ABSTRACT
Associations between depersonalization (DP) and social phobia (SP) were described in the early scientific literature. This connection, however, has not yet been considered in the recent empirical literature and clinical trials on SP. The aim of this study is to examine these associations. In a sample of 100 consecutive inpatients we compare 45 patients with pathological DP to 55 patients without pathological DP with respect to comorbidity and the degree of social anxieties assessed with the SOCIAL INTERACTION ANXIETY SCALE (SIAS) and with the SOCIAL PHOBIA SCALE (SPS) and the extent of shame assessed with the INTERNALIZED SHAME SCALE (ISS). Social phobia was significantly more prevalent in the patients with pathological DP. Furthermore, the patients with pathological DP showed a significantly larger extent of social anxieties (SIAS, SPS) and shame (ISS). The results may be considered as a preliminary empirical support of the assumed associations and thus warrant an enhanced consideration of DP in therapy and research of social anxiety disorders.
Subject(s)
Depersonalization/psychology , Phobic Disorders/psychology , Shame , Humans , Psychiatric Status Rating Scales , Psychological TestsABSTRACT
OBJECTIVE: This pilot study examines the connection between the concept of Fonagy and Target's reflective functioning and the structure axis of operationalized psychodynamic diagnostics (OPD) and assesses the potential of both scales to predict therapy success. METHOD: In the study, 24 (female) patients of the psychotherapy ward of the Frankfurt University Hospital for psychosomatic medicine and psychotherapy aged 18 to 55 were assessed on the basis of a 90-minute, semi-structured interview with regard to their capability for reflective functioning as well as with regard to their structural level according to OPD. In addition, the SCL-90-R was administered at the beginning and end of the 3-month in-patient therapy. RESULTS: A significant correlation was found between reflective functioning and the structure axis of OPD. Reflective functioning also predicted improvement in overall mental condition through a 3-month in-patient therapy. This remained significant even when the influence of the overall assessment of structure according to OPD was removed. CONCLUSIONS: The independence of the concept of reflective functioning (RF) and its implications for the clinical stance are discussed.
Subject(s)
Concept Formation , Psychoanalytic Theory , Adolescent , Adult , Female , Humans , Interviews as Topic , Parent-Child Relations , Pilot Projects , Psychotherapy/methodsABSTRACT
The German Narcissism-Inventory contains a 6-item scale for the assessment of depersonalization (DP) and derealization (DR). The validity of this scale (NI-DRP) was examined in comparison to the German version of the Dissociative Experiences Scale (FDS) and the Cambridge Depersonalization Scale (CDS). The sample consists of 144 psychotherapy patients, of whom showed on the basis of a structured clinical interview n = 51 none, n = 45 mild, n = 28 moderate and n = 20 severe DP-DR. The areas under the curve and the rate of misclassification did not differ for NI-DRP and the scales of the FDS. The CDS showed the lowest rate of misclassifications.
Subject(s)
Depersonalization/psychology , Narcissism , Adult , Depersonalization/classification , Female , Humans , Likelihood Functions , Male , Psychiatric Status Rating Scales , Reproducibility of ResultsABSTRACT
OBJECTIVE: Two literary works of authors suffering from anorexia nervosa were analyzed with the method of the core conflictual relationship theme (CCRT) to prove that novels and/or personal accounts may reveal the same maladaptive relationship patterns typically revealed in psychotherapy sessions with this nosologic group. METHOD: Two novels were selected which promised applicability of the CCRT method due to the completeness of the described relationship episodes. RESULTS: After several methodologic adjustments, the application of the CCRT method revealed the different courses and developments of the novels. Both the positive and negative as well as the conscious and unconscious relationship patterns were clearly expressed. DISCUSSION: The results indicate that after certain adjustments, the CCRT method may be successfully applied to data obtained from sources other than psychotherapy sessions.
