Scientific research on childhood constitutes a relatively new field. As we know today, there is no other period in our lives that more strongly forms us and our culture. Hence, it is surprising that in the past this viewpoint was completely different. Until medieval times, a child's life did not count for much, that is, as long as the child was not the beneficiary of an inheritance. And even if so, social relationships were businesslike, e.g. concerning marriage. J.-J. Rousseau (1712-1778) demonstrated the worthlessness of children even in his recognition of them: The nature of humans is neither good nor bad, and is hardly different from that of animals. Despite Rousseau's idealistic concept of education as a kind of identification process for the child, he put his own five children into the foundling hospital of Paris; he was bothered by them when writing. Up to the beginning of the 19th century, the value of a child was determined by his or her ability to work. In the years 1813 to 1814 in Great Britain, 130,000 out of 213,000 weavers were children under the age of 14. Children had to take part in breadwinning at an early age; their character was regarded as being like that of an immature adult (i. e., a small barbarian). Specific childlike needs were rarely met or even acknowledged by adults.

At the end of the 19th century, the Society for the Prevention of Cruelty to Children was founded in New York, after a barbarous case of neglect and abuse of a girl became public. From then on, children received more and more protection. Only in the 1950s were doctors in the USA bound by law to report cases of putative physical abuse to officials. In Sweden, physical punishment of children has been forbidden since 1989, and in Germany since 2001. The existence of sexual abuse of children had been a taboo subject for centuries, even though individual attempts to break that taboo were made--e. g., by S. Freud in the theory of seduction (Verführungstheorie). Only with the birth of the women's liberation movement in the early 1970s has public awareness arisen. Due to the work of J. Bowlby in the 1950s, it became clear that children of primates need more than air, water and food, namely a relationship between the child and an adult person (attachment). To what degree the basic needs of children are being fulfilled in Western societies today is still a controversial issue.

Two hundred and two consecutive patients with dizziness were evaluated using blind neuro-otological testing and examination, blind psychiatric examination, including structured interviews (according to DSM-IV), the Symptom Check-List (SCL 90 R), and the State-Trait Anxiety Inventory (STAI). In 28% of the patients (N=50) dizziness was of organic origin (O group); in 55.3% (N=99) of psychogenic origin (P group) and in 16.8% comorbid psychiatric disorders were found (Mixed group). In 5.3% (N=10) neither organic nor psychiatric results could be found, which could explain the dizziness (Ideopathic group). Compared with the Organic group the patients with psychiatric disorders (P and Mixed group) had much more extensive workups for dizziness, intense emotional distress (anxiety, depression), greater handicaps, and high somatization scores. In the P and Mixed groups three main subgroups of psychiatric disorders could be found: anxiety (N=56), depressive (N=20), and somatoform disorders (N=53). Patients with anxiety and depressive disorders showed the greatest emotional distress and handicaps. The results indicate that psychiatric disorders, above all anxiety disorders, should be included in the differential diagnosis in patients with a long duration of dizziness and great handicaps. An interdisciplinary treatment (including psychiatric treatment) would be superior to an exclusive somatic one.

With the transition from ICD-9 to ICD-10 the diagnosis of neurotic depression was omitted. Freyberger showed that this diagnosis in the ICD-10 was replaced mainly by the diagnoses of dysthymia, recurrent depression and depressive episode (with this ranking of frequency). A renowned German psychiatrist criticized this change as replacing an unsubstantiated dichotomic with an unsubstantiated dimensional model. The same was the case with the change from DSM-II to DSM-III: Torgersen criticized here that the heterogeneous diagnosis of neurotic depression was basically replaced by the similarly heterogeneous diagnosis of major depression. The underlying rationale behind the omission of the traditional diagnosis of neurotic depression in the new glossaries must be seen in the critical contributions of such renowned researchers as Winokur, Klerman and Akiskal during the 60's and 70's of the last century. The present work compares these exclusively phenomenological approaches to classification with a psychodynamic approach, and the author defends the possibility of operationalizing such an attempt as validly as a mere descriptive one. This view is supported by the successful work of a group of German scientists in promoting the OPD (operationalized psychodynamic diagnostics) system. Operationalizable elements are not only to be found in the critics' own contributions, but in recent empirical studies on dysthymia and the other subsequent diagnoses as well. An operationalized and verifiable diagnosis of neurotic depression would have to go far beyond the two main criteria of the ICD-9 (psychoreactive genesis, exclusion of psychosis) and include new insights and perspectives; this, however, is considered feasible. It must be recognized that there is no place in the prevailing diagnostic scene for such a diagnostic construct. Perhaps with time diagnostic modes will change, as has often been the case in the past.

There is evidence from some prospective and several retrospective studies that early biological and psychosocial stress in childhood is associated with long-term vulnerability to various mental and physical diseases. In the last few years research findings have accumulated on those emotional, behavioural and psychobiological factors which are responsible for the mediation of these lifelong consequences. They are the cause of an increased risk of somatization and other mental disorders. Particularly anxiety, depression and personality disorders often result in high-risk behaviour that itself is associated with physical disease (cardiovascular disorders, stroke, viral hepatitis, type 2 diabetes, chronic lung diseases) as well as with aggressive behaviour. A survey on the current knowledge of how these various factors interact is presented and a bio-psychopathological model of vulnerability is educed. Implications for future research are outlined and contrasted to actual political trends in Germany.

