[Concepts of depressive patients regarding the cause of their disease]. / Vorstellungen depressiver Patienten über die Ursachen ihrer Erkrankung.

In 60 patients suffering from either neurotic or endogenous depression (according to ICD-9), the aetiological concepts regarding their illness were studied by means of content analysis of answers to an interview question. Most patients had multifactorial aetiological concepts. Psychosocial concepts were more frequent than biological ones; this bias, however, was less pronounced in endogenous depressives (and, within this group, in bipolar vs. unipolar patients) than in neurotic depressives. The latter stressed triggering events as causes of illness, whereas for endogenous depressives, dispositions were more important. A positive expectancy of being able to influence the illness correlated with an aetiological model which implied triggering as well as predisposing factors.

Partner relationships of depressives.

A study of the partnerships of 15 endogenous bipolar, 15 endogenous unipolar, 15 neurotic and 16 unclassified depressives, and of 36 control persons showed that there were some common factors and some differences due to sex among the depressives as a total group. The greater differences were to be found, however, among the depressive subgroups. Bipolars: particularly great desire for closeness and for love and attention, low self-esteem where the partner is concerned, the strongest aggression inhibition. Unipolars: arrogance, indirect aggression and emotional distance to the partner. Neurotic depressives: many conflicts, directly and indirectly aggressive, dissatisfied and demanding. Unclassified depressives: extreme fluctuations between clinging and arrogance and withdrawal.

Partnership problems as causes of endogenous and neurotic depressions.

Content analysis of biographic interviews with endogenous and neurotic depressives shows that problems in a partnership carry particular weight as triggers of depression. In this respect, however, separations and the death of a partner play a comparatively less important role. Neurotic depressives become significantly more often depressive because of partnership-related events than endogenous depressives. Also in qualitative respects the causes for depression differ between the two groups: in endogenous depressives a threat of real loss often triggers depression, whereas neurotic depressives fall ill more frequently as a result of disappointments and injuries caused by the partner. Accompanying differences in the course of the partnership, the choice of partner and the premorbid personality are discussed.

Childhood experiences of endogenous and neurotic depressives.

The parent-child relationship, the relationship between the parents, and the contact of the child with the outside world was investigated on the basis of retrospective interview data concerning the childhood of endogenous and neurotic depressives and a nonclinical control group. A number of significant links between childhood experiences and the various forms of depression emerges.

Aggression in depressives and psoriatics.

The Questionnaire for Measuring Factors of Aggression (Fragebogen zur Erfassung von Aggressivitätsfaktoren, FAF) was completed by 113 depressive patients, 38 psoriatics, and 32 healthy controls. The controls had the lowest aggression scores, the neurotic depressives the highest. The monopolar endogeneous depressives had extremely high scores for autoaggressions and extremely low ones for outward aggressions, whereas the psoriatics show a contrary tendency: extremely high scores for outward aggressions and very low ones for autoaggressions.

Aggression and allergic disorder in depressives.

This paper investigates the correlation between aggression and allergic disorder in various forms of depression. As a control factor to allergic disorder we used the factor infectious disease. The aggression was measured with 2 scales of the FAF (Fragebogen zur Erfassung von Aggressivitätsfaktoren--the Questionnaire for Measuring Factors of Aggression). The sample consists of 115 depressives, of whom 26 suffer from allergic disorders and 79 have a previous history of infectious diseases. We recorded significantly higher aggression scores for allergic subjects as opposed to non-allergic subjects (p less than 0.05) in nearly all the subgroups. We also discovered a similar though not so marked tendency for people with infectious diseases. Higher aggression scores are therefore not only specific for depressives with allergic disorders. Sex, psychiatric differential diagnosis and the form of the aggression are important for the degree of the aggression.

Personality attributes of depressive patients.

Three groups of depressive patients (endogenous bipolar, endogenous unipolar, and nonendogenous) and one nondepressive control group displayed statistically significant differences on several personality variables when the patients were in a depression-free interval. Each of the depressive groups had stronger autodestructive-neurotic tendencies than the control group. The nonendogenous patients were overautonomous and aggressive, the endogenous unipolar patients lacked autonomy, and the endogenous bipolar patients had a hypomanic drive toward success and achievement and were anancastic and aggressive. These results were controlled for the influence of persisting symptoms of depression. They rectify generally accepted views and represent a basis for further clinical research.

Neurotic depression: results and cluster analyses.

On a sample of 193 former depressive inpatients (145 female, 53 male), cluster analyses were carried out, both on the subjects and on the items for classficatory reasons. The study was based on 38 items relevant for the diagnostic axes of clinical phenomenology (during illness), characteristics of the course, and (intermorbid) personality. The findings from the multivariate statistical methods support the existence of a neurotic depressive disorder which can be identified by essential features and accessory features on the aforementioned three diagnostic axes. Especially noteworthy are maintained reactivity to the outside world, normal sadness, hypochondriasis, and open aggression; insidious onset of the depressive episode and long duration; and the neurotic basic personality. Despite a certain heterogeneity of the isolated neurotic depressive subgroups and profiles, their similarity is based on substantial common properties. In a comprehensive view of our findings, one can justifiably speak of a specific disorder that need not be defined in the negative as compared to the endogenous depression, but can be characterized in the positive.

