Dittmann R W
Psychosomatische Abteilung, Universitäts-Kinderklinik Hamburg.
Z Kinder Jugendpsychiatr. 1994 Jun;22(2):114-22.
Over a five-month period a 10-year-old girl presented repeatedly with attacks of chest pain that were eventually diagnosed as a conversion disorder (DSM-III-R). A detailed case report of the (just) three sessions with both mother and daughter is given and the process of identifying the conflict constellation (death of a loved one, reproachful attitude toward the mother), aspects of primary and secondary gain, and factors influencing choice and localization of the pain symptoms (models: father and brother) are discussed. The therapeutic lead-in was achieved by noticing and inquiring about the patient's equivocal use of the term "joke" during an interview and in a projective sentence completion test. The therapeutic approach comprised psychoanalytically oriented components, elements of family therapy, suggestive measures, exercises and counseling. Over a follow-up period of two years the patient remained symptom-free and her further development was unproblematic. Aspects of this case that are typical of conversion disorder and factors indicating a good prognosis are discussed with reference to the literature.
在五个月的时间里，一名10岁女孩反复出现胸痛发作，最终被诊断为转换障碍（《精神疾病诊断与统计手册》第三版修订版）。本文给出了与母亲和女儿进行的（仅仅）三次治疗的详细病例报告，并讨论了确定冲突组合（所爱之人的死亡、对母亲的责备态度）的过程、原发性和继发性获益的方面，以及影响疼痛症状选择和定位的因素（模型：父亲和兄弟）。通过在一次访谈和一项投射性句子完成测试中注意并询问患者对“玩笑”一词的含糊使用，实现了治疗导入。治疗方法包括精神分析导向的成分、家庭治疗的要素、暗示措施、练习和咨询。在两年的随访期内，患者没有症状，其进一步发展也没有问题。结合文献讨论了该病例中转换障碍的典型方面以及表明预后良好的因素。
