title: [Psychogenic thoracic pain attacks. Pathogenesis, follow-up, therapy].
abstract: 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.
authors.affiliation: Psychosomatische Abteilung, Universitäts-Kinderklinik Hamburg.
authors.forename: R W
authors.initials: RW
authors.lastname: Dittmann
mesh_terms: D002637:Chest Pain / Q000523:psychology* / Q000628:therapy; D002648:Child; D003291:Conversion Disorder / Q000523:psychology* / Q000628:therapy; D003937:Diagnosis, Differential; D005196:Family Therapy; D005260:Female; D005500:Follow-Up Studies; D006117:Grief; D006801:Humans; D009034:Mother-Child Relations; D010348:Patient Care Team; D012803:Sick Role; D013315:Stress, Psychological / Q000150:complications
vernacular_title: Psychogene thorakale Schmerzattacken. Pathogenese, Verlauf, Therapie.