Beck D
Dtsch Med Wochenschr. 1977 Mar 4;102(9):303-7. doi: 10.1055/s-0028-1104882.
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.
在20名患者中观察到的“专家杀手”综合征是一种自恋型分类，可与其他器质性神经症区分开来。临床上，它具有三联征的特点：a）伴有大量检查和手术的弥漫性疼痛，b）无诊断和适当治疗，c）病理性医患关系。该病基于腹部、颈部和背部的不确定功能性疼痛。由于无法将其归类为临床定义的躯体疾病，导致多次诊断尝试，且随着成功率的降低，尝试变得更加激进。所有病例都有多次手术史。医患关系的特点是患者最初将医生理想化，但由于医生能力有限，很快就转为排斥。患者只容忍与医生进行短暂接触。在人格方面，自恋特质和外部理想化的持续存在很明显。该综合征发生在生活中理想化伴侣让患者失望之时。这些触发因素应被视为自恋性侮辱。功能性疼痛是患者试图恢复受到威胁的自我的一种表现。治疗包括心理治疗。
