Aktuelles zu psychodynamischen und neurobiologischen Einflussfaktoren in der Genese der Alexithymie

Zusammenfassung

Im Folgenden werden aktuelle entwicklungspsychologische Modellvorstellungen zur Entstehung emotionaler Differenziertheit vorgestellt und mit möglichen Ursachen der Alexithymie in Verbindung gebracht. Parallel zur Rolle der frühkindlichen Umgebungsbedingungen für die psychische Entwicklung werden die wachsenden Erkenntnisse über die Wirkung früher psychosozialer Einflüsse auf die reifenden neurobiologischen Strukturen des sich entwickelnden menschlichen Organismus nachgezeichnet. In der Synthese dieses wachsenden Wissens werden Überschneidungen von langjährigen zentralen psychodynamischen Annahmen und neurobiologisch fassbaren Organisationsstrukturen deutlich. Es ist Aufgabe einer modernen Psychosomatik, aus klinisch-psychotherapeutischer Erfahrung generierte Hypothesen unter Berücksichtigung biografischer und aktueller Einflussfaktoren sowie neurobiologisch fassbarer Parameter empirisch zu überprüfen.

Abstract

This article discusses modern theories about the influence of developmental factors on the genesis of alexithymia and about its influence on maturing neurobiological structures. Against this background it becomes clear that core concepts of psychodynamic psychotherapy, like the concept of a unconscious level of experience, are confirmed by modern neurobiological research. Thus, modern psychosomatic research should strive to validate clinical core concepts by the use of empirical studies which also consider neurobiological parameters.

