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We assessed the relation between season of birth and eating disorder symptoms and personality characteristics in a sample of 880 women with eating disorders and 580 controls from two Price Foundation Studies. Eating disorder symptoms were assessed using the Structured Interview of Anorexic and Bulimic Disorders and the Structured Clinical Interview for DSM-IV. Personality traits were assessed using the Temperament and Character Inventory and the Frost Multidimensional Perfectionism Scale. Date of birth was obtained from a sociodemographic questionnaire. No significant differences were observed 1) in season of birth across eating disorder subtypes and controls; nor 2) for any clinical or personality variables and season of birth. We found no evidence of season of birth variation in eating disorders symptoms or personality traits. Contributing to previous conflicting findings, the present results do not support a season of birth hypothesis for eating disorders.

Zusammenfassung Anorektische und bulimische Essstörungen sind bei Jugendlichen und jungen Frauen in entwickelten Industrieländern inzwischen weit verbreitet. Diese Essstörungen finden Beachtung in den Medien und Interesse bei Laien, sind für den Wissenschaftler nicht einfach zu fassen und stellen eine Herausforderung für die Behandlung dar. Generelle Risikofaktoren für die Entstehung von anorektischen und bulimischen Essstörungen sind (1) weibliches Geschlecht, (2) Adoleszenz und (3) das Leben in einer Industrienation. Spezielle Risikofaktoren sind Häufung von (1) Adipositas oder psychischen Erkrankungen (Essstörung, Depression, Substanzmissbrauch in der Familie), (2) prämorbide Charakteristika (frühe Menarche, kindliches Übergewicht, Angststörung, niedriges Selbstvertrauen, Perfektionismus) sowie (3) prämorbide Belastungen. Sowohl biologische und soziokulturelle Faktoren als auch persönliche Belastungen spielen für die Ätiologie eine Rolle. Es gibt viele Einzelbefunde zu möglichen Ursachen, doch wenig Konklusives. Betroffene fühlen sich weniger krank als sie sind und suchen eine Therapie gar nicht oder oft nur widerstrebend auf. Entsprechend schwierig ist oft die Therapie. Dennoch gab es in den letzten Jahren Fortschritte, die uns helfen, diese Krankheitsbilder besser zu verstehen und zu behandeln.

As part of a prospective, long-term treatment study, 30 in-patients with bulimia nervosa (BN) were divided into groups with high and low expressed emotion (EE) family backgrounds according to the Camberwell Family Interview, and followed for a period of six years. The high EE group initially showed significantly more psychopathology than the low EE group. No group x time interactions were found, but the high EE group showed a worse outcome on the “conflict” and “organisation” subscales of the Family Environment Scale. They also showed significantly more eating disorder pathology according to the Eating Disorder Inventory (EDI) and the Structured Interview for anorexia nervosa (AN) and BN before treatment, at discharge, after two years and, to some degree, even after six years. Depth of depression (Beck Depression Inventory) was significantly higher in the high EE group at admission (moderate depression), discharge and after the 6-year follow-up (still slight depression). The Parental Bonding Instrument (PBI) showed no differences between the high EE and low EE groups, but the individuals with “affectionless control” according to the PBI had more negative scores on three of the subscales of the Family Environment Scale (FES). In brief, the high EE individuals with BN were initially sicker and did not fully catch up over time in comparison with the symptomatic recovery of the low EE individuals. These data suggest that EE status upon admission to in-patient treatment is a relevant predictor of the severity and course of BN and depressive symptoms.

Cognitive-Behavioral Treatment of Obsessive Compulsive Disorder: An Inpatient Group Treatment Program Background: While group behavioral treatments have proven effective in treating anxiety-disordered patients such as social phobics, studies that investigate standardized group treatment programs for OCD are rare. This study presents the development and evaluation of an cognitive-behavioral inpatient group treatment program for OCD. Method: 23 inpatients, meeting the DSM-IV criteria for OCD, completed apart from the regular therapeutic program a 7–2-h session manualized group therapy on the basis of self management as well as cognitivebehavioral concepts. Results: Assessments were conducted before treatment, at admission, at the end of treatment and at 3-month follow-up. Y-BOCS scores did not change in the pretreatment period but reduced significantly at posttest [from 25.8 (5.4) to 13.9(6.9)] and were maintained at 3-month follow-up. Clients-ratings of the group treatment program were positive.

