[The "expert-killer" syndrome (author's transl)].

The "expert-killer" syndrome observed in 20 patients is a narcissistic subdivision which can be separated from the other organic neuroses. Clinically it is characterised by the triad: a) diffuse pain with numerous investigations and operations, b) absence of a diagnosis and adequate treatment, c) pathological doctor-patient relationship. The disease is based on indefinite and functional pains in the abdomen, neck and back. The failure to classify it with a clinically defined somatic disease leads to multiple diagnostic attempts which become more aggressive with increasing lack of success. Multiple operations occur in all the histories. The doctor-patient relationship is characterised by an initial idealisation of the doctor which quickly turns to rejection on account of his limited abilities. The patient only tolerates a short contact with the doctor. In the personality narcissistic traits and the persistence of an external ideal are apparent. The syndrome occurs in life at the point when the idealised partner disappoints the patient. These trigger factors are to be considered as a narcissistic insult. The functional pains are an attempt to restore the threatened self of the patient. The treatment consists of psychotherapy.