Alexithymia - developmental psychology - psychodynamics - neurobiology

Literatur

• 1 von Rad M. Alexithymie. Heidelberg; Springer-Verlag 1983
• 2 Taylor G J, Bagby M, Parker J DA. Disorders of Affect Regulation. Alexithymia in Medical and Psychiatric Illness. Campridge; Cambridge University Press 1997
• 3 Rodin G M. Somatization: A Perspective from self-psychology.  J Am Acad Psychoanal. 1991;  19 367-384
• 4 Stolorow R D, Atwood G E. The Mind and the Body.  Psychoanalytic Dialogues. 1991;  1 181-195
• 5 Ruesch J. The infantile personality.  Psychosomatic Med. 1948;  10 134-144
• 6 Marty P, de M'Uzan M. La „pensée opératoire”.  Rev Franc Psychoanal. 1963;  27 345-356
• 7 Sifneos P E. Short-Term Psychotherapy and Emotional Crisis. Cambridge, Mass; Harvard University Press 1972
• 8 Krystal H. Alexithymia and Psychotherapy.  Am Journal of Psychotherapy. 1979;  33 17-31
• 9 McDougall J. The Psychosoma and Psychoanalytic Process.  Int Rev Psychoanal. 1974;  1 437-459
• 10 McDougall J. Theater des Körpers. Ein psychoanalytischer Ansatz für die psychosomatische Erkrankung. Stuttgart; Verlag Internationale Psychoanalyse 2000
• 11 Streeck-Fischer A, van der Kolk B A. Down will come baby, cradle and all: diagnostic and therapeutic implications of chronic trauma on child development.  Aust N Z J Psychiatry. 2000;  34 903-918
• 12 Benedetti G. Beitrag zum Problem der Alexithymie.  Nervenarzt. 2000;  51 534-541
• 13 Parker G. Parental characteristics in relation to depressive disorders.  Br J Psychiatry. 1979;  134 138-147
• 14 Bagby R M, Parker J D, Taylor G J. The Twenty-Item Toronto Alexithymia Scale-I: item selection and cross-validation of the factor-structure.  J Psychosom Res. 1994;  38 23-32
• 15 Fukunishi I. Mothers' low care in the development of alexithymia: a preliminary study in Japanese college students.  Psychol Rep. 1997;  80 143-144
• 16 Fukunishi I, Sei H, Morita Y, Rahe R H. Sympathetic activity in alexithymics with mother's low care.  J Psychosom Res. 1999;  46 579-589
• 17 Fukunishi I, Paris W. Intergenerational association of alexithymic characteristics for college students and their mothers.  Psychol Rep. 2001;  89 77-84
• 18 Mahler M, Pine F, Bergman A. The psychological birth of the human infant: Symbiosis and individuation. New York; Basic Books 1975
• 19 Spitz R A. Vom Säugling zum Kleinkind. Naturgeschichte der Mutter-Kind-Beziehungen im ersten Lebensjahr. Stuttgart; Klett-Cotta 1996 11. Aufl.
• 20 Dornes M. Die frühe Kindheit. Entwicklungspsychologie der frühen Lebensjahre. Frankfurt/M.; Fischer-Verlag 1997
• 21 Gergely G, Watson J S. The social biofeedback theory of parental affect-mirroring: the development of emotional self-awareness and self-control in infancy.  Int J Psychoanal. 1996;  77 1181-1212
• 22 Nichols K, Gergely G, Fonagy P. Experimental protocols for investigating relationships among mother-infant interaction, affect regulation, physiological markers of stress responsiveness, and attachment.  Bull Menninger Clin. 2001;  65 371-379
• 23 Fonagy P. The human genome and the representational world: the role of early mother-infant interaction in creating an interpersonal interpretive mechanism.  Bull Menninger Clin. 2001;  65 427-448
• 24 Kandel E R. A new intellectual framework for psychiatry.  Am J Psychiatry. 1998;  155 457-469
• 25 Gunnar M R. Reactivity of the hypothalamic-pituitary-adrenocortical system to stressors in normal infants and children.  Pediatrics. 1992;  90 491-497
• 26 Fonagy P, Target M. Mit der Realität spielen. Zur Doppelgesichtigkeit psychischer Realität von Borderline-Patienten.  Psyche. 2001;  9/10 961-995
• 27 Strauß B, Buchheim A, Kächele H. Klinische Bindungsforschung. Theorien - Methoden - Ergebnisse. Stuttgart; Schattauer-Verlag 2002
• 28 Laible D J, Thompson R A. Attachment and emotional understanding in preschool children.  Dev Psychol. 1998;  34 1038-1045
• 29 Helmeke C, Poeggel G, Braun K. Differential emotional experience induces elevated spine densities on basal dendrites of pyramidal neurons in the anterior cingulate cortex of Octogon degus.  Neuroscience. 2001;  104 927-931
• 30 Ciompi L. Affects as central organising and integrating factors: a new psychosocial/biological model of the psyche.  Brit J Psychiat. 1991;  159 97-105
• 31 Damasio A R. Descartes' Irrtum. Fühlen, Denken und das menschliche Gehirn. München; DTV 1998 3. Aufl.
• 32 Francis D, Diorio J, Liu D, Meaney M J. Nongenomic Transmission Across Generations of Maternal Behavior and Stress Response in the Rat.  Science. 1999;  286 1155-1158
• 33 Meaney M. Neonatal Maternal Nurturing Reduces Adult Stress Reactivity in a Rat Model. Vortrag. Patricia R Barchas Award, American Psychosomatic Society's 58th Annual Scientific Meeting March 1 - 4, 2000
• 34 Suomi S J. Early determinants of behaviour: evidence from primate studies.  Br Med Bull. 1997;  53 170-184
• 35 McEwen B S. Stress and hippocampal plasticity.  Ann Rev Neurosci. 1999;  22 105-122
• 36 Heim C, Nemeroff C B. The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies.  Biol Psychiatry. 2001b;  49 1023-1039
• 37 Teicher M H, Glod C A, Surrey J, Swett C. Early childhood abuse and limbic system ratings in adult psychiatric outpatients.  J Neuropsychiat Clin Neuroscien. 1993;  5 301-306
