Werner Köpp

Somatic comorbidity in anorexia nervosa: First results of a 21-year follow-up study on female inpatients.

BackgroundAnorexia nervosa is a severe psychosomatic disease with somatic complications in the long-term course and a high mortality rate. Somatic comorbidities independent of anorexia nervosa have rarely been studied, but pose a challenge to clinical practitioners. We investigated somatic comorbidities in an inpatient cohort and compared somatically ill anorexic patients and patients without a somatic comorbidity. In order to evaluate the impact of somatic comorbidity for the long-term course of anorexia nervosa, we monitored survival in a long-term follow-up.MethodOne hundred and sixty-nine female inpatients with anorexia nervosa were treated at the Charité University Medical Centre, Campus Benjamin Franklin, Berlin, between 1979 and 2011. We conducted retrospective analyses using patients medical and psychological records. Information on survival and mortality were required through the local registration office and was available for one hundred patients. The mean follow-up interval for this subgroup was m = 20.9 years (sd = 4.7, min = 13.3, max = 31.6, range = 18.3). We conducted survival analysis using cox regression and included somatic comorbidity in a multivariate model.ResultsN = 41 patients (24.3%) showed a somatic comorbidity, n = 13 patients (7.7%) showed somatic comorbidities related to anorexia nervosa and n = 26 patients (15.4%) showed somatic comorbidities independent of anorexia nervosa, n = 2 patients showed somatic complications related to other psychiatric disorders. Patients with a somatic comorbidity were significantly older (m = 29.5, sd = 10.3 vs m = 25.0, sd = 8.7; p = .006), showed a later anorexia nervosa onset (m = 24.8, sd = 9.9 vs. m = 18.6, sd = 5.1; p < .000) and a longer duration of treatment in our clinic (m = 66.6, sd = 50.3 vs. m = 50.0, sd = 47; p = .05) than inpatients without somatic comorbidity. Out of 100 patients, 9 patients (9%) had died, on average at age of m = 37 years (sd = 9.5). Mortality was more common among inpatients with somatic comorbidity (n = 6, 66.7%) than among inpatients without a somatic disease (n = 3, 33.3%; p = .03). Somatic comorbidity was a significant coefficient in a multivariate survival model (B = 2.32, p = .04).ConclusionSomatic comorbidity seems to be an important factor for anorexia nervosa outcome and should be included in multivariate analyses on the long-term course of anorexia nervosa as an independent variable. Further investigations are needed in order to understand in which way anorexia nervosa and a somatic disease can interact.

Attachment style contributes to the outcome of a multimodal lifestyle intervention

Background & AimsThe long-term success of life-style interventions in the treatment of obesity is limited. Although psychological factors have been suggested to modify therapeutic effects, specifically the implications of attachment styles and the patient-therapist relationship have not been examined in detail yet.MethodsThis study included 44 obese patients who participated in a one-year multimodal weight-reduction program. Attachment style was analyzed by the Adult Attachment Prototype Rating (AAPR) inventory and its relation to a one-year weight reduction program was studied. The patient-therapist-relationship was assessed using the Helping Alliance Questionnaire.ResultsAttachment style was secure in 68% of participants and insecure (preoccupied and dismissing) in 32%. Interestingly a significantly higher weight-reduction was found in securely (SAI) compared to insecurely attached individuals (UAI; p < 0.05). This estimation correlated positively also to the quality of helping alliance (p = 0.004).ConclusionsThe frequency of insecure attachment in obese individuals was comparable to that of the normal population. Our data suggest a greater weight-reduction for SAI than for UAI, and the patient-therapist relationship was rated more positively. The conclusion can be drawn that a patients attachment style plays a role in an interdisciplinary treatment program for obesity and has an influence on the effort to lose weight.

Psychodynamic mechanism and weight reduction in obesity group therapy - first observations with different attachment styles.

Objectives: Successful long-term results are extremely rare in non-surgical obesity treatment. Interactional difficulties with the attending physicians and the limited compliance of obese patients are a frequently described dilemma in repeated psychotherapeutic group treatment attempts. The type of relationship initiation and the attachment behavior probably play a central role in this connection but have not yet been systematically investigated. Methods: This paper focuses on the attachment styles of obese subjects and their effects on psychodynamic group therapy within the context of a weight-reduction program. Results: The attachment styles are characterized in 107 pre-obese and obese patients, and their effects on patients and therapists in group therapy are described. Conclusion: The paper surveys the motivational situation, clinical pictures, and repeated group topics.

