124-ALEXITHYMIA RELATION TO INCREASED SYMPATHETIC ACTIVITY OF AUTONOMIC HEART RATE CONTROL

Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673

158 RESULTS OF THE PROSPECTIVE PSYCHOLOGICAL EVALUATION FIVE YEARS AFTER SURGICAL OBESITY THERAPY Benecke A, Schowalter M, Hoog C. Institute of Psychotherapy and Medical Psychology, Wu¨rzburg, Germany. At the university of Wu¨rzburg every patient requesting a gastric banding operation is examined psychologically (t1) since May 1997. This exploration is part of the selection process to which also belong internal and surgical examinations. Five standardised questionnaires are used during the psychological diagnostic process: Beck Depression Inventory (BDI), one questionnaire referring to self-acceptance (SESA) and one to contentment with life. The Three Factor Eating Questionnaire and the Inventory of Eating Behaviour and Weight Problems describe several patterns of eating behaviour. With every patient two anamnestic explorations are performed. Six months (t2), two years (t3) and five years (t4) after the operation these tests plus a self constructed questionnaire which gives information of specific changes in eating behaviour (especially after gastric banding), social contacts and other aspects are send to the patients. Since June 1997 until October 1999, 100 patients (80 women, 20 men, age between 20 and 59 years, body mass index (BMI) between 33.0 and 69.2 kg/m2) were examined. 19 persons were excluded from the operation, 62 were operated and 13 persons were agreed to be operated under certain conditions, for example accompanying psychotherapy. Five years after the operation we received data from 25 patients so far. BMI decreased significantly from 47.8 (t1) to 37.4 (t4) ( p < .001, t-Test), depression from 13.9 (BDI (t1)) to 8.6 (t4), ( p < .05, t-test) while self-acceptance increased (SESA (t1) = 103.5; t4 = 111.0; p < .05). Control of eating behaviour also increased (FEV t1 = 9.22; t4 = 12.1; p < .05) as did feelings of hunger (t1 = 7.4; t4 = 11.4; p < .05), and disinhibition tended to decrease (t1 = 8.0; t4 = 6.4; p = .051). Altogether the results show improvements in many psychological and eating behaviour parameters. The increase of feelings of hunger is astonishing and is partially due to some patients who show extreme values of hunger and little weight loss. The extent of mean weight loss was expected.

263 BODY-IMAGES IN PATIENTS WITH EATING DISORDERS AND THEIR FAMILIES: A COMPUTER ASSISTED APPROACH Benninghoven D, Ju¨rgens E, Kunzendorf S, Jantschek G. Department for Psychosomatic Medicine, University of Schleswig-Holstein, Campus Lu¨beck, Germany. Background: Eating disorders are associated with distorted perceptions of the own body. So far body-image distortions have mostly been assessed by questionnaires or by selecting drawn silhouettes of body-images also in a paper pencil form. In this study we investigated whether a computer assisted approach to the assessment of body-images in patients with eating disorders and their families could be suitable for research questions and for therapeutic purposes. Method: A computer program is presented that allows modelling body-images from different perspectives: how a person perceives her- or himself, how a person wishes to appear, how a person thinks that an average person of her or his age appears and what kind of body-image would be mostly attractive for a person with

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the opposite sex? The program also allows to assess body-images not only from patients themselves but also from family members and partners. Family members and partners are asked to select their own body-images and the images they have from their eating disordered family member. The selected body-images are compared with standardised questionnaires (EDI, IIP, BDI etc.) and with anthropometric data (body composition, bmi etc.). So far data from 50 patients (30 patients with anorexia and 20 patients with bulimia nervosa) and 30 control subjects have been analysed. Results: Neither the patients nor their family members reported any problems with handling the program. Preliminary analysis of the data shows that patients with anorexia highly overestimate their body fat. Patients with bulimia nervosa perceive their body-image more accurate. Normal control subjects tend to slightly underestimate their body-image. Mothers of patients with anorexia nervosa highly overestimate their own body fat whereas mothers of patients with bulimia nervosa perceive their body-image accurate. An overestimation of ones own body-image is also associated with less satisfaction with the own body-image. Discussion: The computer assisted approach seems to be suitable for the assessment of a most important criterion for the diagnosis of eating disorders. The data from family members seems to validate the impressions family therapists reported from their work with families of patients with eating disorders.

