[Cardiac anxiety syndrome. Etiologic significance of orientation crises and orientation conflicts and their consequences for therapeutic practice].

In the framework of a phenomenological approach to cardiac neurosis the author investigated 20 patients suffering from this disease regarding their kind of communication disorder and conflicts in order to find out the main conditions for etiology. This study is based on the conception of so-called "Anthropological-integrative Psychotherapy" developed by D. Wyss. He conceptualized fundamental structures of communication representing the structural aspect of a psychosomatic disease and modi of communication in order to show its dynamic aspect. The purpose of this investigation was to examine disproportions, deficiencies, compensatory hypertrophy and conflicts in the six fundamental structures of communication (Living Space, Orientation, Order, Time, Body, Performance). In accordance with many other publications separation anxiety, ambivalence between tie and separation, aggressive restraint, sexual disorders and conflicts in the structure of "performance" are confirmed as significant etiological factors. In addition, conflicts, crises and deficiency of orientation have proved to be of major importance. This is the essential result of this study and an important new contribution to our understanding of cardiac neurosis. The therapies of 3 patients suffering from cardiac neurosis are reviewed to illustrate the three main kinds of disorders in orientation. Finally the therapeutic consequences are discussed. The constitution of new orientation in an intersubjective and dialogic process seems to be an essential aim for psychotherapeutic treatment of cardiac neurosis.