OBJECTIVE: Ghrelin is a new gastric hormone that has been identified as an endogenous ligand for the growth hormone (GH) secretagogue receptor subtype 1a (GHS-R1a). Ghrelin administration however not only stimulates GH secretion but also induces adiposity in rodents by increasing food intake and decreasing fat utilization. We hypothesized that impaired ghrelin secretion in anorexia nervosa may be involved in the pathogenesis of this eating disorder. To examine this hypothesis and to further investigate the role for ghrelin in regulating energy homeostasis, we analyzed circulating ghrelin levels in patients with anorexia nervosa and examined possible correlations with clinical parameters before and after weight gain. METHODS: Plasma ghrelin levels were measured in overnight fasting plasma samples from 36 female patients with anorexia nervosa (age: 25.0+/-1.2 years, BMI: 15.2+/-0.2 kg/m(2)) before and after weight gain following psychotherapeutic treatment intervention in a psychosomatic institution. Plasma ghrelin levels were also measured in fasting plasma samples from 24 age-matched female controls (31+/-1.4 years, BMI: 22.9+/-0.45 kg/m(2)). For quantification of ghrelin levels a commercially available radioimmunoassay (Phoenix Pharmaceuticals, USA) was used. RESULTS: Fasting plasma ghrelin levels in anorectic patients were significantly higher (1057+/-95 pg/ml) than in normal age-matched female controls (514+/-63 pg/ml n=24, P=0.02). Therapeutic intervention in a psychosomatic institution caused an BMI increase of 14% (P<0.001) leading to a significant decrease in circulating ghrelin levels of 25%, (P=0.001). A significant negative correlation between Deltaghrelin and DeltaBMI was observed (correlation coefficient: -0.47, P=0.005, n=36). CONCLUSION: We show for the first time that fasting plasma levels of the novel appetite-modulating hormone ghrelin are elevated in anorexia nervosa and return to normal levels after partial weight recovery. These observations suggest the possible existence of ghrelin resistance in cachectic states such as caused by eating disorders. Future studies are necessary to investigate putative mechanisms of ghrelin resistance such as a possible impairment of intracellular ghrelin receptor signaling in pathophysiological states presenting with cachexia.

OBJECTIVE: Ghrelin is a new gastric hormone that has been identified as an endogenous ligand for the growth hormone (GH) secretagogue receptor subtype 1a (GHS-R1a). Ghrelin administration however not only stimulates GH secretion but also induces adiposity in rodents by increasing food intake and decreasing fat utilization. We hypothesized that impaired ghrelin secretion in anorexia nervosa may be involved in the pathogenesis of this eating disorder. To examine this hypothesis and to further investigate the role for ghrelin in regulating energy homeostasis, we analyzed circulating ghrelin levels in patients with anorexia nervosa and examined possible correlations with clinical parameters before and after weight gain. METHODS: Plasma ghrelin levels were measured in overnight fasting plasma samples from 36 female patients with anorexia nervosa (age: 25.0+/-1.2 years, BMI: 15.2+/-0.2 kg/m(2)) before and after weight gain following psychotherapeutic treatment intervention in a psychosomatic institution. Plasma ghrelin levels were also measured in fasting plasma samples from 24 age-matched female controls (31+/-1.4 years, BMI: 22.9+/-0.45 kg/m(2)). For quantification of ghrelin levels a commercially available radioimmunoassay (Phoenix Pharmaceuticals, USA) was used. RESULTS: Fasting plasma ghrelin levels in anorectic patients were significantly higher (1057+/-95 pg/ml) than in normal age-matched female controls (514+/-63 pg/ml n=24, P=0.02). Therapeutic intervention in a psychosomatic institution caused an BMI increase of 14% (P<0.001) leading to a significant decrease in circulating ghrelin levels of 25%, (P=0.001). A significant negative correlation between Deltaghrelin and DeltaBMI was observed (correlation coefficient: -0.47, P=0.005, n=36). CONCLUSION: We show for the first time that fasting plasma levels of the novel appetite-modulating hormone ghrelin are elevated in anorexia nervosa and return to normal levels after partial weight recovery. These observations suggest the possible existence of ghrelin resistance in cachectic states such as caused by eating disorders. Future studies are necessary to investigate putative mechanisms of ghrelin resistance such as a possible impairment of intracellular ghrelin receptor signaling in pathophysiological states presenting with cachexia.

