Reinhard Liedtke

Temperament and character personality profiles and personality disorders in chronic pain patients

Abstract In his psychobiological model of personality, Cloninger developed a novel approach concerning the relationships between psychopathological syndromes and personality. We investigated 207 chronic pain patients (CPPs) and compared them to 105 pain‐free control subjects. Participants were assessed using the Temperament and Character Inventory (TCI), the Structured‐Clinical‐Interview‐II, the Beck Depression Inventory and the Spielberger Anxiety Inventory. The CPPs scored higher on the depression and state anxiety scales and 41% fulfilled the criteria of having at least one personality disorder (PD). We used a covariance analysis to control for depression and state anxiety and found that the CPPs scored higher on the Harm Avoidance Temperament Dimension and lower on the Self‐Directedness and Cooperativeness Character Dimensions. In CPPs, the symptom counts of all PD subtypes were significantly related to low Self‐Directedness and, to a lesser degree, low Cooperativeness. The PD symptoms in Cluster A were related to low Reward Dependence, those in Cluster B were related to high Novelty Seeking and the PD symptoms in Cluster C were related to high Harm Avoidance. In multiple hierarchical regression analyses, controlling for age, gender, depression and state anxiety, TCI scales predicted on average 23% in PD symptom counts. The Self‐Directedness and Cooperativeness personality traits appeared to be significant predictors in determining the presence or absence of a PD by correctly classifying 75.8% of CPPs. The TCI provides further insight into the mechanisms underlying the development of chronic pain. This useful diagnostic instrument helps to economically and validly facilitate the identification of core PD features.

Chorioretinopathia centralis serosa und psychische Belastung

ZusammenfassungHintergrund. Die Ätiologie der Chorioretinopathia centralis serosa ist bis heute nicht sicher geklärt. Vorangegangene Studien diskutierten u. a. inadäquate Bewältigungsstrategien und fehlende soziale Unterstützung bei Belastung als Auslösefaktoren. In der vorliegenden Untersuchung wurde der Frage nach einem Zusammenhang zwischen der Chorioretinopathia centralis serosa und psychischer Belastung nachgegangen. Patienten und Methode. 35 männliche Patienten mit Chorioretinopathia centralis serosa wurden mit einer Kontrollgruppe von 21 männlichen Patienten mit traumatischen Augenleiden verglichen. Neben soziodemographischen Daten und Krankheitssymptomatik wurden Persönlichkeitsfaktoren, kritische Lebensereignisse in der Vorgeschichte, Stressverarbeitung und körperliche Beschwerden untersucht. Ergebnisse. Die Patienten mit Chorioretinopathia centralis serosa zeigten signifikant mehr körperliche (nicht auf die Augensymptomatik bezogene) Beschwerden gemessen mit der Beschwerden-Liste (B-L). Im Freiburger Persönlichkeitsinventar zeigten sie eine höhere emotionale Labilität und Beanspruchung sowie eine niedrigere Extraversion. Schlussfolgerung. Die Ergebnisse der Untersuchung weisen in die Richtung einer höheren psychischen Belastung von Patienten mit Chorioretinopathia centralis serosa als Folge einer unangemessenen Bewältigung, die sich in einer verstärkten Äußerung körperlicher Beschwerden abbildet.AbstractBackground. To date we know little about the etiology of central serous chorioretinopathy. Former investigations discussed inadequate coping strategies and critical life-events as important psychological aspects. In this study we investigated the relationship between central serous chorioretinopathy and stress. Materials and Methods. 35 male patients with central serous chorioretinopathy (group1) were compared to 21 male patients with traumatic eye diseases. The evaluated data included sociodemographic data as well as data regarding the patients coping strategies, critical live-events before outbreak of the disease, personality factors and general physical complaints. Results. Group 1 showed a significantly higher amount of general physical complaints, measured with a complaints questionnaire (B-L). In a personality inventory (FPI-R) it scored significantly higher on the scales emotional instability and strain, significantly lower on the scale extraversion. Conclusion. The results indicate that patients with central serous chorioretinopathy are more stressed because of inadequate coping strategies, which can be seen in a higher amount of physical complaints.

