Transcript The Concepte of Sensitivity

Dr. Samuel Pfeifer
Klinik Sonnenhalde, CH-4125 Riehen, Switzerland
The concept of
Sensitivity
Between normal psychology
and illness
The salt of the earth
„The exalted and
deplorable family of
the highly sensitive is
the salt of the earth“
French writer Marcel Proust
(1871 - 1922)
Highly sensitive people
Diana
Marilyn Monroe
Yves Saint Laurent
Vincent van Gogh
„I am very sensitive“ - POSITIVE
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finely tuned to others, tender hearted
understanding, susceptible
intensive emotions
deep perceptions and passions
touched by the beauty of nature, music, art, poetry,
film, relationships.
 not hardened against the suffering of other people
 sensitive for the transcendent.
I am overly sensitive – negative 1
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overreacting
vulnerable – easily hurt
reading between the lines
thinking too much - ruminating
introverted and shy
anxious, fearful
not robust / no power reserves
at my limits
everything is coming too close
defenseless
I am overly sensitive – neg 2
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often so overwhelmed that I cannot speak
negative perceptions of other people
tendency to overreact
touchy, irritable , moody
easily exhausted
feelings cause physical discomfort
etc.
Test for Sensitivity (E.N. Aron)
„The highly sensitive person“
– German psychiatrist W. Klages 1978
 Existence between normal psychology and
psychopathology.
 beyond the psychologically understandable,
but do not reach the degree of psychiatric
illness.
Sensitive perceptions
– causing intensive feelings and reactions
smell
taste
auditory sense
visual sense
touch
synaesthesia
pathological startle reflex
according to Klages
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Peculiarities of highly sensitive persons
Intensive struggle with verbal expression
increased exhaustion
frequent mood swings, irritability
sexuality and inhibition
paranormal sensitivity
according to Klages
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When sensitivity turns into illness
– negative impact on
 Ability to enjoy
 Ability to relate
 Ability to work
„Neurosis“
The changing meaning of „neurosis“
 until 1979: Definition based on the possible
causes (mother, early trauma, sexual
conflicts)
 DSM-III (1980): description of symptoms,
the term „neurosis“ is dropped
 New term: „Disorder“: e.g. „anxiety
disorder“, „obsessive-compulsive disorder“,
„dysthymia“
BUT: Problems have remained the same
Descriptive definition of „neurosis“
 psychological disorder with anxiety, obsessions,
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mood swings, increased sensitivity
inhibition, insecurity, conflictuous
reality testing is intact
disorders of somatic functions
reduced performance at work or social role
„difficult“ relationships
symptoms persist or recur
not a transient reaction to stress
Common features
Ambivalence
Impaired
contact
Inhibitions
Physical
Complaints
Emotional
lability
Psychosomatics
Reduced
ability to
perform
New terms
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Subclinical disorders
Atypical depressions
“Masked” depression
Subsyndromal disorders
Spectrum Disorders
Subthreshold Disorders
Spectrum Disorders
Depression
BulimiaAnorexia
OCD
Social
Phobia
PanicAgoraphobia
Migraine gastro-intestinal
evtl ADHD?
Criteria of Spectrum Disorders
 Criteria for the classic disorder are not fully
present.
 Symptoms are either limited or isolated, however
combined with depressive mood.
 Symptoms lead to impairment in social relations,
work performance or other important areas of life.
 Symptoms lead to “emotionally loaded
relationships” with dependence and social conflict.
Spectrum
healthy aspects
Disorder
suffering
threshold
subthreshold
• Personality problem
• isolated symptoms
atypical
classic syndrome
Core
syndrome
Course of illness
threshold
Illness episodes
Sensitization / Vulnerability
Later triggers (subklinical)
First trigger (Trauma)
chronic
Development
Personality
Temperament
Psychosocial
environment
„Vulnerable“
Personality
Stress
Sensitive Crisis
Sensitive Syndromes
Somatization
Emotional
Instability
Depression
Exhaustion
Anorexia
Ansiety
Disorders
Phobias
ObsessiveCompulsive
Disorders
Bulimia
ILLNESS
Somatic
Syndromes
Migraine
Gastrointestinal
disorders
a)Enhanced***** Erhöhte
Erregbarkeit der
Rückenmarksneuronen nach
einer Verletzung
b) Vergrösserung der
Empfindungsfelder der
Neuronen
c) Verminderte
Schmerzschwelle
d) Aufbau neuer afferenter
Inputs
Quelle: Staud R. (2005). The neurobiology of chronic musculosceletal pain (including chronic
regional pain). In: Wallace DJ & Clauw DJ (eds.) Fibromyalgia & Other Central Pain Syndromes.
Philadelphia: Lippincott Williams & Wilkins. S. 45 - 62.
Sensitization and the problem of pain
Pain sensitization
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Individual differences in pain processing
Nociceptor signaling pain
Pain threshold is lowered
Influential factors: Bradykinin, Prostaglandin E2
and Serotonin. When the concentration of these
substances is exceeding a certain limit, their will
be a pain sensation.
