Marianne Springer-Kremser

Physical, sexual, and psychological violence in a gynaecological―psychosomatic outpatient sample: Prevalence and implications for mental health

OBJECTIVE The main objective was to assess the prevalence of physical, sexual, or psychological violence in a cohort of patients with gynaecological symptoms who presented at a psychosomatic outpatient clinic. We assessed differences in prevalence rates of gynaecological symptoms and mental health problems in women with and without a history of experiencing violence. STUDY DESIGN We performed a cohort study of women (n=424) who attended a psychosomatic-gynaecological outpatient clinic during a 6-year-period of time. Information about lifetime victimization, mental health status, and socio-demographic characteristics were systematically obtained through semi-structured interviews. Psychiatric diagnoses were made using questions adapted to the structured interview for DSM-IV. RESULTS Some form of violence was reported by 39.9%. Of the total sample, physical violence was reported in 25.2%, sexual violence in 13.0%, and psychological violence in 23.8%. Of those with a history of experiencing violence, 26.1% experienced two different kinds of violence, and 14.8% were victims of all three kinds of violence. Perpetrators of physical and psychological violence were, predominantly, the partner or the father. With respect to sexual violence, perpetrators were exclusively male, including family members or friends in more than 80% of all cases. Women with a history of experiencing violence suffered significantly more often from major depressive disorders (29.6%) than those without a history of experiencing violence (16.5%) (p<.002). Post-traumatic stress disorder (PTSD) was significantly more frequent in women with a history of experiencing violence (7.1%) (p<.001). CONCLUSIONS We found a high lifetime prevalence of different forms of violence toward women in our sample. Perpetrators were most often male family members, highlighting the impact of domestic violence. Our study provides evidence that women who attend a psychosomatic unit should be cautiously screened for a potential history of traumatic violent experiences.

Psychosocial Testing and Pretreatment of Women for in Vitro Fertilization

Thanks to extensive media coverage, both the public, in general, and infertile patients desiring children, in particular, have been alerted to the fascinating prospects of in vitro fertilization (IVF) and embryo transfer (ET). Many infertile couples would do anything to have a child of their own. As a consequence, they have come to attach high hopes to this new method, just as they were hopeful of other methods in the past.

The triage-function of a psychosomatic liaison-service for gynecological patients

The psychosomatic psychotherapeutic consultation liaison (CL)-service for gynecological patients at the Vienna University has been evaluated. Research interest focused on success and failure of the initial interview, conceptualized for a specific clientele. The interview has a triage function for treatment planning. By the type of treatment that was applied, patients were divided into three groups: Group A, patients with one single contact with the unit; Group B, patients who were referred to external psychotherapy; Group C, patients who were treated with short-term psychoanalytic psychotherapy as offered by the service unit. The drop-outs figured as Group D. The questionnaires completed by the patients at the first consultation and 6 moths after their final contact with the clinic covered socio-demographic data, ego functions; the motivation for psychotherapy, a complaints list and finally, at the second contact only, an individual retrospective judgement concerning personal consequences of the consultation. Patients needs in CL-services call for quick decisions, which therapeutic measure would be most adequate. An experienced clinicians decision is based on several circumstances: individual feeling of suffering, therapy-motivation and ego-strength, as well as social and demographic facts. Comparing groups with different therapeutic recommendations showed that the psychometric tests discriminated well between these four groups and thus the validity of the clinical recommendation has been confirmed.

Cycle disturbances, psychosomatic complaints, and self-image: an analysis of interdependencies between self-perception and psychosomatic disturbances

A coincidence of psychosomatic vulnerability and cycle disturbance led us to attempt to identify the origin of what appears to be a consistent pattern of psychosomatic susceptibility. Self-esteem, as measured by the discrepancy between the Ego-ideal and the perceived self-image, seems to play a substantial role in the relationship between psychosocial conditions and cycle disturbances. The association between self-esteem and psychosomatic vulnerability offers an approach for the study of several questions: To what extent is self-esteem socially transmitted, and thus to what extent can the degree of psychosomatic reactions be viewed as the result of socialization processes?