CROSS-CULTURAL COMPARISON OF EXPLANATORY MODELS OF ILLNESS IN SCHIZOPHRENIC PATIENTS IN JORDAN AND GERMANY

This study investigated illness concepts of schizophrenic patients in an Arab-Islamic and a western European cultural background. 24 Jordanian and 23 German inpatients were interviewed using an illness concept scale and a causal belief questionnaire. Jordanian patients tend to believe more in esoteric factors underlying their illness, and they perceive the illness to be more threatening. There were no differences regarding biological explanations of illness and trust in medication; however, Jordanian patients reported more trust in the treating physician. Nearly all patients mentioned psychosocial stress as an important factor underlying their illness. Concerning treatment, only Jordanian patients believed religion to be an important factor and mentioned distance from the family as beneficial. The study highlights that culturally specific factors influence illness concepts of schizophrenic patients from an Arab-Islamic and a western European cultural background. Knowledge of these illness concepts is important to establish a helpful relationship between physician and patient.

Disclosing the cancer diagnosis: what contributes to patient satisfaction?

Despite the growing attention to the how, when and where of disclosing a cancer diagnosis, not all patients are satisfied with how the news is broken to them. As in German-speaking countries there is a lack of empirical studies on this subject, this analysis was conducted to determine how the cancer diagnosis was given in a German sample, and how satisfied the patients are with the disclosure experience. Patients and Methods: 162 outpatients received a self-report questionnaire focusing on their experiences with physician-patient communication when the diagnosis was disclosed. Results: Guidelines had been respected in most cases. 17% of patients were dissatisfied with the diagnosis disclosure. They reported a significantly shorter duration of the interaction, lack of privacy, deficits in understanding the information, and less emotional support by the physician. Conclusion: Adherence to guidelines of diagnosis disclosure in the German sample was fairly high. Respecting both informational and emotional needs is essential for patient satisfaction and can be taught in communication training.

Turning against self and its relation to symptom distress, interpersonal problems, and therapy outcome: A replicated and enhanced study

Abstract The relation of the turning against self defense mechanism to symptom distress, interpersonal problems, and therapy outcome was explored in 75 inpatients in a psychodynamic setting. In accordance with former studies, the patients showed a high initial level of turning against self, and its reduction during therapy was correlated with a good symptom reduction. The validity of the measurement of this mechanism by the FKBS, a German version of the Defense Mechanisms Inventory, was confirmed by high correlations with scales from the State-Trait Anger Expression Inventory and the Toronto Alexithymia Scale. A new issue was how turning against self correlated with interpersonal behavior. Patients with a frequent use of turning against self had more interpersonal problems, predominantly of the friendly–submissive type and significantly fewer of the domineering–hostile type. Identifying and reducing a strong turning against self, as well as challenging the related interpersonal behavior, thus represent central tasks in psychotherapy. A multimodal inpatient setting with a combination of psychodynamic and behavioral interventions proved to be effective. Finally, the question of favorable therapist variables is raised.

Impact of the Turning-Against-Self Defense Mechanism on the Process and Outcome of Inpatient Psychotherapy

The authors examined the relation between specific defense mechanisms and treatment process and outcome in psychodynamic psychotherapy. Three measures, Questionnaire for Conflict Coping Strategies, Questionnaire on the Experience of the Inpatient Therapeutic Process, and Symptom Checklist-90-R, were given to 65 inpatients of a psychosomatic clinic, predominantly with depressive or eating disorders. Turning against self was the most frequently used defense mechanism in the patient group. A high level of turning against self that could be reduced significantly during treatment was associated with good adaptation to treatment setting and positive treatment outcome defined by symptom distress reduction. Assessment of defense mechanisms and their interaction with therapeutic factors in the therapy setting can be useful to better understand the treatment process and the subsequent development of specific interventions to enhance treatment outcome.

