life line" or in his assessment of the quality of remissions. There is general agreement that a schizoid primary personality has an unfavorable influence on the long-term prognosis. This is still true today, in spite of modern possibilities of treatment and rehabilitation. Prophylactic aspects have been discussed for a long time but have remained unhelpful clinically. Often it may be difficult to distinguish between schizoids and mild hebephrenias. In spite of this the clinical concept "schizoid" should never be used for "mild schizophrenia"...

The personality structure of patients suffering from psychovegetative disorders is described in the present article from aspects of the psychology of the ego. The focus of all such disorders is a defective desomatization of affectations and the functions of perception. In proportion to the extent of the developmental disorder this specific pathology of the ego is either employed regressively in the defense of conflicts or serves for the release of a structurally strongly limited ego. More precise investigation of the ego structure leads to the descrimination between vegetative neuroses as limited ego pathology on the one hand and psychovegetative disorders in the context of a more extensive ego pathology, as they occur in borderline syndromes or serious narcissistic disorders of the personality on the other. Diagnostically the discrimination may be made by considering the patients own description of their complaints and the structure of their characters, by evaluating the quality of anxiety and affectations, and on the basis of the dynamics of the psychotherapeutic relationship. Consequently there are characteristic differences for the course of treatment.

After the successful classification of endogenous psychoses only by a vector of measuring dates of covering curves of the arterial pulse waves was tested, whether the concrete state of activity of the generally activating reticular system observed in this case may be described also according to the peculiarity of centrally regulated variations of the cardiac rhythm. Using the vectors of the measuring values of these regulation influences we also got a rate of correct classification of endogenous psychoses of about 80%.

The therapist's emotional reactions and attitudes in time-limited short-term therapy are presented. Limitations of time and scope this kind of therapy must be dealt with emotionally by the therapist; emotional reactions and attitudes can be expected to vary according to the therapist's personality structure; schizoid, depressive, compulsive or hysterical. Transference in time-limited short term therapy can be very intense but is easier to indendify. This has implications for countertransference reactions caused by the patient's transference.

38 schizoid and 70 hysterical patients with neurotic disturbances are compared with regard to social data, intelligence and triggering situation. Schizoids are more frequently single, childless and live alone, while hysterics are married, remarried or divorced, have one child and live with their partner and the child. With nearly the same education and intelligence, schizoid patients are more often workers/skilled workers, pupils/apprentices/students or have no profession; hysterically structured individuals, being predominantly women, are more frequently housewives. Nearly half of the most frequent triggering events are equally distributed in both structure groups; these are particularly events signalling a change during development, which, in degree of severity, can just as well be minor threshold situations as serious reverses. With an earlier age of onset, schizoids decompensate significantly more often in "developmental stages", whereas hysterical patients are more likely to do so in connection with events of "love-sexuality" and those which provoke hysterical anxieties. Of the 15 most frequent events, only 6 each occur in either the schizoids (starting school, puberty, moving away from home, entering into a heterosexual relationship in terms of a casual encounter, beginning an apprenticeship or studies, failure in a test) or the hysterically structured individuals (vacation, marriage, pregnancy/delivery, marital disharmony, extra-marital relationship and severe illness of the patient).

This part examines the symptoms and diseases of neurotics with either a schizoid (38) or a hysterical (70) personality structure, comprising 5% and 10% respectively of the first admissions in 7 years. Compared to the hysterical structure, schizoids more frequently show the following characteristics: they are men and have as their secondary component a mixed character structure, an earlier age of onset, a longer duration of illness but earlier referral for psychotherapy. They suffer mainly from psychic symptoms--depressive states and contact difficulties as the indicating signs. Further complaints are defective concentration, feelings of apprehension and difficulty in working, also bulimia and the inability to breathe deeply. They were mostly born between 1940 and 1959. Their relatives suffered from psychiatric disorders. Compared to the schizoids, hysterically structured individuals are almost exclusively women, their second most important structural component being obsessive-compulsive. They develop their illness later, have it for a shorter time and are referred for psychotherapy later. Their indicating signs manifest themselves more often somatically, less frequently as anxiety states or phobias. The symptoms occur simultaneously in several organ systems, particularly the respiratory tract, the gastrointestinal tract and the musculoskeletal system. Common symptoms are dyspnea and/or hyperventilation tetany, nausea, weight gain, frigidity and fluor as well as crying fits. They formerly suffered from gynecological disorders and had to undergo operations. They were mainly born between 1920 and 1939. Their relatives had cardiac disorders and their symptoms were identical or similar to those of their father.

615 neurotic patients from two outpatient Clinics were divided into three groups: only children, siblings with minimal age difference group, siblings not of minimal age difference group. The following hypothesis were to be examined: The younger of two siblings with minimal age difference are at greater risk to develop schizoid disorders. The hypothesis was proved correct. Amongst our patients the younger of two siblings of minimal age difference were at a particularly high risk in becoming schizoid. In addition we found the following risiko configuration in the early developmental period. Frequently these patients originated from families with many children, the age difference to the next sibling is also minimal, the mother is frequently lost before the age of three and the father is often self employed. These results confirm the so called "hypothesis of neglect" as it is observed in the development of schizoid disorders. A reexamination of the result of this research is to be desired.

Compared to the hysterical structure, the following characteristics are more frequent in schizoids: they are illegitimate, are born late after several siblings and are quiet and shy as children. The mother is irascible, the father aloof; on the other hand, the parental combination "mother and father affectionate" is more common. The father is often absent in early childhood, and there is the additional stress caused by changes of residence. In their earliest childhood memory, the mother and father are named as central reference persons. According to the impairment score, the schizoids are more severely disturbed. In contrast, hysterical patients have young mothers that taboo sexuality and irascible fathers; they criticize the mothers more and also idealize the father. The hysterically structured individual is an only child or has few siblings. As children, these patients are well-behaved, lively, athletic, have many friends, fight and compete with siblings. In their earliest childhood memory, they name other adults--not family members--and topics centering on possession and contact. Their childhood is affected by stress arising from the death of the father and other close reference persons as well as from flight experiences. The results make it possible to describe a markedly different line of development in the structure groups and a greater degree of stress due to various risk factors in the schizoids.

It has been reported about the results of ambulatory psychotherapy in groups. We believed that the process in a group will be stimulated specifically by different concepts and kinds of intervention. Thus, the behaviour of the therapeut seems to be very important. Special attention is also paid to the preparation of the patients within a complex therapy programme. In this way it is possible, also to improve ambulatory ability and indication of dynamie psychotherapy in a group.

The relation between sociodemographic characteristics and structure of personality (MMPI) was analyzed using the results of the "Basle Adolescence Study". Type of housing, family structure, employment of the mother and number of working hours of the father produced statistically significant differences, which, however, were small in respect to the general variability of the structure of personality.

Schizophrenia and its variations, the different concepts and criteria for the diagnosis of schizophrenia and the possibilities of "prognostic diagnosis" at the beginning of the disease are discussed. There is only a differential typology between schizophrenia and cyclothymia and no sharp differential diagnosis. The numerous attempts to separate the two large groups of disease types are critically reported. Uncharacteristically pure residual states which leave the center of personality intact are more frequent than typical schizophrenic personality changes; the majority of schizophrenic patients are socially cured after more than two decades. More recent investigations on the course lead to an approximation to the concept of the "homogenous psychosis" and compel a greater observation of the "stratification rule" in the diagnosis.