Zusammenfassung: Es wird der Fall eines homosexuellen Patienten mit HIV-Infektion und Bulimia nervosa geschildert. Diese Einzelfalldarstellung soll Hinweise liefern ber die Verlaufscharakteristika bei gemeinsamem Auftreten von Bulimia nervosa und HIV-Infektion unter besonderer Betrachtung des Aspektes der Homosexualitt. Der Patient erlebte eine Reihe von schweren Traumata und Missbrauchserlebnissen, die vermutlich deutlichen Einfluss auf die Entwicklung der Bulimia nervosa nahmen. Als typisch fr die Bulimia nervosa bei homosexuellen Mnnern kann das vom Patienten gezeigte Streben nach dem Schlankheitsideal betrachtet werden, das sich in bermigem Beschftigtsein sowie einer Unzufriedenheit mit Figur und Gewicht zeigte. Weiter scheinen mnnliche Essgestrte wie auch der beschriebene Patient berzufllig hufig bergewicht im Vorfeld der Bulimia nervosa aufzuweisen. Die HIV-Infektion des Probanden hatte keinen Einfluss auf den Ausprgungsgrad der Bulimia nervosa. Allerdings wirkte sich die Bulimia nervosa negativ auf den Verlauf der HIV-Infektion aus.

The Structured Interview (SIAB-EX) and Questionnaire (SIAB-S) for Anorexic and Bulimic Eating Disorders for DSM-IV and ICD-10 Background: The Structured Inventory for Anorexic and Bulimic Syndromes according to DSM-IV and ICD-10 consists of the Structured Expert Interview for Anorexic and Bulimic Syndromes (SIAB-EX) and the corresponding self report questionnaire (SIAB-S). These instruments assess symptoms of eating disorders and other symptoms often found in eating-disordered individuals (e.g. anxieties, symptoms of OCD, depression, substance abuse and impairment of sexuality and social integration). Thus, parallel forms for self-report and expert rating are available. Separate factor analyses resulted in very similar factor structures for self-report and interview as well as for both time points assessed: ''current'' (last 3 months before the interview) and ''past'' (time from puberty up to 3 months before the interview). Both assessments can be used for diagnosing eating disorders according to DSM-IV and ICD-10 and a total score can be computed. Method: Test criteria were assessed using a sample of 377 inpatients treated for an eating disorder. For the expert interview, SIAB-EX data were collected in a community sample of 202 young women without eating disorders. Results: Test criteria were satisfying or better. Interrater reliability (ĸ) for the expert interview SIAB-EX was 0.81 (current) and 0.85 (past). Sensitivity, specificity, and positive predictive value were very good for the SIAB-EX (ppv = 0.91 lifetime) and the SIAB-S (ppv = 0.98 lifetime). Means for SIAB-EX and SIAB-S for the inpatient sample are reported. For the expert interview SIAB-EX norms for 202 young non-eating disordered women are given. Conclusion: The expert interview SIAB-EX can be seen as a ''gold standard'' for the assessment of eating disorders. The SIAB-EX is available in German, English, Italian and Spanish.

Self-help Organizations and Groups in Behavioral Medicine: Overview and DescriptionBackground: Over the past years self-help organizations have become an essential part of prevention and rehabilitation in German health care. It was the aim of our enquiry to inform experts and interested persons about the most important self-help organizations (SHO) and self-help groups (SHG) of different fields in behavioral medicine. Methods: 70 SHO and SHG of different fields in behavioral medicine were selected dealing with allergy and asthma, congenital disorders, relatives of patients with psychic disorders, anxiety disorders, chronic pain disorders, eating disorders, diseases of the musculoskeletal system, diseases of the gastrointestinal tract and incontinence, skin diseases, hearing and speech disorders, life crises, disorders pertaining to the nervous system, personality disorders and psychic problems, abuse, or obsessive-compulsive disorders. The selected SHO and SHG received a structured questionnaire including questions regarding (1) address, (2) means of contact, (3) group of interest, (4) tasks and aims, (5) provision, (6) structure of organizations, and (7) comments. Results: 90% of SHO replied, 56 SHO sent back the questionnaire completely answered, 5 institutions sent material of information instead, and 30 included both questionnaire and information material. The data clearly show the extensive support SHO might offer to sufferers. Conclusions: This report provides an informative overview of SHO. It might help to support the already existing cooperation between experts and SHO in this field.