Bewertung des Therapieerfolgs durch Patienten mit Angststörungen nach stationärer Psychotherapie

ZusammenfassungZiel. Identifikation von Einflussfaktoren auf die subjektive Bewertung des Therapieerfolgs nach stationärer Angstpsychotherapie. Methode. 231 Angstpatienten wurden in einer multizentrischen Studie zu Therapiebeginn und -ende sowie in der 1-Jahres-Katamnese untersucht. Die subjektive Erfolgsbewertung wurde mittels des Helping Alliance Questionnaire erfasst; in diesem Zusammenhang wird der Begriff “Patientenzufriedenheit” diskutiert. Ergebnis. Die Bewertung des Therapieerfolgs korreliert weder mit Alter, Geschlecht oder Bildungsstand noch mit Krankheitsdauer, Symptombelastung bei Therapiebeginn oder Behandlungsdauer. Am höchsten korreliert die Bewertung des Therapieerfolgs mit dem symptombezogenen Therapieerfolg, wobei das absolute Ausmaß der Symptomausprägung nach der Therapie (“klinische Signifikanz”) enger mit der subjektiven Erfolgsbewertung zusammenhängt als der Betrag der erfolgten Symptomreduktion (“statistische Signifikanz”). Schlussfolgerung. Unabhängig von personenbezogenen oder krankheitsbezogenen Variablen nehmen Angstpatienten ihren Therapieerfolg differenziert wahr und bewerten ihn positiv. Unsere Ergebnisse zeigen, dass die aktuelle Diskussion um die Bewertung von Therapieergebnissen nach “statistischer” und “klinischer” Signifikanz auch für die subjektive Perspektive der Patienten von Bedeutung ist.SummaryObjective. To identify factors influencing the subjective assessment of patients regarding the outcome of in-patient psychotherapy for anxiety disorders. Methods. A total of 231 patients were tested at admission, discharge and 1-year follow-up in a multi-center study. Subjective outcome assessment was measured with the revised German version of the Helping Alliance Questionnaire. The use of the term “outcome satisfaction” is discussed. Results. Patient outcome assessment did not correlate with age, sex, or education, or with duration or severity of illness or duration of treatment. Outcome assessment was closely connected with therapy success. Reaching a low symptom level (“clinical significance”) had a higher impact than a high pre-post-difference (“statistical significance”). Conclusions. Anxiety patients give a generally positive assessment of their therapy outcome, which is most determined by symptom-related treatment success. The differentiation of “clinical” and “statistical significance” of success is of importance for the patients subjective view of the therapy outcome.

Patients with obesity show reduced memory for others' body shape

Social comparison theory assumes that individuals regularly compare themselves to others and that the comparisons are relevant for their self-esteem. For individuals with obesity, these social comparisons will yield a negative outcome with respect to body shape in the majority of social contacts. It is proposed that, when confronted with other persons, individuals with obesity avoid social comparisons on the dimension of body shape. Using a multinomial account of social categorization, 19 female psychotherapy patients with morbid obesity were compared to 19 non-obese female psychotherapy patients. As predicted, results reveal reduced memory for body shape categories in patients with obesity, indicating a reduced processing of body shape information.