[Personality types in endogenous and non-endogenous depression]. / Les types de personnalité des dépressions endogènes et des dépressions non endogènes.

The post depressive personality of three groups of previously depressed patients (19 bipolar endogenous, 95 unipolar endogenous, 58 non endogenous) and of a control group of 33 normal subjects was examined. The contaminating influence of the residual depressive symptomatology on the personality measures, when present, was eliminated. Using uni- and multivariate procedures, the existence of statistically significant inter-group differences was demonstrated. The results contradict some previous assertions. "Neuroticism' is significantly higher in the three groups of depressive as in the control group. In addition, the non endogenous are high on "autonomy' and "aggression', the unipolar endogenous are low on "autonomy', and the bipolar endogenous are high on "hypomanic drive towards success and performance', and on 'obsessional trends and aggression.

Themes of endogenous and nonendogenous depressions.

In a study of 29 endogenous and 24 nonendogenous depressive patients, the two diagnostic groups showed significant differences in the thematic content of their depressions. We found no specific themes characteristic of endogenous depression and - in contrast to the nonendogenous group - relatively little linkage of the depressive mood to the endogenous patients' problems. The nonendogenous patients, however, could be clearly identified by the contents of their depression, which revolved around the patients' ambivalent emotional involvement with the environment in general, and their partners in particular. Endogenous and nonendogenous patients differed in degree of inner involvement with the people around them, and this factor, in accord with psychoanalytic experience, proved to be of decisive importance in differentiating between the two groups.

Loss events preceding endogenous and neurotic depressions.

Ninety unipolar endogenous depressives and 38 neurotic depressives with distinct depressive episodes were questioned concerning deaths of parents, siblings, children or partners, and separation from children (leaving the parental home) or from important partners. The age of the patients at the time of the event was compared with their age during the depressive episodes. The results indicate that significantly more neurotic depressives than endogenous depressives had experienced the loss of a close person in the year before a depression. When the loss experiences were divided up, however, it became clear that the difference was due only to separations, and in particular to separations from an important partner.

Identification of the endogenous depressive syndrome based on the symptoms and the characteristics of the course.

Using a sample of 198 depressed patients (145 female, 53 male) retrospective histories of the illnesses were collected during a depression-free interval, based on a catalogue containing 38 symptom items and the course of the depression (including the interval personality). A cluster analysis on persons and items filtered out an endogenous depressive item profile, corresponding with the clinical syndrome of patients diagnosed as endogenous depressives in the clinics, although determined without reference to the clinical diagnoses. Our study supports many results from earlier multivariate statistical studies. We consider our data to be an essential contribution towards the establishment of a multiaxial clinical picture.

[Loss events in childhood as predisposing factors for neurotic and psychotic depression (author's transl)]. / Verlustereignisse in der Kindheit als prädisponierende Faktoren für neurotische und psychotische Depressionen.

In a semistructured interview 90 endogenous depressives, 38 neurotic depressive patients, and 41 controls, 47-67 years of age, were questioned to ascertain the loss events during childhood. 1. The endogenous depressives, the neurotic depressive patients, and the control group had experienced an equal amount of deaths and separations in their childhood. 2. The depressive patients who first became ill after their 41st year of life were as frequently separated from their parents during childhood as the control group. Patients who had first become ill before their 41st year of life had experienced a separation from their parents more frequently than the control group. 3. Within the depressive patient group the following applies: Patients with illnesses before the age of 40 had lost their father earlier than those who became ill after 40; likewise, patients who were ill two and more times had more frequently experienced the loss of a father than those who were depressively ill only once.

[Individual reaction to stress with former concentration camp immates (author's transl)]. / Bedrängnis und Bewältigung im Spiegel des Einzelschicksals. Individuelle Stressreaktion bei ehemaligen KZ-Häftlingen.

The individual disposition to react to different stressors to play an important role in an extreme stress situation, i.e. the incarceration in concentration camps. Ten to fourteen years after their liberation, 219 former concentration camp inmates now living in Bavaria, New York and Israel were given semi-structured interviews. Since no statistically significant correlations between psychic and somatic complaints and incarceration could be found, we computed a factor analysis on illness dimensions. We found high correlations between these and the stress induced by concentration camp incarceration. An important answer to the above mentioned questions was the fact that there was no homogeneous reaction syndrome, such as it has always been described in the literature on concentration camp syndromes. We found four patterns of delayed reaction to stress. According to the contribution of somatic and psychic complaints, the factors were named as follows: 1. psycho-physical syndrome, 2. internal disease, 3. gynaecological illness, 4. psychic (social) syndrome. Personality factors played an important role in the development of these syndromes, because they modified the degree of stress endured. Personality factors were shown to be dependent on life history. The importance of these results for mastering stressors is being discussed.