Download PDF
Psychother Psychosom Med Psychol 2002; 52(11): 479-486
DOI: 10.1055/s-2002-35278
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Aktuelles zu psychodynamischen und neurobiologischen Einflussfaktoren in der Genese der Alexithymie

Psychodynamic and Neurobiological Influences in the Etiology of AlexithymiaHarald  Gündel1 , Andres  O.  Ceballos-Baumann2 , Michael  von Rad1
  • 1Institut und Poliklinik für Psychosomatische Medizin, Psychotherapie und Medizinische Psychologie, Klinikum rechts der Isar, TU München
  • 2Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, TU München
Further Information

Publication History

Eingegangen: 13. Mai 2002

Angenommen: 9. August 2002

Publication Date:
05 November 2002 (online)

Also available at
    Permissions and Reprints

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.

Key words

Alexithymia - developmental psychology - psychodynamics - neurobiology

Literatur

  • 1 von Rad M. Alexithymie. Heidelberg; Springer-Verlag 1983
    Google Scholar
  • 2 Taylor G J, Bagby M, Parker J DA. Disorders of Affect Regulation. Alexithymia in Medical and Psychiatric Illness. Campridge; Cambridge University Press 1997
    Google Scholar
  • 3 Rodin G M. Somatization: A Perspective from self-psychology.  J Am Acad Psychoanal. 1991;  19 367-384
    PubMedGoogle Scholar
  • 4 Stolorow R D, Atwood G E. The Mind and the Body.  Psychoanalytic Dialogues. 1991;  1 181-195
    PubMedGoogle Scholar
  • 5 Ruesch J. The infantile personality.  Psychosomatic Med. 1948;  10 134-144
    PubMedGoogle Scholar
  • 6 Marty P, de M'Uzan M. La „pensée opératoire”.  Rev Franc Psychoanal. 1963;  27 345-356
    PubMedGoogle Scholar
  • 7 Sifneos P E. Short-Term Psychotherapy and Emotional Crisis. Cambridge, Mass; Harvard University Press 1972
    Google Scholar
  • 8 Krystal H. Alexithymia and Psychotherapy.  Am Journal of Psychotherapy. 1979;  33 17-31
    PubMedGoogle Scholar
  • 9 McDougall J. The Psychosoma and Psychoanalytic Process.  Int Rev Psychoanal. 1974;  1 437-459
    PubMedGoogle Scholar
  • 10 McDougall J. Theater des Körpers. Ein psychoanalytischer Ansatz für die psychosomatische Erkrankung. Stuttgart; Verlag Internationale Psychoanalyse 2000
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Benedetti G. Beitrag zum Problem der Alexithymie.  Nervenarzt. 2000;  51 534-541
    PubMedGoogle Scholar
  • 13 Parker G. Parental characteristics in relation to depressive disorders.  Br J Psychiatry. 1979;  134 138-147
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 15 Fukunishi I. Mothers' low care in the development of alexithymia: a preliminary study in Japanese college students.  Psychol Rep. 1997;  80 143-144
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 17 Fukunishi I, Paris W. Intergenerational association of alexithymic characteristics for college students and their mothers.  Psychol Rep. 2001;  89 77-84
    PubMedGoogle Scholar
  • 18 Mahler M, Pine F, Bergman A. The psychological birth of the human infant: Symbiosis and individuation. New York; Basic Books 1975
    Google Scholar
  • 19 Spitz R A. Vom Säugling zum Kleinkind. Naturgeschichte der Mutter-Kind-Beziehungen im ersten Lebensjahr. Stuttgart; Klett-Cotta 1996 11. Aufl.
    Google Scholar
  • 20 Dornes M. Die frühe Kindheit. Entwicklungspsychologie der frühen Lebensjahre. Frankfurt/M.; Fischer-Verlag 1997
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 24 Kandel E R. A new intellectual framework for psychiatry.  Am J Psychiatry. 1998;  155 457-469
    PubMedGoogle Scholar
  • 25 Gunnar M R. Reactivity of the hypothalamic-pituitary-adrenocortical system to stressors in normal infants and children.  Pediatrics. 1992;  90 491-497
    PubMedGoogle Scholar
  • 26 Fonagy P, Target M. Mit der Realität spielen. Zur Doppelgesichtigkeit psychischer Realität von Borderline-Patienten.  Psyche. 2001;  9/10 961-995
    PubMedGoogle Scholar
  • 27 Strauß B, Buchheim A, Kächele H. Klinische Bindungsforschung. Theorien - Methoden - Ergebnisse. Stuttgart; Schattauer-Verlag 2002
    Google Scholar
  • 28 Laible D J, Thompson R A. Attachment and emotional understanding in preschool children.  Dev Psychol. 1998;  34 1038-1045
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 31 Damasio A R. Descartes' Irrtum. Fühlen, Denken und das menschliche Gehirn. München; DTV 1998 3. Aufl.
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 34 Suomi S J. Early determinants of behaviour: evidence from primate studies.  Br Med Bull. 1997;  53 170-184
    PubMedGoogle Scholar
  • 35 McEwen B S. Stress and hippocampal plasticity.  Ann Rev Neurosci. 1999;  22 105-122
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 41 DeBellis M D, Putnam F W. The psychobiology of childhood maltreatment.  Child Adolescent Psychiat Clin North Amer. 1994;  3 663-678
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 52 Devinsky O, Morell M, Vogt B. Contributions of anterior cingulate cortex to behaviour.  Brain. 1995;  118 279-306
    CrossrefPubMedGoogle Scholar
  • 53 Cotteril R MJ. On the unity of conscious experience.  J Consciousness Studies. 1995;  2 290-312
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 55 Bush G, Luu P, Posner M I. Cognitive and emotional influences in anterior cingulate cortex.  Trends Cogn Sci. 2000;  4 215-222
    CrossrefPubMedGoogle Scholar
  • 56 Rolls E T. The Brain and Emotion. New York; Oxford University Press 1999: 257
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 60 Min S K, Byung O L. Laterality in Somatization.  Psychosomatic Medicine. 1997;  59 236-240
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 62 Anderson M C, Green C. Suppressing unwanted memories by executive control.  Nature. 2001;  410 366-369
    CrossrefPubMedGoogle Scholar
  • 63 Weiner H. The Dynamics of the Organism: Implications of Recent Biological Thought for Psychosomatic Theory and Research.  Psychosom Med. 1989;  51 608-635
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 65 Alexander F. Psychosomatische Medizin. Gruyter 1971 2. Aufl.: 32 (amerikanische Originalausgabe: Psychosomatic Medicine, 1950)
    Google Scholar
  • 66 Polan H J, Hofer M A. Maternally directed orienting behaviors of newborn rats.  Dev Psychobiol. 1999;  34 269-279
    CrossrefPubMedGoogle Scholar
  • 67 Schöttler C. Zur Behandlungstechnik bei psychosomatisch schwergestörten Patienten.  Psyche. 1981;  35 111-141
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar

Dr. med. Harald Gündel

Institut und Poliklinik für Psychosomatische Medizin, Psychotherapie und Medizinische Psychologie · TU München · Klinikum rechts der Isar

Langerstraße 3

81675 München

Email: H.Guendel@lrz.tu-muenchen.de