Verhaeghe Paul, Vanheule Stijn, De Rick Ann
Department of Psychoanalysis, Ghent University, Belgium.
Psychoanal Q. 2007 Oct;76(4):1317-50. doi: 10.1002/j.2167-4086.2007.tb00306.x.
Starting from a contemporary critique of the DSM-IV, this paper argues that the diagnostic categories of panic disorder somatization, and undifferentiated somatoform disorders can be understood as belonging to a common type of psychopathology--i.e., the Freudian actual neuroses. In addition to their strong clinical similarity, these disorders share an etiological similarity; and the authors propose a combination of Freud's focus on this type of patient's inability to represent an endogenous drive arousal with the post-Freudian focus on separation anxiety. An etiological hypothesis is put forward based on contemporary psychoanalytic attachment theory, highlighting mentalization. Concrete implications for a psychoanalytically based treatment are proposed.
本文从对《精神疾病诊断与统计手册第四版》（DSM-IV）的当代批判出发，认为惊恐障碍、躯体化障碍和未分化躯体形式障碍的诊断类别可被理解为属于一种常见的精神病理学类型，即弗洛伊德所说的现实神经症。除了它们在临床上有很强的相似性外，这些障碍在病因上也有相似之处；作者们提出将弗洛伊德对这类患者无法表征内源性驱力唤起的关注与后弗洛伊德时代对分离焦虑的关注相结合。基于当代精神分析依恋理论提出了一个病因假说，突出了心理化。还提出了基于精神分析的治疗的具体意义。