The "Inflammatory Bowel Disease Stress Inventory (IBD-SI)" measures a broad spectrum of disease-specific every day stress factors in patients with inflammatory bowel disease (IBD). Based on a multistage factor analysis on 300 CED patients, the final form comprises 32 items assigned to 8 different domains: depressed mood, doctor-patient relationship, anxiety about loss of bowel control, occupational impairment, worries about deteriovation, stress from medical treatment, impairment of sexuality/partnership and physical complaints. In addition, a global stress score can be obtained. The reliability values of the 8 subscales with 4 items each indicate a good internal consistency (alpha = 0.76 - 0.89) and a high retest reliability (r = 0.75 - 0.92). Significant correlations with medical and psychological variables supports the external validity of this questionnaire.

We have assessed the influence of somatisation on the outcome of treatment in 81 patients with chronic low back pain.All, irrespective of whether treatment was surgical or conservative, had a significantly better (p < 0.001) health-related quality of life at follow-up on all but one scale of the SF-36. Lower health-related quality of life at follow-up correlated significantly with a higher tendency to somatise before treatment and at follow-up. A logistic regression analysis yielded two factors which predicted the outcome; somatisation (p < 0.001) and 'doctor shopping' (the number of physicians consulted before the present inpatient treatment, p < 0.001). These factors accurately distinguished between patients with good and those with poor outcomes in 82%. Patients with somatisation and 'doctor shopping' were at a higher risk for a poor outcome. The results show the relevance of somatisation in the outcome of treatment in patients with low back pain.

OBJECTIVES:We investigated the nature of illness behavior and the meaning of emotional deficiencies during childhood in patients with irritable bowel diseases (IBS).DATA:A consecutive study in two tertiary referral centers was conducted with 48 patients suffering from irritable bowel diseases (IBS) and 91 patients with inflammatory bowel disease (IBD).METHODS:The diagnosis of IBS was made by following the Manning criteria, a positive diagnosis of IBD was established through physical, endoscopic and radiologic examinations and was confirmed histologically. Psychological data were obtained by structured psychiatric interviews and psychological self-report measures (GBB).RESULTS:We found that the rate of physician visits given in the course of the disease, is increased for those having irritable bowel disease (IBS). These patients are dissatisfied with the physicians and prone to psychophysiological complaint. In the daily routine and in occupation they are more impaired than those with inflammatory disease. This finding emphasizes in particular that patients with irritable bowel diseases (IBS) have experienced emotional deficiencies in childhood as an after effect of loss, divorce of the parents etc.CONCLUSIONS:Implications for doctor-patient relationship and the necessity for epidemiological studies in Germany are discussed.

STUDY DESIGN:For this study, a prospective cohort of 109 patients was recruited consecutively at an orthopedic inpatient unit of a university hospital. Three self-report instruments were administered to patients with sciatica believed to be caused by a herniated lumbar disc to examine their quality of life and psychic stress at baseline and at the 1-year follow-up visit.OBJECTIVES:To investigate whether patients who have undergone a previous discectomy experience greater psychic stress than patients with no surgery, and to determine whether the groups differed regarding their health-related quality of life at the follow-up visit.SUMMARY OF BACKGROUND DATA:Previous studies have described psychic abnormalities in patients with long-term back pain, particularly patients with severe chronicity (i.e., history of surgeries and persistent problems) or those who underwent a previous discectomy. Additionally, a series of studies has shown that psychic and psychosocial parameters exert a significantly greater influence on the success of treatment than do clinical and imaging findings or the extent of disc abnormality.METHODS:The Short Form Health Survey 36, the Symptom Checklist 90, and Screening for Somatoform Disorders were administered to 109 patients consecutively treated in the authors' orthopedic university clinic, at baseline and at the 1-year follow-up visit.RESULTS:In all the patients examined, the physical and mental quality of life improved regardless of their group classification. The psychological distress, according to the Symptom Checklist 90, was clearly reduced in both groups at the follow-up visit, with the exception of somatization, as indicated by Symptom Checklist 90 and Screening for Somatoform Disorders. Whereas the patients who had undergone surgery remained nearly unchanged with regard to their somatization, the patients with no previous surgery improved significantly, as indicated by Screening for Somatoform Disorders and Symptom Checklist 90. Somatization, particularly that surveyed by the comprehensive Screening for Somatoform Disorders, proved to be quite a stabile factor over time in both groups. The extent of the physical impairment before treatment was nearly the same in both groups, as indicated by Short Form Health Survey 36. Despite a markedly higher chronicity of reported problems, patients who had undergone surgery were hardly more greatly impaired in terms of their mental quality of life and psychological distress, as indicated by Symptom Checklist 90, than those without a history of surgery. At the follow-up visit, the differences tended to be minimal as well. As compared with those who had no previous surgeries, the patients who had undergone surgery were significantly more heavily impaired in their physical quality of life despite significant improvements.CONCLUSIONS:Patients with sciatica demonstrated less abnormality in terms of the psychopathologic markers investigated than described in previous studies. Nevertheless, the predisposition to somatize influences health-related quality of life to a high degree.

Background: The purpose of this study is to give a detailed survey of the disease-specific and generic quality of life (HRQOL) of adult patients suffering from inflammatory bowel disease (IBD) in Germany. Methods: 1322 patients suffering from IBD were examined in a cross-sectional study. A questionnaire assessing disease-specific and generic quality of life, coping, and hopelessness was sent to members of the German Crohn/Colitis association. Results: