Individuals with body dysmorphic disorder (BDD) suffer from unpleasant, repetitive thoughts about imagined defects in appearance which are difficult to control.

The purpose of this study was to test for deficits in cognitive inhibition in BDD.

To test for deficits in cognitive inhibition in BDD, we applied a negative priming paradigm. Specifically, we explored whether BDD patients exhibit greater deficits in cognitive inhibition when lexical targets are threatening than when they are non-threatening.

Surprisingly, BDD patients exhibited deficits in cognitive inhibition only for non-threatening but not for threatening information.

Although BDD patients often describe their negative thoughts about their appearance as distressing, they may experience them as valid and thus may not try to control them.

Alterations of the immune–neuroendocrine interplay have been described in chronic fatigue syndrome (CFS). Employing a recently developed method, the study set out to investigate whether patients with CFS have an altered sensitivity to glucocorticoids (GCs) when under stress.

A total of 21 CFS patients and 20 healthy age- and gender-matched controls underwent a standardized psychosocial stress test (Trier Social Stress Test, TSST). Salivary and plasma cortisol levels were measured repeatedly following exposure to the stressor. GC sensitivity was assessed in vitro by dexamethasone inhibition of lipopolysaccharide-stimulated production of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNC-α).

Cortisol responses following the TSST did not differ significantly between CFS patients and healthy controls. GC sensitivity differed significantly between CFS patients and healthy controls, with CFS patients showing a greater sensitivity towards GCs (TNF-α: F1/39 = 7.32, P = 0.01; IL-6: F1/39 = 9.73, P = 0.004).

Consistent with recent evidence, CFS patients are characterized by an enhanced sensitivity to glucocorticoids. The implications for secondary processes, such as the regulatory influence of glucocorticoids on immune processes, are discussed.

The present epidemiological study investigates sex- and age-adjusted 4-week, 12-month, and lifetime prevalence rates of somatoform disorders in in-patients with musculoskeletal and cardiovascular diseases in comparison with prevalence rates of these disorders in the general population in Germany.

Prevalence rates were calculated from two samples, one from rehabilitation in-patients with musculoskeletal (n = 187) or cardiovascular (n = 116) diseases, and one from a large sample of the German National Health Interview and Examination Survey – Mental Health Supplement (GHS-MHS; n = 3889). The prevalence rates were based on the M-CIDI, an interview for the assessment of mental disorders.

The adjusted prevalence rates of any mental disorder in both clinical samples are higher compared with rates of the general population (e.g. lifetime musculoskeletal, 59.3%; cardiovascular, 56.2%; general population, 47.9%). Prevalence rates of patients with cardiovascular (e.g. 12.2%) and musculoskeletal (21.5%) diseases do not indicate an increased prevalence of somatoform disorders compared with the general population (18.2%).

The results confirm that patients with chronic somatic diseases have increased prevalence rates of mental disorders. However, these increased prevalence rates go primarily back to affective and anxiety disorders and not to somatoform disorders. The diagnostic criteria for somatoform disorders and the question algorithm of the M-CIDI are probably responsible for potential underestimation of somatoform disorders in patients with chronic somatic diseases.

The psychopharmacotherapy of somatoform disorders (SD; ICD-10: F45) has been less frequently investigated and is not as well established as in other (neurotic) disorders of ICD-10 section F4, i.e. generalized anxiety disorder (GAD; ICD-10: F41.1). The atypical compound opipramol is very often used to treat SD and GAD in clinical practice in Germany. However, state-of-the-art controlled clinical trials have not yet been performed.

Two clinical trials were performed with the aim of confirming the efficacy and tolerability of opipramol in SD and GAD.

Both trials were performed as randomized, double-blind, placebo-controlled, multicenter studies. While the GAD trial was a three-arm study with opipramol (200 mg/day) vs. placebo and alprazolam (2 mg/day) for 28 days, the SD trial was a placebo-controlled two-arm study with a treatment duration of 42 days. Each group consisted of about 100 patients.

Significant differences (alpha = 0.05) were found for the primary efficacy criteria (HAMA total score in GAD, HAMA somatic subscore in SD) and most of the secondary criteria in favor of the active drug therapies. Considerable differences between the psychopathology of SD and GAD were detected.

The well-tolerated anxiolytic opipramol is the first psychotropic drug with proven efficacy in somatoform disorders with effects on symptoms of somatization, anxiety, and depression. The compound is also effective and safe in GAD.

The intention of this study was to evaluate therapy outcome of a cognitive-behavioral group treatment program for functional gastrointestinal disorders. As a particular characteristic, gastrointestinal symptoms were investigated independently from diagnostic categories on a dimensional basis, considering the persistence of symptoms as well as the aspect of severity.

A total of 64 subjects participated in the 10-week treatment program, and 49 completed the study. Subjects underwent four assessments (baseline, pre-, post-treatment, 12-month follow-up), each comprising several self-rated questionnaires on gastrointestinal, somatoform, depressive, hypochondriacal and anxious symptoms, and health locus of control, as well as a diagnostic interview of functional gastrointestinal and mental disorders at the baseline assessment. Treatment effects were controlled by subjects' waiting list period before treatment.

Gastrointestinal symptoms, as well as comorbid psychopathology scores, decreased significantly during treatment and remained unchanged during the follow-up period, whereas no relevant changes were found in health locus of control. Largest effect sizes were found for gastrointestinal symptoms, which decreased by 30–50% of their initial number.

The group treatment investigated was effective and particularly successful with respect to functional gastrointestinal symptoms. However, the mechanisms of treatment outcome remain indistinct. Further studies comparing different setting conditions directly are required to clarify the question of whether group treatment is significantly superior or inferior to individual therapy.

The aim of the controlled therapy study was to evaluate the effect of a 6 session biofeedback intervention program on cognitive aspects of patients with somatoform disorders. The treatment consisted of psycho-physiological demonstrations how mental processes can influence biological functions. We expected this treatment to be of high credibility, to change maladaptive cognitions, to enhance acceptance of psychosocial causal attribution and to improve coping.

Patients were assessed using a structured interview to diagnose somatization syndrome (SSI-8) and comorbidity according to DSM-IV criteria. Fifty patients were recruited and randomly assigned to biofeedback treatment or control relaxation group. Participants completed a questionnaire battery assessing cognitive characteristics, causal attributions and controllability before and after intervention as well as evaluation protocols for each session.

The results suggest that biofeedback modified the patients' cognitive schemata: Patients with somatization syndrome of the biofeedback group showed a greater reduction of catastrophizing of somatic sensations and higher acceptance of psychosocial causal attributions than the control group. Both groups improved significantly in the conviction of self-efficacy.