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242-UNFINISHED MOURNING AND SOMATIZATION
Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673
populations face a lot of problems, but the DSM can serve as a heuristic concept. Objectives: To provide prevalence estimates of mental distress like posttraumatic stress disorder, depressiveness, anxiety and culture specific symptoms of mental and somatic disorders and to determine relationships between experiences of organised violence and mental distress and mental disease symptoms. Methods: Cross sectional survey in an ethnic homogeneous nonclinical sample using the;Harvard-Trauma-Questionnaire; and the; Hopkins-Symptom-Checklist; and ethnographic methods. Results: Serious forms of distress were found.
242 UNFINISHED MOURNING AND SOMATIZATION Makhashvili N. Georgian Center for Psychosocial and Medical Rehabilitation of Torture Victims, Tbilisi, Georgia. Georgian Center for Psychosocial and Medical Rehabilitation of Torture Victims (GCRT) is implementing rehabilitation program for torture survivors since 2000. The main target groups encompass Internally Displaced Persons, Refugees from Chechnya, Persons tortured by law-enforcements agencies, also other traumatized population (e.g., domestic violence survivors, Stalin repression victims). GCRT deals with primary and secondary trauma consequences on different levels: individual, family, school and at societal/community levels. The centre is supported by funding from EC and UNVFTV. This paper is based on the working experience with a group of 17 women who represent the State Commission on Missing Persons. The program ‘‘Psychosocial Support to Families of Missing Persons’’ is sponsored by the International Committee of Red Cross. The war conflict with Abkhazians has resulted in many deaths and also a large number of people who-after 10 years-is still missing (the number of Georgian families with missing member is approximately 1500). Paper discusses: problems and needs of persons with uncompleted grief, also clinical findings both on somatic and psychological levels; particulars of traumatic experience – namely, intensified active imagination will be discussed; defenses and coping strategies including denial and dissociation, also ‘‘magical thinking’’, common rituals and group sharing will be described; specifics of prolonged and unfinished mourning in terms of cultural context—we think that the bereavement process is aggravated due to social representative of ‘‘sorrowful mother’’; the problems of attachment formation and upbringing styles in Georgian families also largely contributes to ‘‘traumatic bonding’’ and unaccepted loss; At last, we will try to link the severity of traumatic symptoms, adjustment/socialization process and somatization of persons who suffer from prolonged and still ‘‘open’’ trauma. GCRT two-faced approach and the intervention program will be presented—the program is designed for a holistic intervention at different ‘‘levels’’ of personality-identity, cognition, emotions, behavior, somatic level and interpersonal relations.
165 BODY IMAGE AND EATING DISORDERS Maximiano J, Miranda M, Tome´ C, Maia T. Psychiatry Department of Amadora Sintra Hospital, Amadora, Portugal. The authors present a bibliographic revision on body image in eating disorder patients. They also explore the concept of body scheme and revise evaluation scales of body image and scheme.
651
Furthermore, the authors approach the importance of lifeexperience or events in these patients and posterior influence in the construction of an adequate body image. The implication of morphological changes in body and their relation to proprioceptors adaptation and neurological structuring of the corporal scheme are also revised. The majority of studies on body image conclude that the concept is multidimensional, involving socio-cultural, historical and individual (biological, affective and cognitive variables) issues. The construction of the body image results from the subjective corporal experience and should be evaluated according to two main aspects:-Subjective (global positive or negative body attitude); Perceptive (global perception of body dimensions and estimation of body volume). The studies consider that overestimation of body size is not always present in anorectic patients, thus being a characteristic linked to the pathology of cognitive and affective corporal experience process. The authors are part of a liaison psychiatry multidisciplinary team in a psychiatry department, formed by two psychiatrists, a psychologist and a psychomotricist. The follow-up begins with psychiatric evaluation where the diagnosis and therapeutic plan is established. The patients are then referred to psychology and psychomotricity. Psychomotricity is a body mediation therapy, using the body as an instrument of emotional relation and perception. This body experience (relaxation and expressiveness) leads the individual to a better comprehension and insight of his/hers subjectivity in personal and affective history, understanding as a whole in the inter and innerindividual relation. The referral of the eating disorder patient to psychomotricity is based on body-identity cleavage, and the use of the body as an aggressive instrument to their peers. This revision will enable to consolidate knowledge in this field. In the near future the authors intend to translate, adapt and validate the evaluation scales of body image concept in eating disorder.