124 ALEXITHYMIA RELATION TO INCREASED SYMPATHETIC ACTIVITY OF AUTONOMIC HEART RATE CONTROL Beresnevaite M, Raugaliene R, Vasiliauskas D, Krisciunas A, Grizas V, Leimoniene L. Institute of Cardiology, Kaunas University of Medicine, Cardiac Rehabilitation Laboratory, Kaunas University of Medicine Institute of Cardiology, Clinic of Rehabilitation, Kaunas Medical University Hospital, Kaunas, Lithuania. Alexithymia relation to increased sympathetic activity of autonomic heart rate control: are the alexithymic patients after coronary angioplasty at higher risk of sudden cardiac death? Aim: It is known that abnormal autonomic heart activity plays an important part in the development of sudden cardiac death. Our aim was to research if alexithymia is related to the increased sympathetic activity in coronary heart disease (CHD) patients after percutaneous transluminal coronary angioplasty (PTCA). Methods: 41 CHD pts (33 men and 8 women aged 58.0+/
9.0) after PTCA were investigated. Alexithymia was assessed by using 20-item Toronto Alexithymia Scale (TAS-20). Spectral heart rate variability (HRV) was expressed as low-frequency (LF) component (a marker of sympathetic modulation); high-frequency (HF) one (as a marker of parasympathetic activity); LF/HF ratio and heart rate reaction (DltRRb) to active orthostatic test (AS LF/ HF  1.1 and/or DltRRb  200ms show increased sympathetic activity. Data were analysed using t-tests, chi-square tests and multiple regression analysis. Results: This study demonstrates that 90% of pts had increased sympathetic activity. T-tests and chi-square tests didn’t show the differences of parameteres of heart rate variability in alexithymic and non-alexithymic pts. The results of multiple regression analysis have shown that LF component is related to TAS-20 score (b = 0.789; p = .038; 95%CI 0.052 – 1.625). There were small number of pts

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Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673

in this study, so we suggest, that alexithymia association with increased sympathetic activity could be confirmed by other parameteres of HRV (LF/HF ratio, DltRRb) by larger studies. Conclusion: The findings of this research suggest that TAS-20 score is related to LF component of HRV in CHD pts after PTCA. It is possible that alexithymic patients after PTCA are at higher risk of sudden cardiac death. It would be important for the rehabilitation programmes for these pts. Further studies are required for the confirmation of the alexithymia relation to the risk of sudden cardiac death in CHD pts after PTCA.

208 FIBROMYALGIA AND FACIAL EXPRESSION Bernardy K. Bliestal Clinics, Blieskastel, Germany. Background and aim: Relationship patterns of Fibromyalgia (FM) patients are often characterised as difficult. It is assumed that patients with mental diseases implement a specific interaction pattern, that is expressed in the facial expression and particularly in facial-affective micro-behaviours. The aim of the present study was the analysis of facial-affective behaviour of inpatient female FMpatients in comparison to healthy women. Methods: Videotaped psychodynamic interviews of each 15 inpatient female FM-patients and healthy women (absence of mental/ psychiatric disorder according to ICD-10) were coded using the Emotional Facial Acting Coding System, an instrument for the registration of facial movements with emotional relevance. Afterwards these analysis were connected with gazing behaviour. Results: FM-patients showed neither a reduction of overall facial expressions nor a reduced frequency of facial affects in comparison to healthy women. Healthy women however showed significantly more ‘‘genuine joy’’ and a reduced portion of ‘‘contempt’’ than patients did. Taking the gazing behaviour into consideration it became obvious, that FM-patients expressed a significantly reduced portion of ‘‘genuine joy’’ and a significantly increased portion of ‘‘contempt’’ during phases of mutual gaze compared to healthy women. Conclusions: The difficulties in establishing a positive relationship with FM patients are somewhat clarified by these results: on the one hand is the non existing reduction of overall facial expressions, and thus the affective ‘‘vividness’’ contrary to the detailed descriptions of complaints, on the other hand it became obvious, that at the same time elements stabilizing a relationship are missing and dissociating ones are implemented.