Zusammenfassung: Anliegen der Arbeit war die Inanspruchnahme medizinischer und psychosozialer Dienste durch psychisch erkrankte Münchener Obdachlose festzustellen. Um zu einer repräsentativen Stichprobe zu gelangen, wurde in einem ersten Schritt die Grundgesamtheit Obdachloser in verschiedenen Bereichen erarbeitet. Im nächsten Schritt wurde daraus eine repräsentative Stichprobe gezogen. 146 obdachlose Männer und 32 obdachlose Frauen wurden u. a. mit Hilfe des Diagnostic-Interviews-Schedule (DIS) in standardisierter Weise interviewt. Die Lifetime- und 6-Monats-Prävalenz für psychische Störungen nach DSM-III war hoch. Medzinische und psychosoziale Einrichtungen wurden in Anspruch genommen, jedoch meist nur kurzfristig als Krisenintervention. Es erfolgte keine kontinuierliche Betreuung. Frauen waren häufiger in Behandlung als Männer. Andere soziodemographische Faktoren wie Alter und Ausbildungsniveau zeigten kaum Einfluss auf das Hilfesuchverhalten. Trotz hoher Prävalenz an Suchterkrankungen wurden Alkohol- und Drogenkliniken selten konsultiert. Schizophrene und angsterkrankte Obdachlose waren am häufigsten behandelt. Mittels logistischer Regressionsmodelle wurden Prädiktoren der Inanspruchnahme analysiert. Neue Versorgungsmodelle sind notwendig, die Hemmschwelle für die derzeitige Versorgungsstruktur ist zu groß. Eine kontinuierliche Betreuung erfolgt selten.

This study evaluated the concordance among different approaches to diagnose patients with multiple somatoform symptoms. Inpatients (N =108) of a center for behavioral medicine were diagnosed using a structured clinical interview. Somatization disorder according to DSM-TV and ICD-10 was as rare as somatization disorder according to DSM-III-R. The overlap between the criteria of DSM and ICD for somatization disorder was lower than that between DSM-III-R and DSM-IV. Somatoform autonomic dysfunction, a diagnostic category proposed by ICD-10, included fewer patients diagnosed with somatization disorder than the criteria of Escobar and colleagues for abridged somatization disorder (SSI-4/6: this Journal 177:140–146, 1989). Therefore, the Escobar criteria may be a common link between ICD-10 and DSM-IV. Although the original Escobar criteria were built upon the symptom list of DSM-III-R somatization disorder, SSI-3/5 is an empirically derived equivalent according to DSM-IV in our study (a minimum of 3 symptoms for men or 5 symptoms for women out of the list of 33 somatization symptoms according to DSM-IV).

A random sample of 1298 non-medical mental health workers in West Berlin was asked to fill out a questionnaire concerning professional training, description of their working place, clients treated, financing, special professional qualifications and continuing education. An analysis was made of the distribution of therapists within the city. About half were engaged in intensive counselling only and the rest also practised psychotherapy. Results indicate that there are large differences in the rates per 100,000 inhabitants between the districts for all professional groups (e. g. medical doctors generally, psychiatrists, non-medical psychotherapists (total), medical psychotherapists in private practice, psychologists and social workers). In addition clear differences in the proportions of university and postuniversity training qualifications were found between districts. The same pattern of maldistribution was found for all therapists regardless of their theoretical background, and for major areas of work, for most service institutions and for the major diagnostic groups of clients treated. Highly significant correlations between socio-demographic variables of the twelve districts and therapist variables were found indicating that significantly more therapists and therapist with a higher degree of training are practising in the more affluent districts.

Summary Various studies have indicated that bulimics are more easily hypnotized and dissociate more readily than control groups and patients with other eating disorders. A comparison is reported of 15 inpatients with bulimia nervosa (DSM III-R) with 15 subjects in a control group comparable in age and education. The instrument used was the Harvard Group Scale of Hypnotic Susceptibility/Form A (HSGHS: A), which includes 12 standardized test suggestions. The results show that bulimics have higher scores in hypnotizability than the control group. A method study (comparison of self-evaluation with a video recording) shows that this is a result of the behaviour itself and not of the answering pattern used by the subjects in the questionnaire. It is possible that differing expectations regarding the experiment may have influenced the results. Considerations concerning the increased ability of bulimics to dissociate as a causal factor versus an accompanying phenomenon of the disorder are discussed.