149 POSTTRAUMATIC STRESS DISORDER: A VALID DIAGNOSIS FOR BREAST CANCER PATIENTS? Mehnert A. Institute of Medical Psychology, University Clinic Hamburg-Eppendorf, Hamburg, Germany. Purpose: Since life-threatening illness was included a as a potentially traumatic event in the revised DSM-IV, posttraumatic stress disorder (PTSD) has been increasingly diagnosed as an additional morbidity among cancer patients. The prevalence of PTSD differs from 0% to 35% in adult cancer patients. The aim of this prospective study is to identify acute and posttraumatic stress responses and risk factors in women with breast cancer diagnosis. Methods: Interviews were conducted with N=127 women at various disease stages (0 – 4) during their stay at the University Gynecology Clinic in Hamburg within an average of three days (range 0 – 11) after breast operation (participation: 83%) (T1). 23% had a diagnosis of recurrent cancer. We used SCID-DSM-IV modules for PTSD, Acute Stress Disorder (ASD), Major Depression, Dysthymic Disorder, Generalized Anxiety Disorder and Adjustment Disorder. Additionally, women completed questionnaires including IES-R, PCL-C, HADS, Dealing with Illness Inventory (DWI), and Life Attitude Profile (LAP-R), among others. Six months after the interview (T2), the women were given the same questionnaires with a few additional instruments (Response rate: 78%). Results. On the basis of the SCID, prevalence rates were rather low, with 2% for each cancer-related ASD
populations face a lot of problems, but the DSM can serve as a heuristic concept. Objectives: To provide prevalence estimates of mental distress like posttraumatic stress disorder, depressiveness, anxiety and culture specific symptoms of mental and somatic disorders and to determine relationships between experiences of organised violence and mental distress and mental disease symptoms. Methods: Cross sectional survey in an ethnic homogeneous nonclinical sample using the;Harvard-Trauma-Questionnaire; and the; Hopkins-Symptom-Checklist; and ethnographic methods. Results: Serious forms of distress were found.
242 UNFINISHED MOURNING AND SOMATIZATION Makhashvili N. Georgian Center for Psychosocial and Medical Rehabilitation of Torture Victims, Tbilisi, Georgia. Georgian Center for Psychosocial and Medical Rehabilitation of Torture Victims (GCRT) is implementing rehabilitation program for torture survivors since 2000. The main target groups encompass Internally Displaced Persons, Refugees from Chechnya, Persons tortured by law-enforcements agencies, also other traumatized population (e.g., domestic violence survivors, Stalin repression victims). GCRT deals with primary and secondary trauma consequences on different levels: individual, family, school and at societal/community levels. The centre is supported by funding from EC and UNVFTV. This paper is based on the working experience with a group of 17 women who represent the State Commission on Missing Persons. The program ‘‘Psychosocial Support to Families of Missing Persons’’ is sponsored by the International Committee of Red Cross. The war conflict with Abkhazians has resulted in many deaths and also a large number of people who-after 10 years-is still missing (the number of Georgian families with missing member is approximately 1500). Paper discusses: problems and needs of persons with uncompleted grief, also clinical findings both on somatic and psychological levels; particulars of traumatic experience – namely, intensified active imagination will be discussed; defenses and coping strategies including denial and dissociation, also ‘‘magical thinking’’, common rituals and group sharing will be described; specifics of prolonged and unfinished mourning in terms of cultural context—we think that the bereavement process is aggravated due to social representative of ‘‘sorrowful mother’’; the problems of attachment formation and upbringing styles in Georgian families also largely contributes to ‘‘traumatic bonding’’ and unaccepted loss; At last, we will try to link the severity of traumatic symptoms, adjustment/socialization process and somatization of persons who suffer from prolonged and still ‘‘open’’ trauma. GCRT two-faced approach and the intervention program will be presented—the program is designed for a holistic intervention at different ‘‘levels’’ of personality-identity, cognition, emotions, behavior, somatic level and interpersonal relations.
