Organ neurosis

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Classification according to ICD-10
F45 Somatoform disorders
ICD-10 online (WHO version 2019)

Organ neurosis refers to an experience-related form of somatization disorder that relates to Freud's conversion model . It is to be understood as a causally effective mental disorder that affects certain areas of the body or certain organs . Initially, this takes place without clearly identifiable anatomical and physical changes and often even without physiological abnormalities. This is the talk of a psychogenic causation of the physical condition . These abnormalities are often so-called functional syndromes . This does not mean that functional syndromes are synonymous with psychogenic causation or neurosis . See Fig. 1 - Organ neuroses are more likely to be viewed as psychosomatoses. They are more on the right side of the curve in Fig. 1. According to Freud's theory, the cause is trauma . The term vegetative neurosis is a synonym for organ neurosis , which is particularly used to describe the functional disorders of individual internal organs or organ systems.

Examples :

  • Cardiac Neurosis or Cardiovascular Syndrome / Effort Syndrome / DA-COSTA Syndrome etc.
  • Gastric neurosis or functional gastrointestinal complaints
  • Penile neurosis

Concept development and delimitation

Fig. 1 - Organ neuroses in contrast to conversion neurosis can, for. Sometimes also understood as functional disorders as a result of chronically suppressed emotional tensions. The further to the right the complementary series of diseases continues on the red curve, the more the perception of fear decreases.

The term organ neurosis represents a disease concept for the mind-body problem . In medical psychology, these problems can be illustrated by the model of psychophysical correlation . In this way, the psychotherapeutic understanding could be extended to previously incomprehensible diseases. In 1945, the psychoanalyst Otto Fenichel (1897–1946) created the term organ neurosis and thus set up a broader treatment concept than the conversion model. In 1950 Franz Alexander (1891–1964) coined the term vegetative neurosis . He wanted to point out the role of chronic emotional conflicts . Over time, they manifest themselves in functional physical symptoms of internal organs. The acute subjective pressure of suffering or the unbearable emotional involvement decreases as the symptoms change . The term organ disorder represents an extension of Freud's previously known conversion model. The way in which somatization is processed suggests a lack of ego strength. Both the conversion model and the model of organ neurosis and vegetative neurosis describe the transition from the mental to the physical. Thure von Uexküll is of the opinion that the defense , as it was described by Freud with regard to the conversion model, is bound to the limits of the social convention from which it also starts. This psychosocial assumption is confirmed by the well-known demonstrative character of conversion hysterical symptoms. As is well known, they are externally visible to everyone and in principle can also be interpreted by everyone. The addressee of this meaningful, albeit unconscious, conversion hysterical message from the sick person is his psychosocial environment. The message aims at the symbolic representation of the underlying conflict as well as the expectation of understanding assistance. Under the aspect of the primary or unconscious subjective gain from illness , Freud pointed out the predominantly social aspect of such disorders. This mechanism usually no longer applies to vegetative symptoms in internal diseases. Üexküll therefore distinguished the illnesses of readiness from the illnesses of expression . In the case of supply diseases, deviations from the physiological norm that lack a clear expressive character should rather be observed.

Therapeutic ability

According to Freud, social motives are decisive for the effectiveness of therapy (→ transference neurosis ). He distinguished the narcissistic neuroses from transference neuroses . According to him, they differed in that in these clinical pictures the libido is completely withdrawn from the individual. They do not show any “ belle indifférence ” (nice carefree) that is common in transference neuroses . This affective indifference in those affected contains a positive message for anyone who feels called to interpret the specific symbolic modes of expression. Freud described being in contact with doctors and professional helpers as countertransference . Already by ancient doctors like Galenus or Aretäus , a connection between mental and physical changes was referred to as agreement or as "consensus" or sympathy . In romantic medicine, the affect states were assigned to the sympathetic nervous system , such as the emotions . Freud assumed that the prerequisite for interpretation by the therapist is only given if the patient is able to symbolically encode the symptoms of the disease. Freud considered the forms of illness he regarded as narcissistic to be incapable of therapy. In addition to anxiety neurosis, he also counted hypochondria among them . However, Freud gave a detailed description of vegetative symptoms that is still valid today for anxiety neurosis. In the case of anxiety neurosis, however, Freud assumed that there was no psychogenic, but rather a somatogenic cause. He saw this as being due to the abnormal diversion of somatic sexual excitement from the psychic. In contrast, Heinrich Meng had already pointed out in 1934 that early damage to the ego can be observed in the psychoanalytical treatment of patients with anorexia, tuberculosis, diabetes and gallbladder disease, which is otherwise only observed in psychoses . It can therefore be assumed that there are early childhood relationship disorders (→ affect equivalent ), which are decisive for the lower therapeutic success. Meng therefore suggested that they should not be understood as organ neuroses, but as " organ psychoses ". The organodynamic theory associated with the name of Henri Ey has also become known in Germany . The possible connection between a disorganization of the soul, assumed by Henri Ey, and the psychoanalytic theory of ego weakness should be mentioned. Therapeutic progress was made insofar as the vegetative symptoms were no longer understood as simply incomprehensible and as a mere physiological-mechanical correlate (without psychological "meaning"). Rather, this understanding was expressed in the fact that the concept of organ language already used by Freud was applied to these symptoms in a therapeutic sense.

Ontogenetic Aspects

On the basis of his first fear theory, Freud believed that the actual neurotic trauma in adulthood, which is stressful and has an impact on the body as a result of real fear, relates to the voluntary muscles. The pregenital conversion neuroses are mainly tics and stuttering . According to Freud and Fenichel, depending on the severity of the symptoms, they represent fixations on the early or late anal phase . The organ neuroses, on the other hand, are earlier disorders and, according to both authors mentioned, relate to the late oral phase . This view of Freud is an expression of his second fear theory. According to her, repressed and therefore unconscious experiences can also be the starting point for a fear signal (so-called signal fear).

More body disorders

Physical participation in the context of psychogenic influences is also represented by the syndromes of depersonalization and derealization . The development processes of personal identification and self-image are linked to the development of the body schema . Through dissociative development processes of alienation it can a. there is also a change in the body scheme, which is usually shaped by a continuum of personal experiences and ideals. These own ideas can, for example, differ from physical development tendencies, especially during puberty, for example with anorexia nervosa . In the case of anorexia nervosa and the anorectic reactions, physiological processes and social ideals and customs are combined.

Mixed images

The Freudian concept of conversion, which was initially further supplemented and continued with the concept of organ neurosis coined by Fenichel, ultimately contributed to the formation of a comprehensive theoretical model of somatization. As already shown above, this can be understood both in social psychiatric and physiological terms. The continuation of this idea has led to the term somatoneurosis , which was coined in 1953 by E. Carp and B. Stovkis. These include not only conversion hysterical phenomena and organ neuroses, but also psychosomatic diseases i. e. S., which are regarded as disease units even if only somatic categories are used, but are often regarded as classic psychosomatoses triggered by chronic conflict , such as B. the gastric ulcer, cf. a. → Holy Seven . In the case of these diseases, however, physical causes have also been confirmed; the exclusively psychogenic origin is questionable. Psychosomatic illness i. e. However, S. only means the psychologically triggered development. In practice, however, these are mostly somatic manifestations of the disease. Therefore, in addition to the psychosomatic, the somatopsychic triggering of disease symptoms must be taken into account (psychosomatic illness in the broader sense). This mixed manifestation is particularly important in neuropsychiatric diseases. It is therefore necessary to emphasize the combined and integrative view of both points of view, something which Stavros Mentzos in particular pointed out.

A similarly integrative view is represented by Niels Birbaumer , who as a brain researcher, if not psychoanalytical concepts, then at least represents psychodynamically sound therapeutic approaches for a number of neuropsychiatric diseases, such as epilepsy , strokes , ADHD . These non-medicinal and therefore not externally intervening strategies are referred to as “almost limitless potentials”, through which the brain can be influenced in order to positively determine thinking and acting.

Therefore questions arise about the so far only unclear nosological classification of neuropsychiatric clinical pictures. Tourette's syndrome is an example . The automatisms and tics observed here allow social-psychiatric as well as neuropsychological and neurophysiological interpretations. Social psychiatric parameters apply to the disease mentioned insofar as tics, similar to the conversion hysterical phenomena, predominantly occur on visible parts of the body, similar to the expressive movements (facial expressions, gestures) and thus allow conclusions to be drawn about the soul. In the age of biological psychiatry , psychopharmacological treatment methods and thus biological cause research often take precedence over psychotherapeutic models.

Individual evidence

  1. ↑ a b c d Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology . Urban & Schwarzenberg, Munich 3 1984; (a) Wb.-Lemma “Organ neuroses”: p. 388; (b) Wb-Lemma “Organo-dynamic theory”: p. 388; (c) Wb-Lemma “Somatoneurosis”: p. 524; (d) Wb-Lemma "Tic": p. 563 f.
  2. ↑ a b Wilhelm Karl Arnold et al. (Ed.): Lexicon of Psychology . Bechtermünz, Augsburg 1996, ISBN 3-86047-508-8 ; (a) on Lex.-Lemma “Organneurose”: Col. 1518; (b) on lex. lemmas "conversion" and "organ neurosis": Sp. 1138, 1518.
  3. ↑ a b c Thure von Uexküll (Ed. And others): Psychosomatic Medicine . Urban & Schwarzenberg, Munich 3 1986, ISBN 3-541-08843-5 , (a) Fenichel as namesake p. 277; (b) Hypochondria and anxiety neurosis as examples of narcissistic neurosis pp. 227, 486; Organ language used by Freud: p. 52.
  4. ↑ a b c d e Sven Olaf Hoffmann , G. Hochapfel: Theory of Neuroses, Psychotherapeutic and Psychosomatic Medicine. Compact textbook. Schattauer, Stuttgart 6 2003, ISBN 3-7945-1960-4 ; (a + b) based on S. Freud: (a) view of O. Fenichel p. 255; (b) opinion of F. Alexander p. 199; (c) Role of the body schema in the course of ontogenesis p. 35; (d) Changes in self-image e.g. T. in the course of the conversion hysteria pp. 170 f., 239; (e) Re. “Anorexia nervosa”: p. 345.
  5. ↑ a b Thure von Uexküll: Basic questions of psychosomatic medicine. Rowohlt Taschenbuch, Reinbek near Hamburg 1963; (a) Reg. expression diseases: p. 150 ff .; (b) Re. “Expression diseases and gain from disease”: p. 197.
  6. ↑ a b Walter Bräutigam : reactions, neuroses, psychopathies . A plan of the small psychiatry. dtv Scientific Series, Georg Thieme, Stuttgart 2 1969; (a) Re. “Countertransference”: p. 84; (b) on taxation “Depersonalization” and “Derealization”: p. 110 ff.
  7. ↑ Peter R. Hofstätter (Ed.): Psychology . The Fischer Lexicon, Fischer-Taschenbuch, Frankfurt a. M. 1972, ISBN 3-436-01159-2 ; P. 268 f.
  8. ↑ Sigmund Freud : About the justification to separate a certain symptom complex from neurasthenia as an "anxiety neurosis". (1895 b) In: Collected Works, Volume I (Studies on Hysteria - Early Writings on Neuroses), S. Fischer, Frankfurt / M, 3 1953, ISBN 3100227034 ; Vegetative symptoms of anxiety neurosis: pp. 317–324; Cause of anxiety neurosis: p. 334.
  9. ^ Heinrich Meng : The problem of organ psychosis in psychological treatment of organically ill. In: Int. Z. Psa. 16: 400-410 (1980).
  10. ↑ Stavros Mentzos : Neurotic Conflict Processing. Introduction to the psychoanalytic theory of neuroses, taking into account more recent perspectives. © 1982 Kindler, Fischer-Taschenbuch, Frankfurt 1992, ISBN 3-596-42239-6 ; P. 244 f.
  11. ^ Sigmund Freud: XXV. Lecture. The fear . (1916-1917) In: Gesammelte Werke, Volume XI, Lectures for Introduction to Psychoanalysis, Fischer Taschenbuch, Frankfurt / M 1999, ISBN 3-596-50300-0 ; P. 419 ff.
  12. ↑ EADE Carp Stokvis and B. (ed.): Acta Psychotherapeutica, Psychosomatica et Orthopaedagogica. Vol. 1, No. 1. Karger, Basel 1953, 93 pages.
  13. ↑ Stavros Mentzos: Psychodynamic Models in Psychiatry. Vandenhoeck & Ruprecht, Göttingen 2 1992, ISBN 3-525-45727-8 ; P. 15 f., 101 f.
  14. ↑ Niels Birbaumer : Your brain knows more than you think . Ullstein, Berlin 2 2014, ISBN 978-3-550-08031-9 .
  15. ↑ Asmus Finzen : The Pinel pendulum. The dimension of the social in the age of biological psychiatry. Edition Das Narrenschiff im Psychiatrie-Verlag, Bonn 1 1998, ISBN 3-88414-287-9 .