The fatal outcome of an individual with anorexia nervosa and Sheehan's syndrome as a result of acute enterocolitis: a case report.

OBJECTIVES To illustrate the close association between a disturbed psychosocial up-bringing, frequent physical illness, and medical interventions. METHOD We report a case of a 44-year-old woman with anorexia nervosa (AN) and Sheehans syndrome who died as a result of a toxic cardiac arrest. RESULTS The patient presented with a BMI of 13.6 kg/m(2). She refused any intensive-care treatment and died from toxic cardiac arrest. Postmortem examination revealed an acute gastroenterocolitis. DISCUSSION The history of this patient illustrates how psychological deprivation led to eating disturbances, early pregnancy, and the life-threatening delivery of twins. This resulted in a diagnosis of Sheehans syndrome, hepatitis C, and a ventricular ulcer. A psychosocial event triggered a late exacerbation of her AN. A helpful alliance between patient and staff did not occur as she rejected it.

Gesellschaftliche Aspekte narzisstischer Störungen

ZusammenfassungSeit den siebziger Jahren des letzten Jahrhunderts beschrieben Psychoanalytiker immer wieder, wie sich das Spektrum seelischer Störungen von der neurotischen Konfliktpathologie hin zu strukturellen Störungen der Persönlichkeit verschoben hat. Niemand wird aber mit einer narzisstischen oder antisozialen Haltung geboren. Ausgehend von den Arbeiten Laschs und Ottomeyers wird in der vorliegenden Arbeit versucht, solche gesellschaftlichen Aspekte in den hoch entwickelten kapitalistischen Ländern zu markieren, die mithelfen, die Menschen loyal gegenüber den sie prägenden oder konfigurierenden Verhältnissen bleiben zu lassen. In diesen Verhältnissen wird das narzisstische Größenselbst des Individuums mit einem idealen Entwurf der Selbst-Verwirklichung zum destruktiven Ideal. Im Fall des Scheiterns bleibt dann scheinbar nur noch folgende Wahl: Entweder das Scheitern wird als persönliche, selbst verursachte Katastrophe und als selbst verursachter schuldhafter Makel – das heißt als verdient – erlebt, oder das Subjekt greift zum „Opium des Kollektivstolzes“, zum Beispiel durch die Identifikation mit der Fußballnationalmannschaft, um die gekränkte Selbstachtung nicht „wahr haben“ zu müssen.AbstractSince the 1970s psychoanalysts have repeatedly described how the spectrum of mental disorders has shifted from neurotic conflict pathology to structural disorders of the personality. Nobody, however, is born with a narcissistic or antisocial attitude. Based on the works of Lasch and Ottomeyer, in this article an attempt is made to highlight such social aspects in highly developed capitalistic countries, which provide assistance to allow people to remain loyal to the circumstances that impregnate and configurate them. In these circumstances the narcissistic grandiose self of the individual with an ideal blueprint of self-realization becomes a destructive ideal. In the case of failure only the following choice then seems to remain: either the failure is experienced as a personal, self-induced catastrophe and as a self-induced culpable blemish (i.e. as deserved) or the subject resorts to the “opium of collective pride”, e.g. by identification with the national football team, in order not to have to “accept the truth” of the injured self-esteem.

Interpersonelle Muster bei Adipositaspatienten

In the last decades the number of obese and pre-obese patients in Western industrial nations increased. Obese patients have been largely unsuccessful in losing weight over time, but the causes of their difficulties and the causes of their obesity have remained unclear. We examined whether the attachment style and its interaction with interpersonal processes would shed light on this question. We analyzed 107 obese or pre-obese patients before the start of a weight loss intervention program. We used the Adult Attachement Prototype Rating (AAPR)-interview and related questionnaires (Helping Alliance Questionnaire (HAQ), Inventory of Interpersonal Problems (IIP-D), Brief Symptom Inventory (BSI)). According to the AAPR-rating 54% of the patients were secure and 46% insecure attached. The results suggest that insecure attachment style has an impact on psychic strain in obese patients unrelated to weight, gender and age. Additionally the insecure attachment style influences the therapeutic alliance experienced by patients and the therapist.