In a two-wave community study a representative sample of 402 very old people (older than 85 years) was restudied 1 year later. Four instruments in the clinical examination were used for case identification: (a) the Geriatric Mental State Interview (GMS-A); (b) the Structured Interview for the Diagnosis of Dementia (SIDAM); (c) the Global Deterioration Scale (GDS); and (d) the Mini Mental State Examination (MMSE). The clinical examination was performed by the interviewing physician who made a diagnosis according to DMS-III-R. The focus of the present study is on the (true) incidence of dementia in a representative community sample. The establishment of incidence rates is particularly important for dementia because the prevalence of dementia is affected by the length of survival, which is reducd in dementia and with increasing age. The annual incidence rates per 1000 person years on the basis of the SIDAM DSM-III-R were 116.6 for all cases at risk, 113.6 for those aged 85–89 years, 112.5 for those aged 90–94 years and 235.7 for those aged 95 years and older at first assessment (t1). Incidence rates based on the other methods of assessment are reported. In order to obtain the most meaningful estimate of incidence rates a compound dementia diagnosis was defined. According to this the annual incidence rate per 1000 person years was 144.1 for all persons at risk. The incidence rate tended to be higher in the older-age cohorts: It was 126.2 for those aged 85–89 years, 193.1 for those aged 90–94 years and 295.5 for those aged 95 years and older. In comparison with the literature the incidence rates were high. The results are plausible when the very old age of the sample is taken into account.

The aim of the study was to reliably assess the 6-month and lifetime prevalence of mental illness according to DSM-III criteria in a representative sample of homeless individuals in the city of Munich, Germany. Because the characteristics of the homeless population were unknown, we first conducted a pre-sampling survey to determine a proportionate allocation of the main interviews in three nested sampling strata. For the pre-sampling we approached 300 males, who appeared tobe homeless, for a brief interview; of these, 271 were homeless according to our definition and were allocated to one of three sectors (“shelter”, “meal services”, “outdoor”). Thereafer, we randomly sampled homeless males in these three strata until the indicated allocations were met. The Diagnostic Interview Schedule (DIS) was used for diagnostic classification according to DSM-III in the main interview. Results from this representative urban sample show that the mean age of the homeless males was 43 years; most were unmarried or divorced, had a relatively low level of school education and a long duration of homelessness. Based on the main interviews with 146 homeless males the following lifetime prevalence rates were obtained: 91.8% for substance use disorder (82.9% alcohol dependence), 41.8% for affective disorders, 22.6% for anxiety disorders and 12.4% for schizophrenia. Of the homeless males in Munich, 94.5% had at least one DIS/DSM-III axis I diagnosis. Six-month prevalence data is also presented. Results are compared with those of a very similar study on homeless individuals in Los Angeles, which also used DIS/DSM-III diagnoses. In comparison with representative community samples in the United States and in Germany, mental illness was much more frequent among homeless individuals in Munich as well as in Los Angeles. Implications for health care planning are discussed.

This study addresses the issue of need for and provision of psychotherapy care in urban and rural areas. In the first part, prevalence of mental disorders based on epidemiological field studies in the county of Traunstein and the city of Mannheim are discussed. Among patients of general practitioners the prevalence of mental disorders was slightly higher in Mannheim than in Traunstein. Concerning the provision of care, results of a questionnaire survey of a random sample of 1542 nonmedical counsellors or psychotherapists in Traunstein, Mannheim and the metropolitan area of West Berlin are presented. The rate of nonmedical therapists/100,000 inhabitants was the same for Traunstein and Mannheim. A more detailed analysis of their service capacity revealed that it was by 17% to 20% higher for Mannheim than for Traunstein; the prevalence of mental disorders in patients of general practitioners was shown to be about 10% higher in Mannheim than in Traunstein. Under the assumption that there is a linear relationship between prevalence and need for care, there appears to be a slight, but not marked undersupply of services by doctors and nonmedical counsellors or psychotherapists in Traunstein as compared to Mannheim. In comparison, the districts of West Berlin were classified into those with high and those with a low percentage of blue collar workers. The rate of nonmedical counsellors or psychotherapists in the “upper class” districts in West Berlin was almost four times higher than that for the “lower class” districts of West Berlin, in Mannheim and Traunstein. The rate/100,000 for the service capacity of nonmedical counsellors or psychotherapists in the “upper class” districts of West Berlin was much higher, and in the “lower class” districts of West Berlin much lower, than in Traunstein or Mannheim. Our data show that there are some discrepancies in the provision of care between rural and urban areas, which however are not large when Traunstein is compared with Mannheim; there were however, substantial discrepancies in the provision of care between cities (Mannheim and West Berlin) and between districts within the same city (West Berlin).