165 BODY IMAGE AND EATING DISORDERS Maximiano J, Miranda M, Tome´ C, Maia T. Psychiatry Department of Amadora Sintra Hospital, Amadora, Portugal. The authors present a bibliographic revision on body image in eating disorder patients. They also explore the concept of body scheme and revise evaluation scales of body image and scheme.
651
Furthermore, the authors approach the importance of lifeexperience or events in these patients and posterior influence in the construction of an adequate body image. The implication of morphological changes in body and their relation to proprioceptors adaptation and neurological structuring of the corporal scheme are also revised. The majority of studies on body image conclude that the concept is multidimensional, involving socio-cultural, historical and individual (biological, affective and cognitive variables) issues. The construction of the body image results from the subjective corporal experience and should be evaluated according to two main aspects:-Subjective (global positive or negative body attitude); Perceptive (global perception of body dimensions and estimation of body volume). The studies consider that overestimation of body size is not always present in anorectic patients, thus being a characteristic linked to the pathology of cognitive and affective corporal experience process. The authors are part of a liaison psychiatry multidisciplinary team in a psychiatry department, formed by two psychiatrists, a psychologist and a psychomotricist. The follow-up begins with psychiatric evaluation where the diagnosis and therapeutic plan is established. The patients are then referred to psychology and psychomotricity. Psychomotricity is a body mediation therapy, using the body as an instrument of emotional relation and perception. This body experience (relaxation and expressiveness) leads the individual to a better comprehension and insight of his/hers subjectivity in personal and affective history, understanding as a whole in the inter and innerindividual relation. The referral of the eating disorder patient to psychomotricity is based on body-identity cleavage, and the use of the body as an aggressive instrument to their peers. This revision will enable to consolidate knowledge in this field. In the near future the authors intend to translate, adapt and validate the evaluation scales of body image concept in eating disorder.
149 POSTTRAUMATIC STRESS DISORDER: A VALID DIAGNOSIS FOR BREAST CANCER PATIENTS? Mehnert A. Institute of Medical Psychology, University Clinic Hamburg-Eppendorf, Hamburg, Germany. Purpose: Since life-threatening illness was included a as a potentially traumatic event in the revised DSM-IV, posttraumatic stress disorder (PTSD) has been increasingly diagnosed as an additional morbidity among cancer patients. The prevalence of PTSD differs from 0% to 35% in adult cancer patients. The aim of this prospective study is to identify acute and posttraumatic stress responses and risk factors in women with breast cancer diagnosis. Methods: Interviews were conducted with N=127 women at various disease stages (0 – 4) during their stay at the University Gynecology Clinic in Hamburg within an average of three days (range 0 – 11) after breast operation (participation: 83%) (T1). 23% had a diagnosis of recurrent cancer. We used SCID-DSM-IV modules for PTSD, Acute Stress Disorder (ASD), Major Depression, Dysthymic Disorder, Generalized Anxiety Disorder and Adjustment Disorder. Additionally, women completed questionnaires including IES-R, PCL-C, HADS, Dealing with Illness Inventory (DWI), and Life Attitude Profile (LAP-R), among others. Six months after the interview (T2), the women were given the same questionnaires with a few additional instruments (Response rate: 78%). Results. On the basis of the SCID, prevalence rates were rather low, with 2% for each cancer-related ASD