Can legislation provide a better match between demand and supply in psychotherapy

Background: There is evidence showing that psychotherapy very often does not reach the persons most in need of it. A change in patterns of “consumer behaviour” is difficult to achieve on the basis of individual behavioural change. Can it be achieved by changes in legislation? Methods: By comparing socio-demographic criteria of patients seen at the University Clinic of Psychoanalysis and Psychotherapy between 1990 and 1996, we are able to give some evidence that changes in legislation, concerning psychotherapy, which took place in the years 1991, 1994 and 1995, had a significant effect on the socio-demographic composition of our patient population, showing a convergence of patient population towards the socio-demographic criteria of the population of Vienna. Conclusion: We argue that the changes in legislation in Austria, concerning funding of psychotherapy, and introducing a new profession “psychotherapist”, have a measurable effect which works in two ways:1) direct effect: decreased financial charge of patients;2) indirect effect: increased motivation of patients, resulting from a reduction in stigmas attached to the role of “psychiatric patient”.

Die Sexualität der älteren Frau

Der Anthropologe Ashley Montague kommt in seinem Buch „Social Problems of an ageing population“ (1962) zu dem Schlus, das das Alter nicht anhand eines Kalenders gemessen werden kann, sondern nur anhand des tatsachlichen „space of being“ einer Person ohne Rucksicht auf das chronologische Alter.

Gender and perversion – what constitutes a “Bad Mother”

SummaryBackground: There is a need for reconsidering the conceptualisations of female perverse behavior, especially in connection with motherhood. Methods and findings: Based on case material obtained through psychoanalytic psychotherapy with female patients from a psychosomatic gynecological outpatient clinic, the characteristics of the psychic structure of these patients who presented symptoms of deliberate self harm and of misusing and mistreating their children, are outlined. Another common trait is the embeddedness of their perverse behavior in a generational chain of transmission. Female patients who mistreat their children had been victims of traumatising experiences in their own biography, inflicted by their mothers and directed towards their bodies. Discussion: Female perverse behavior, therefore, is fundamentally different from male perversion: the perverse act in women is aimed against themselves and/or their children. Currently used diagnostic statistical manuals lack categories to describe this symptomatology adequately. Further research is requested to understand a mothers perverse actions and thus develop treatment strategies, without marginalizing these patients.

Femara®: der neue Aromatasehemmer

Ziel aller hormonellen Behandlungsmassnahmen ist die Ausschaltung der östrogenbedingten Wachstumsstimulation von Tumorzellen. Dies ist durch Suppression der Östrogenproduktion, durch Medikamente, die die Östrogenrezeptoren besetzen, ohne östrogene Wirkung auszuüben, und durch Reduktion der zellulären Östrogenrezeptoren möglich. Aromatasehemmer unterdrücken die zelluläre Umwandlung von Androstendion zu Östron. Androstendion wird in der Nebennierenrinde gebildet und kann in den peripheren Geweben, auch im Tumorgewebe, zu Östron umgewandelt werden. Dieser Stoffwechselweg stellt die Hauptquelle der Östrogenproduktion postmenopausaler Patientinnen dar. Die Gruppe der Aromatasehemmer hat während der letzten Jahre einen festen Platz in den Therapiekonzepten für Patientinnen mit hormonabhängigen, metastasierenden Mammakarzinomen einnehmen können. Neue Aromatasehemmer wie Letrozol oder Anastrozol lassen die Steroidsynthese in der Nebenniere weitgehend unbeeinflusst.

Psychische Auswirkungen einer adjuvanten Hormonersatztherapie bei prämenopausalen Patientinnen: Einfluss auf die Lebensqualität

: The influence of acute and chronic affects on hormonal activities via the neuropeptides is beyond speculation: for some women, times of hormonal changes are more likely to be linked with affective disorders - the biological or sociocultural reasons may be heterogenous. Our aim must be to identify this group at risk and offer hormonal, psychopharmacological, or psychotherapeutical support. We cannot rely on evidence-based recommendations for improving the quality of life in patients with gynecological malignoma by hormone replacement therapy. But we have evidence that adequate psychotherapeutic support has a positive effect on the individual woman s well-being.