[Personality functioning and physical health]. / Persönlichkeitsstruktur und körperliche Gesundheit.

Objectives: Considering direct and indirect evidence of associations between deficits in personality functioning and high somatic morbidity, our exploratory study determined whether and, if so, which physical illnesses may be associated with impairments in personality functioning. Method: A large sample of diagnostically heterogeneous psychotherapy inpatients (N = 5401) was assessed with the short version of the Structural Questionnaire of the Operationalized Psychodynamic Diagnosis (OPD-SQS) and the Work Ability Index (WAI). In addition, discharge diagnoses were recorded. For a subsample (N = 2582), levels of personality functioning were assessed by their therapists according to the OPD system. Results: While consistent associations were found between personality functioning and neurological, urogenital, dermatological, and musculoskeletal disorders, findings on possible associations with other disorders revealed inconsistencies. The number of diseases as surrogate marker for disease burden was significantly associated with several indicators of personality functioning. Conclusions: Our results suggest associations between impairments in personality functioning and poor physical health. We discuss potential mechanisms as well as clinical implications.

[Impact of dissociative phenomena on treatment outcome of inpatient psychotherapy of patients with borderline personality disorder]. / Einfluss dissoziativer Phänomene auf das Behandlungsergebnis stationärer Psychotherapie von Patienten mit einer Borderline-Persönlichkeitsstörung.

Impact of dissociative phenomena on treatment outcome of inpatient psychotherapy of patients with borderline personality disorder Objectives: Although dissociative phenomena belong to the diagnostic criteria of borderline personality disorder (BPD) and are of high clinical relevance, their predictive significance with regard to the treatment outcome has hardly been investigated. Because some therapeutic and experimental studies suggest that dissociation can impede emotional learning and thus adversely affect the response to psychotherapy, we examined this issue in patients with BPD. Methods: In this naturalistic psychotherapy study we assessed 342 patients with BPD at the beginning and end of inpatient dialectical behavioural therapy (DBT) with self-report measures for dissociation (Questionnaire on dissociative symptoms, FDS, as German version of the Dissociative Experiences Scale, DES) as well as general and borderline specific pathology (Brief Symptom Inventory, BSI; Borderline Symptom List, BSL) and quality of life (SF-12). Results: Both the general mental distress (BSI) and the borderline-specific pathology (BSL) as well as the psychosocial quality of life improved less in patients with initially severe dissociative symptoms than in those with less pronounced symptoms; this effect was mainly driven by the subscale derealisation of the Dissociative Experience Scale (DES), and was found particularly in women. Conclusion: Consistent with earlier findings, dissociative phenomena proved to be negative predictors of the therapeutic outcome in BPD women completing inpatient DBT. Whether this also applies to outpatient and other evidence-based treatment approaches for BPD remains to be clarified. Our results indicate the necessity to identify and treat dissociative symptoms as early as possible for a successful psychotherapy.

Soziale Probleme in der hausärztlichen Praxis.

Social problems in primary care Objectives: Social problems appear in clinical work as well as in expert opinions for courts and insurances as a major factor in frequently chronic psychosomatic diseases, both in the professional and private environment. On the assumption that unemployed individuals show a higher risk for the development of mental and psychosomatic diseases, we investigated our hypothesis that mostly social issues lie at the center of patients' motivation for consultations. METHODS: Our questionnaire was dispatched by the Medical Association of Mecklenburg-Vorpommern (MV) to all established general practitioners in that state (n = 1025). It collected information on how social problems were handled in primary-care practices. RESULTS: The large majority of social problems in MV arise from unemployment and job-related conflicts. Doctors often evaluate these problems using pathological dimensions (medicalization) and provide certificates of disability as a "dysfunctional" approach to the problem. CONCLUSIONS: The medicalization of social problems indicates a lack of alternatives in our medical system and highlights the inadequate handling up to early retirement based on dysfunctional behavior (incorrect diagnosis, certificate of disability).