Ungelöste Paarkonflikte bei männlicher Infertilität

ZusammenfassungHintergrund und Fragestellung. Heute kann als gesichert gelten, dass Sterilität und die damit verbundenen diagnostisch-therapeutischen Maßnahmen eine erhebliche psychische Belastung bedeuten und sich dementsprechend auf die Partnerschaft auswirken. Empirische Befunde zur männlichen Infertilität zeigen u. a. eine erhöhte Somatisierungsneigung und ein vermindertes Selbstwertgefühl der Männer sowie eine Dominanz ihrer Partnerinnen.Welche Paarkonflikte bestehen nun im Einzelnen bei der Diagnose einer männlichen Infertilität? Patienten/Methodik. Es wurden 84 infertile Männer mit Kinderwunsch, die sich in einer andrologischen Abteilung vorstellten, mit einem Fragebogen zur Partnerschaftsdiagnostik untersucht, der hinsichtlich Quantität und Qualität ungelöster Paarkonflikte ausgewertet wurde. Ergebnisse. Die Ergebnisse zeigen, dass infertile Männer in ihrer Partnerschaft nicht mehr unlösbar erscheinende Konfliktbereiche angeben als gesunde Männer. Unter qualitativem Aspekt bestehen jedoch aufällige Unterschiede. Schlussfolgerungen. In Relation zur Kontrollgruppe gesunder, zufriedener Männer kann die Spezifität der Konfliktbereiche bei den Infertilen vor dem Hintergrund austauschtheoretischer Überlegungen im Sinne einer sterilitätsbedingten Dysbalancierung der Paarbeziehung erklärt werden.AbstractBackground and Objective. There is empirical evidence that sterility causes a considerable amount of distress and affects correspondingly the partnership. Empirical results concerning male infertility show increased somatic complaints and reduced self-esteem of the men as well as a dominance of the accompanying partners. Which couple conflicts arise after the diagnosis of male infertility? Patients/Methods. 84 infertile men were examined with a partnership diagnostic questionnaire. The questionnaire was evaluated with regard to quantity and quality of unsolved couple conflicts. Results. The results show that infertile men do not mention more unsolved conflict areas in their partnership than healthy men. If one looks qualitatively at the mentioned conflict areas, striking differences in comparison to the control group can be seen. Conclusions. In comparison to the control group of healthy men, the specificity of conflict areas in infertile couples can be best understood on the basis of exchange-theoretical considerations.

Alexithymie und Somatisierung bei infertilen Männern

ZusammenfassungHintergrund und Fragestellung.In einer vorangegangenen Untersuchung konnten wir nachweisen, dass bei männlicher Infertilität ein höheres Ausmaß an Alexithymie und eine höhere Somatisierung bestehen. In dieser Replikationsstudie werden diese Ergebnisse überprüft.Patienten/Methodik.Es wurden 88 infertile Männer (48 mit idiopathischer Infertilität, 40 mit somatisch begründbarer Infertilität) konsekutiv in die Untersuchung einbezogen. Als Vergleichsgruppe dienten 44 gesunde, alters- und bildungsmäßig vergleichbare Männer. Als Messinstrumente wurden die 20-Item-Toronto-Alexithymie-Skala und die Symptom-Checkliste-90-R eingesetzt.Ergebnisse.Es ergaben sich keine Unterschiede zwischen den Untergruppen infertiler Männer hinsichtlich Alexithymie und Somatisierung. Bei der Gesamtgruppe infertiler Männern zeigte sich im Vergleich zur Kontrollgruppe ein signifikant höherer Gesamtwert auf der Toronto-Alexithymie-Skala (p<0,01) sowie ein höherer Wert auf der Skala Somatisierung in der Symptom-Checkliste-90-R (p<0,05).SchlussfolgerungenIn der Untersuchung konnten die Befunde der vorangegangenen Studie repliziert werden. Alexithymie und Somatisierung werden als Folgen der schwierigen Bewältigung männlicher Infertilität diskutiert.AbstractBackground and ObjectiveIn a previous study, we found a higher degree of alexithymia and somatization in infertile men (Hum Reprod 2001 Vol.16(3),587–592). This study was designed to confirm the findings of the former studyPatients/Methods88 infertile men (48 idiopathic infertility, 40 somatic infertility) were consecutively enrolled in the study. The control group consisted of 44 healthy men. Alexithymia was measured by the 20-item-Toronto-Alexithymia-Scale;somatization was measured by the Symptom Checklist-90-R.ResultsThere were no differences between the subgroups of infertile men. The study group showed a significantly higher sum score in the TAS-20 (p<0.01) and a higher score on the scale somatization in the Symptom Checklist-90-R (p<0.05) compared to the control group.ConclusionsOur study replicated the findings of the previous investigation. Alexithymia and somatization are discussed as consequences of coping with male infertility.