Subject(s)
Anorexia Nervosa/psychology , Literature, Modern , Medicine in Literature , Psychoanalysis/methods , Female , Germany , Humans , Reproducibility of ResultsABSTRACT
Although the literature on depersonalization (DP) indicates links between DP and anxiety disorders, there has been no systematic investigation of the association of DP with social anxiety. The present study explores a hypothesized connection between DP and social anxiety by using correlative and regression analyses in a sample of 116 psychotherapy inpatients, 54 outpatients with epilepsy, and 31 nonpatients. Corresponding to our hypothesis, we found a connection of medium to large effect size between DP and social fears exceeding the impact of general psychopathologic symptom severity both for the psychotherapy patients and the nonpatients. The association of social anxiety with DP merits further research. A general consideration of DP in clinical and neurobiological trials on anxiety disorders like social phobia is warranted.
Subject(s)
Depersonalization/diagnosis , Phobic Disorders/diagnosis , Adolescent , Adult , Aged , Comorbidity , Depersonalization/epidemiology , Depersonalization/psychology , Diagnosis, Computer-Assisted , Dissociative Disorders/diagnosis , Dissociative Disorders/epidemiology , Dissociative Disorders/psychology , Epilepsy/epidemiology , Epilepsy/psychology , Female , Germany/epidemiology , Hospitalization , Humans , Male , Middle Aged , Models, Psychological , Personality Inventory/statistics & numerical data , Phobic Disorders/epidemiology , Phobic Disorders/psychology , Psychiatric Status Rating Scales/statistics & numerical data , Psychotherapy , Regression Analysis , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
OBJECTIVES: The importance of shame for the understanding of eating disorders has been well-known for a long time, but only few empirical studies exist to date on this aspect. Particularly the sense of self-esteem and external appearance have been attributed a major influence in the emergence of shame. Since social anxiety has increasingly been considered to be a factor in recent discussions related to eating disorders, and shame is a primary symptom of social phobia and of social anxiety in general, the present study focuses on shame and social anxiety in anorexia and bulimia, as compared to other clinical disorders. Another research question is the extent to which the prevalence of shame in eating disorders is influenced by self-esteem, attitudes about appearance and social anxiety. METHODS: The sample consists of 104 (female) patients, comprising 26 patients, respectively, with anorexia nervosa, bulimia nervosa, anxiety disorders and depression. The various variables were recorded with the Internalized Shame Scale (ISS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Scale (SPS), the Appearance Attitude Scale (AAS) and the Social Autonomous Self-Esteem Scale (SAS). RESULTS: Patients with anorexia and bulimia nervosa have higher scores in internalized global shame than patients with anxiety disorders and depressions. In contrast to anorectic patients, however, patients with bulimia also have higher scores than the other two groups in the area of social performance anxiety; they also differ significantly from the anxiety disorders in terms of interaction anxiety. In the multiple regression analysis of the patients with eating disorders, self-esteem, performance anxiety and perfectionism with regard to appearance prove to be predictors of the affect of shame. DISCUSSION: The findings indicate that not just shame, but also social anxiety, should be regarded as important influencing factors, especially in the case of bulimia nervosa. The question remains as to what extent social anxiety is a result of shame being projected onto the body. For therapeutic considerations, it seems advisable to work on the affect of shame and also include the aspect of social anxiety in focused therapy strategies.
Subject(s)
Anorexia Nervosa/psychology , Bulimia/psychology , Phobic Disorders/diagnosis , Shame , Adolescent , Adult , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Comorbidity , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Humans , Internal-External Control , Interpersonal Relations , Male , Middle Aged , Personality Inventory/statistics & numerical data , Phobic Disorders/psychology , Psychometrics , Self ConceptABSTRACT
OBJECTIVES: The goal of this study is to investigate the applicability of the German adaptation of the Dissociative Experiences Scale, the "Fragebogen zu dissoziativen Symptomen (FDS)", for research on depersonalization (DP) and derealization (DR), and to elucidate the phenomenology of DP / DR. METHODS: 101 consecutively recruited inpatients were diagnosed with the German version of the Structured Clinical Interview for DSM-IV Dissociative Disorders for depersonalization/derealization. Furthermore, the FDS and the SCL-90-R were administered. RESULTS: 47 of 101 Patients were diagnosed with pathological DP / DR. The mean score of the DES scale of the FDS was 32.00 +/- 15.52. A cut-off score of 17.5 for the DES scale of the FDS yielded a 83.0 % sensitivity and 77.8 % specificity. Depressive disorders, anxiety disorders and trauma-associated disorders were the most common comorbidity. CONCLUSIONS: The findings are comparable to the Anglo-American samples. The FDS was found to be quite effective for screening of DP / DR. The three-factor solution of the FDS was not well supported in this sample.