10 PSYCHOTHERAPY WITH REFUGEE TORTURE SURVIVORS—TRAUMATIC PROCESSES AND DIFFERENT CULTURAL BELIEFS Birck A. Berlin Center for the Treatment of Torture Survivors, Germany. The Berlin Center for the Treatment of Torture Survivors has acquired 11 years experience of diagnostic and therapeutic work. As a result of severe and repeated traumatizations on the one hand and ongoing incertainty and stress in exile on the other hand, the survivors suffer from complex posttraumatic disorders with a high tendency of chronification. In Germany, refugees live in a social and legal situation, which is characterized by repeated stress and severe restrictions. The helplessness stemming from this situation

is a further traumatizing factor for victims of war and persecution (third phase in the sequential traumatization process). The individual traumatic process and the clinical symptoms are influenced by the experiences which follow the former traumatic events. When trauma survivors are faced with further stressors and with public denial of trauma, posttraumatic symptoms and clinical disorders often deteriorate. Psychotherapy with refugees is mostly a cross-cultural relation. Most people are unaware about the influence of their own culture and take their beliefs and behaviours as ‘‘normal’’. The presentation focuses on common cultural biases, which may be present in mental health professionals. E.g., most psychological theories suggest that people grow from dependence to independence and that mature functioning implies autonomous thought and behaviour. An alternative suggestion, which may be more appropriate for many refugees is that maturity involves growth toward connection and relationship. Many of our patients (E.g., Kurds or Bosnians from rural areas) come from cultures where relatedness to others is important, where status and authority are politely respected and where the goals of the group (family, community etc.) are more important than individual ones. Therefore, every person should act according to collective norms. Conformity and harmony are necessary and conflicts are avoided. This implies also culture specific resources as it has been shown that strong social support following trauma (implying some degree of dependency) is essential to prevent further difficulties with trauma-related disorders. Examples how to establish a common understanding of the problem and the cure are discussed.

168 HEALTH ANXIETY, HEALTHCARE UTILIZATION AND SOMATIZATION AMONG OUTPATIENTS IN CBT Bleichhardt G. Department of Clinical Psychology, University of Mainz, Germany. Health anxiety (HA) refers to health-related fears and beliefs, based on interpretations of bodily signs and symptoms as being indicative of a serious illness. Health Anxiety is understood as a continuum with the severe end of it representing hypochondriasis. In order to gain information on the prevalence of HA among outpatients in cognitive-behavioral therapy (CBT) as well as to ascertain characteristics of patients with high HA, a sample of 111 patients of an ambulatory cognitive-behavioral practice was screened with the Illness Attitude Scales, the Screening for Somatoform Symptoms and the Symptom Checklist SCL-90-R. Additionally, all patients underwent a semistructured interview pertaining to DSM-IV. Although 31% of the patients could be categorized as high HA patients, only three of them (2.9%) met criteria for DSM-IV hypochondriasis. Further results show that high HA patients suffer from much more somatoform symptoms that the rest of the subjects ( p < .001, Cohen’s d = 0.76). High HA individuals had higher scores on almost all SCL-90-R subscales as well as on the global symptom index GSI ( p < .01, d = 0.76). There was a high rate of visits to the doctor with a mean number of 24 visits per year for high HA patients (compared to 11 visits for low HA patients; p < .01, d = 0.91). Interestingly, the number of visits to the doctor correlates higher with HA (r = .34, p < .01) than with the number of somatoform symptoms (r = .26, p < .05). These results signalize that health anxiety can be held responsible as one important factor accounting for the high health care costs in Germany. Although hypochondriasis as a mental disorder seems to be relatively rare in the CBT