Five samples of adolescents were assessed in three countries: (1) 867 Greek pupils in Munich (Germany), (2) 2,700 Greek pupils in Veria (Greece), (3) 567 girls in Ioannina (Greece), (4) 2,783 adolescents in Istanbul (Turkey), and (5) 157 adolescents in Upper Bavaria (Germany). A two-stage procedure was used for samples one, two and four using the Anorexia Nervosa Inventory for Self-rating (ANIS) for screening and a standardized interview (Structured Interview for Anorexia Nervosa and Bulimia) for personal exploration of possible cases and final case identification. Results of all samples were compared. Greek girls in Germany scored higher than Greek boys in Germany and Greek boys and girls in Germany scored lower than Greek girls in Veria in the ANIS factors figure consciousness, insufficiency, anancasm, negative effect of meals and bulimia in practically all age groups. The frequency distribution of the ANIS main factor figure consciousness was the same for both Greek samples in Greece, while the Turkish sample and the Greek sample in Munich had significantly lower scores. In the second stage the prevalence rates for anorexia nervosa according to Feighner criteria (modified for the purpose of a field study) were: 1.10% for Greek girls in Munich, 0.41% for Greek girls in Veria and 0.35% for Greeks in Ioannina. Thus, while Greek girls in Germany had lower scores in ANIS factors and other self-ratings (General Health Questionnaire) the actual rate of anorexic syndromes was highest among Greek girls in Munich. Socio-cultural influences and selection factors are discussed.

Samples of 867 Greek adolescents in Munich, 2,702 Greek adolescents in Greece and 2,780 Turkish adolescents in Turkey were assessed concerning mental health in a two-stage procedure. In the first stage the General Health Questionnaire (GHQ) was used for screening. Significant age differences in the GHQ 28-item scale and most of its subscales were observed mainly for the samples in the homeland. Male adolescents had lower scores than female adolescents in the GHQ 28-item scale and its sub-scales while social class appeared to be of little influence. Significantly higher GHQ-28 scores were obtained for Greeks and Turks in their homelands as compared to Greeks in Munich. The GHQ-28 correlations with the Anorexia Nervosa Inventory for Self-Rating were fairly high. A principal component analysis with Varimax rotation showed fairly consistent results for this age group when compared with the results of Goldberg and Hillier (1979). With the exception of the GHQ factor social dysfunction Greek adolescents in their homeland had significantly higher scores in the total GHQ-28 and its sub-scales than Greeks in Germany. Thus, our data do not confirm the acculturation-stress hypothesis. The data would be consistent with the hypothesis of selective migration which states that Greek adolescents in Germany constitute a positive selection with respect to risk for mental illness.

The 28-item version of the General Health Questionnaire was administered to Greek and Turkish school pupils in their mother country as well as to Greeks in Munich. Principal component analysis with varimax rotation was carried out separately for both the individual populations and sexes separately. Visual inspection of the matrices suggested overall agreement with the sub-scales obtained by Goldberg and Hillier (1979). The coefficient of factor similarity, calculated between matrices, suggested a highly similar principal component structure between the population samples as a whole and separately for the sexes living in their own country, but not between male and female Greek pupils in Germany. Highly similar component matrices were obtained for Greek males living in Greece with those in Germany, but not for females.

Zusammenfassung: Um 1900 stellten deutsche Psychiater Geisteskrankheiten wie die „Dementia praecox“ als häufige Ursache des Landstreichertums dar. Das Psychopathiekonzept der 20er Jahre faßte die Landstreicherei eher als eine „charakterologische Minderwertigkeit“ auf. Die Verknüpfung von psychiatrischen Diagnosen mit gesellschaftlichen Moral- und Wertmaßstäben bereitete den Weg für die Verfolgung der als „asozial“ bezeichneten Obdachlosen während der Zeit des Nationalsozialismus. Die steigenden Zahlen von Obdachlosen haben in den vergangenen 20 Jahren erneut das Forschungsinteresse der Psychiatrie geweckt. Größere epidemiologische Studien belegen erhöhte Prävalenzzahlen v. a. für schwere psychische Erkrankungen (Schizophrenie, affektive Erkrankungen, Suchtmittelabhängigkeit) unter Obdachlosen und dokumentieren einen dringenden Hilfebedarf für die Gruppe der psychisch kranken Obdachlosen.

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