 However, even when the threshold is not yet
reached, even minor concentrations of these
substances can increase the irritability of
nociceptors --- PAIN SENSITIZATION.
Nociceptive feedback loops
Bradykinin (+)
Prostaglandin E2 (+)
Serotonin (+)
Pain stimuli
nociceptors
Blood
vessel
Substance P
„Kindling“ and Sensitization
 Kindling describes a phenomenon in which
relatively minor and repeated stimuli lead to a
profound alteration in brain function resulting in
epileptical seizures.
 The effects are not only local. There are also
neuronal changes in distant brain areas.
 Synaptic plasticity leads to „sensitization“ of the
brain, even without manifest external stimuli.
Steps of Sensitization
GENETIC DISPOSITION
Intracellular and
neurobiological changes
Synaptic plasticitiy –
Shift in the balance of
Neurotransmitters
TRAUMA
Neuroanatomic changes
(Adrenal gland in Depression,
Hippocampus in PTDS)
persisting psychological
sensitivity
Reduced Stresstolerance
Altered stress reaction
somatoform symptoms
Applicability for psychological disorders
 Psychodynamic concepts and clinical experience can
be brought in line with neurobiological models.
 They provide an explanation for the course of socalled „endogenous“ disorders (such as bipolar
disorder) which can relapse without adequate external
stimulus.
 They provide a model for „sub-threshold disorders“
in psychosomatic medicine – helping to understand
and support patients with atypical syndromes.
Sensitization in the psychiatric literature
 Anxiety sensitivity
 Rejection Sensitivity & Interpersonal
sensitivity. -- Atypical Dep.
 „Central sensitization syndromes“ –
Fibromyalgia and other pain syndromes
 Affective disorders and stress
supersensitivity
Transduction of psychosocial stress (R.M. Post)
Coping with
high sensitivity
The Goal: Living with limitations
Tasks
Sensitive
Personality
Ressources
Excessive
demands
Stress
Life Events
Decompensation
„tipping the balance“
Protecting yourself
1. Find a balance between overactivity and regression!
2. Learn to understand your body‘s language!
3. Accept the limitations of your sensitivity!
4. Do not take everything too personal!
5. Take time to relax and to enjoy!
6. Do not take too much responsibility!
7. Explain your condition to others!
8. Recognize your shadow and work at improving your
weaknesses.
“I consider it as my
strength to accept my
weaknesses.”
(quote of a patient)
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Literature
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Aron E.N. (1996). The Highly Sensitive Person. How to thrive when the world overwhelms you. New York: Broadway.
Aron E.N. (2000). The Highly Sensitive Person in Love. New York: Broadway.
Aron E.N., & Aron A. (1997). Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and
Social Psychology 73:345–368.
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Rossi J 3rd. - Sensitization induced by kindling and kindling-related phenomena as a model for multiple chemical
sensitivity. Toxicology. 1996 Jul 17;111(1-3):87-100. Review.
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Bell IR, Miller CS, Schwartz GE. An olfactory-limbic model of multiple chemical sensitivity syndrome: possible relationships to
kindling and affective spectrum disorders. Biol Psychiatry 32:218-242, 1992.
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Post RM, Weiss SR.: Sensitization and kindling phenomena in mood, anxiety, and obsessive-compulsive disorders: the role
of serotonergic mechanisms in illness progression. Biol Psychiatry. 1998 ;44(3):193-206.
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Pietrobon D.: Migraine: new molecular mechanisms. Neuroscientist. 2005; 11(4):373-86.
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Maier SF, Watkins LR: Stressor controllability and learned helplessness: the roles of the dorsal raphe nucleus, serotonin, and
corticotropin-releasing factor. Neurosci Biobehav Rev. 2005;29(4-5):829 - 841.
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Anisman H, Merali Z, Poulter MO, Hayley S.: Cytokines as a precipitant of depressive illness: animal and human studies.
Curr Pharm Des. 2005;11(8):963-972.
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Anisman H, Merali Z.: Cytokines, stress and depressive illness: brain-immune interactions. Ann Med. 2003;35(1):2-11.
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Stahl S.M. (2003): Here today and not gone tomorrow: the curse of chronic pain and other central sensitization syndromes.
Journal of Clinical Psychiatry 64:863-864.
Yehuda R.: Biology of posttraumatic stress disorder. J Clin Psychiatry. 2001;62 Suppl 17:41-46.
Simmons DA, Broderick PA.: Cytokines, stressors, and clinical depression: augmented adaptation responses underlie
depression pathogenesis. Prog Neuropsychopharmacol Biol Psychiatry. 2005 Jun;29(5):793-807.
Staud R. (2005). The neurobiology of chronic musculosceletal pain (including chronic regional pain).
In: Wallace DJ & Clauw DJ (eds.) Fibromyalgia & Other Central Pain Syndromes. Philadelphia: Lippincott Williams & Wilkins.
S. 45 - 62.