Klett-Cotta-Verlag Psychology
Wissenschaft

Schizophrenie und Somatisierung

Zwei Seiten einer dissoziativen Medaille?


August 2017, 11. Jahrgang, Heft 3, pp 206-215

DOI 10.21706/tg-11-3-206



Zusammenfassung
Bei Schizophrenie finden sich gehäuft Traumatisierungen und Dissoziation. Umgekehrt neigen traumatisierte und dissoziierende Individuen zu psychotischen Symptomen wie halluzinatorischen und paranoiden Syndromen. Phänomenologische Unterschiede beziehen sich dabei eher auf die Art der Fehlwahrnehmungen, während quantitative Unterschiede nicht wegweisend sind. Diese Befundlage spricht für eine schizophrene Diathese, die durch Trauma und Dissoziation geprägt ist und zumindest bei einem Teil der Erkrankten eine tragende pathogenetische Rolle spielt. In Analogie dazu weisen posttraumatische Syndrome auch im Hinblick auf Körpersymptome eine Parallele zur schizophrenen Symptombildung auf, die sich in dysmorphophoben, hypochondrischen und leib-halluzinatorischen Phänomenen äußern kann. Sowohl im Hinblick auf tatsächlich posttraumatische als auch im Hinblick auf tatsächlich schizophrene Erkrankungen führen Fehldiagnosen in der Regel zu Therapiefehlern. Vor diesem Hintergrund gibt die vorliegende Arbeit einen Überblick über die relevanten Unterschiede und Gemeinsamkeiten der diskutierten klinischen Phänomene. Zudem diskutieren wir die möglichen neurobiologischen Hintergründe einer derartigen Symptomüberlappung unter der Annahme einer traumaassoziierten Genese dieser Symptome.

Abstract
Schizophrenia and Somatization. Two sides of a dissociative medal?
People diagnosed with schizophrenia often report complex traumatization and high levels of dissociative symptoms. Likewise, dissociation and posttraumatic symptomatology are linked to psychotic symptoms. Given these parallels and the overlap between schizophrenia and dissociation, there may be diagnostic errors and a systematic neglect of posttraumatic etiology. Regarding schizophrenia, the syndromal overlap with dissociation may even hint to a dissociative subtype of schizophrenia. On the contrary, coenesthetic hallucinations may be misinterpreted and mistreated as posttraumatic symptomatology. Therefore, the present article reviews the differences as well as commonalities between these syndromes along with the necessity to acknowledge them with respect to the distinct therapeutic implications that correspond to the etiological distinction. Not least, we review common neurophysiological mechanisms possibly accounting for the clinical overlap between dissociation and schizophrenia.

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