Subject(s)
Depersonalization/diagnosis , Dissociative Disorders/diagnosis , Personality Inventory/statistics & numerical data , Adult , Comorbidity , Cross-Cultural Comparison , Depersonalization/psychology , Dissociative Disorders/psychology , Female , Germany , Humans , Language , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Middle Aged , Psychometrics/statistics & numerical data , Reproducibility of Results , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires , United StatesABSTRACT
Self-rating scales have proved to be essential in the study of depersonalisation, which regrettably, is still seldom recognised in clinical practice. In recent studies the Cambridge Depersonalisation Scale (CDS) has emerged as an useful instrument for the study of depersonalisation. Here we report a validation study of the authorised German version of the CDS in a sample of 91 inpatients, 43 of whom had pathological depersonalisation and 48 without pathological depersonalisation. The SCID-D Interview for depersonalisation and derealisation was used as the gold standard and the German version of the Dissociative Experiences Scale was used to test the external validity of the scale. The German version of the CDS was found to have high internal consistency and reliability (alpha = 0,95 and Guttman Split-half = 0,95) and could differentiate patients with pathological depersonalisation from the control group. We therefore conclude that the German version of the CDS can be considered as reliable and valid.
Subject(s)
Depersonalization/diagnosis , Germany , Humans , Language , Psychiatric Status Rating ScalesABSTRACT
We used psychotherapeutic measures and functional magnetic resonance imaging (fMRI) to assess the effect of a combined psychodynamic and cognitive behavioral treatment of a patient suffering from a severe obsessive compulsive disorder (OCD). The clinical outcome was controlled by a detailed case description and psychometric test instruments. Intensive exploration of the patient made possible the creation of an idiosyncratic imagination paradigm suitable for fMRI. The patient shows at the end of treatment a decrease in symptoms as assessed by clinical as well as psychometric instruments. Especially recapitulation and cleaning obsessions decreased, but the cognitive avoidance strategies remained almost unchanged. fMRI showed no orbito-fronto-striatothalamic activation corresponding to obsessive compulsive symptoms, but an increased activation of the medial prefrontal (MFC) and anterior cingulate cortex (ACC). The lack of activation of the orbito-fronto-striatothalamic circuits and at the same time the occurrence of the increased activation of the MFC and ACC reflects the cognitive avoidance strategies still triggered by the symptom provoking stimulus.
Subject(s)
Obsessive-Compulsive Disorder/physiopathology , Obsessive-Compulsive Disorder/therapy , Psychotherapy , Adult , Cerebral Cortex/physiopathology , Humans , Image Processing, Computer-Assisted , Imagination/physiology , Magnetic Resonance Imaging , Male , Nerve Net/physiopathology , Obsessive-Compulsive Disorder/psychology , Treatment OutcomeABSTRACT
This paper examines the connection between the therapy success, group cohesion and defence-formation during an inpatient psychoanalytically oriented group-therapy treatment. Over a period of one year, the Stuttgarter Bogen was given every third week after each therapy group. At the beginning and at the end of the three-month treatment, the patients were examined with the defence-mechanism computer test (Abwehrmechanismus-Computer-Test, ACT) and SCL-90-R. In addition, the 48 patients were divided into a successful and unsuccessful group by means of the General-Symptom-Index (GSI) of the SCL-90-R. On the whole, the results stressed the importance of group cohesion as a factor with a major influence on therapeutic efficacy. In the defences, there is a dominance of projective and introjective mechanisms. In the group of successful patients, there was an increase in group cohesion as well as a change in individual defence-mechanisms over the course of treatment: Repression increased and identification with the aggressor decreased. In the case of the unsuccessful patients, on the other hand, there was increased regression in the defences over the course of treatment, and there was no change in group cohesion. Accordingly, the connections found between group cohesion and defencemechanisms can be regarded as an indication of internal stabilization in the successful patients, whereas the findings for the patients that did not improve represent a reaction to excessive strain.