• 38 Anderson E E, Clement P W, Oettinger L. Methylphenidate compared with behavioral self-control in attention deficit disorder: preliminary report.  J Dev Behav Pediatr. 1981;  2 (4) 137-141
• 39 Giedd J N, Blumenthal J, Molloy E, Castellanos F X. Brain imaging of attention deficit/hyperactivity disorder.  Ann NY Acad Sci. 2001;  931 33-49
• 40 Reiss D, Neiderhiser J M, Hetherington E M, Plomin R. The Relationship Code. Deciphering Genetic and Social Influences on Adolescent Development (Adolescent Lives). Harvard; Harvard University Press 2000
• 41 DeBellis M D, Putnam F W. The psychobiology of childhood maltreatment.  Child Adolescent Psychiat Clin North Amer. 1994;  3 663-678
• 42 Mooy J M, de Vries H, Grootenhuis P A, Bouter L M, Heine R J. Major stressful life events in relation to prevalence of undetected type 2 diabetes: the Hoorn Study.  Diabetes Care. 2000;  23 197-201
• 43 Hammen C, Davila J, Brown G, Ellicott A, Gitlin M. Psychiatric history and stress: predictors of severity of unipolar depression.  J Abnorm Psychol. 1992;  101 45-52
• 44 Norman R M, Malla A K. A prospective study of daily stressors and symptomatology in schizophrenic patients.  Soc Psychiatry Psychiatr Epidemiol. 1994;  29 244-249
• 45 Mohr D C, Goodkin D, Boudewyn A C, Huang L. The Relationship between Stress and the Subsequent Development of New Brain Lesions in Multiple Sclerosis Patients.  Psychosomatic Medicine. 2000;  62 103
• 46 Maguire E A, Gadian D G, Johnsrude I S, Good C D, Ashburner J, Frackowiak R S, Frith C D. Navigation-related structural change in the hippocampi of taxi drivers.  Proc Natl Acad Sci USA. 2000;  97 4398-4403
• 47 Teasdale J D, Howard R J, Cox S G, Ha Y, Brammer M J. et al . Functional MRI Study of the Cognitive Generation of Affect.  Am J Psychiatry. 1999;  156 209-215
• 48 George M S, Ketter T A, Parekh P I, Horwitz B, Herscovitch P, Post R M. Brain Activity During transient Sadness and Happiness in Healthy Women.  Am J Psychiatry. 1995;  152 341-351
• 49 Mayberg H S, Liotti M, Brannan S K, McGinnis S, Mahurin R K, Jerabek P A, Silva J A, Tekell J L, Martin C C, Lancaster J L, Fox P T. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness.  Am J Psychiatry. 1999;  156 675-682
• 50 Damasio A R, Grabowski T J, Bechara A, Damasio H, Ponto L, Parvizi J, Hichwa R D. Subcortical and cortical brain activity during the feeling of self-generated emotions.  Nature neuroscience. 2000;  3 (10) 1049-1056
• 51 Liotti M, Mayberg H S, Brannan S K, McGinnis S, Jerabek P, Fox P T. Differential limbic-cortical correlates of sadness and anxiety in healthy subjects: implications for affective disorders.  Biol Psychiatry. 2000;  48 (1) 30-42
• 52 Devinsky O, Morell M, Vogt B. Contributions of anterior cingulate cortex to behaviour.  Brain. 1995;  118 279-306
• 53 Cotteril R MJ. On the unity of conscious experience.  J Consciousness Studies. 1995;  2 290-312
• 54 Lane R D, Ahern G L, Schwartz G E, Kaszniak A W. Is Alexithymia the Emotional Equivalent of Blindsight?.  Biol Psychiatry. 1997;  42 834-844
• 55 Bush G, Luu P, Posner M I. Cognitive and emotional influences in anterior cingulate cortex.  Trends Cogn Sci. 2000;  4 215-222
• 56 Rolls E T. The Brain and Emotion. New York; Oxford University Press 1999: 257
• 57 Lane R D, Fink G R, Chan P M, Dolan R J. Neural activation during selective attention to subjective emotional responses.  Neuroreport. 1997;  8 (18) 3969-3972
• 58 Bowers D, Blonder L X, Feinberg T, Heilman K M. Differential impact of right and left hemisphere lesions on facial emotion and object imagery.  Brain. 1991;  114 2593-2609
• 59 Spalletta G, Pasini A, Costa A, De Angelis D, Ramundo N, Paolucci S, Caltagirone C. Alexithymic features in stroke: effects of laterality and gender.  Psychosom Med. 2001;  63 944-950
• 60 Min S K, Byung O L. Laterality in Somatization.  Psychosomatic Medicine. 1997;  59 236-240
• 61 Gündel H, López-Sala A, Deus J, Cardoner N, Marten-Mittag M, Ceballos-Baumann A, von Rad M, Pujol J. Anatomical variability of the anterior cingulate gyrus in relationship to alexithymia.  Psychosomatic Medicine. 2002;  64 110
• 62 Anderson M C, Green C. Suppressing unwanted memories by executive control.  Nature. 2001;  410 366-369
• 63 Weiner H. The Dynamics of the Organism: Implications of Recent Biological Thought for Psychosomatic Theory and Research.  Psychosom Med. 1989;  51 608-635
• 64 Traue H C, Gottwald A, Henderson P R, Bakal D A. Nonverbal Expressiveness and EMG Activity In Tension Headache Sufferers And Controls.  J Psychosom Res. 1985;  29 375-381
• 65 Alexander F. Psychosomatische Medizin. Gruyter 1971 2. Aufl.: 32 (amerikanische Originalausgabe: Psychosomatic Medicine, 1950)
• 66 Polan H J, Hofer M A. Maternally directed orienting behaviors of newborn rats.  Dev Psychobiol. 1999;  34 269-279
• 67 Schöttler C. Zur Behandlungstechnik bei psychosomatisch schwergestörten Patienten.  Psyche. 1981;  35 111-141
• 68 Taylor G J. Clinical application of a dysregulation model of illness and disease: A case of spasmodic torticollis.  Int J Psychoanal. 1993;  74 581-595